I have hair where? — coping with unwanted hair growth

Unwanted hair under your chin or arms is quite distressing. Growing hair in places where you never had it before or developing thickening body hair is an incredibly sensitive topic because women’s perspectives can vary widely based on personal preference. Many women want to get rid of excess hair as quickly and permanently as possible while others are happy to let it grow as a natural (and yes, beautiful, thank you!) expression of themselves.

Body hair carries cultural and social associations that have transformed through the years. Today’s popular style, for example, is to have no hair anywhere except on your head, with waxing salons on every corner. But during the 60s and 70s, the au naturale look was popular, with what would now be seen as “shocking” amounts of underarm, leg and pubic hair visible on many women. Despite all these ups and downs in body hair fashion, most women have experienced the surprise of hair showing up or getting thicker in places they’d rather not have it.

Fortunately, unwanted hair growth is usually just a benign annoyance. But there are cases where excess hair growth can be caused by increasing insulin resistance. There are differences between common and uncommon hair growth, as well as real reasons why you may have more body hair than you used to. And there is more to know if you choose to do — or not do — something about it.

Is this extra hair normal?

Women in menopause often feel the need to talk to their doctors about alopecia, or hair loss, but many don’t realize that similar hormonal imbalances can also cause unwanted hair growth. For many of my patients, managing “extra” body hair is more than just an annoyance; it creates real frustration, anger and resentment — some even call it a “battle” they’ve fought all their adult lives.

Women want to know if excess hair is a sign of a health problem. Maybe they’ve heard that hair growth is related to changes in insulin sensitivity, or that it might be a signal for PCOS (polycystic ovarian syndrome). But the question they ask most is, “What is normal for a woman when it comes to hair growth?”

To distinguish between normal and not-so-normal hair growth, it helps to think about the types of hair the human body grows, and the stages of life when it grows, or doesn’t. We actually have hair all over our bodies from the very beginning. In the womb, a fine layer of hair called lanugo covers a fetus and keeps it insulated. After birth, we develop very soft and light vellus hair better known as “peach fuzz” which stays on our bodies for our entire lives. Vellus hair can be a little thicker or darker depending on the person, but it’s usually less than 2 mm long, and can appear all over the body.

But uncommon hair growth in women is usually associated with something called terminal, or androgenic, hair. Terminal hair begins to appear during the hormone changes of puberty, and continues to develop long after. It’s darker and coarser than vellus hair, and is found on the scalp, chin region, armpits, and the pubic area in women. Men have more terminal hair on their bodies, due to higher amounts of androgens. That’s why hair growth related to hormonal imbalance tends to be in a “male pattern” such as on the face or “beard” area.

Our genetic make-ups in conjunction with certain key life stages when hormone levels fluctuate are typically the root cause of unwanted hair regardless of where it grows. For some women, unwanted body hair can also be a signal of a condition called hirsutism.

Hirsutism can be a symptom of hormonal imbalance

Hirsutism, also called hypertrichosis, is the growth of terminal hair or thickened vellus hair in places more typical for men than women. It can either be genetic or caused by one of the body’s natural reactions to hormonal and biochemical imbalances, like insulin resistance and high levels of androgen hormones.

How severely or quickly hirsutism develops, and where it occurs, varies. The three main factors include:

• Production of abnormally high levels of androgens like testosterone.
• The amount of androgens being bound up by SHBG, or sex-hormone–binding globulin, versus how much is freely available in the bloodstream.
• The degree that androgen receptors around the hair follicles themselves become sensitized to androgen hormones.

Androgens are produced by your ovaries, your adrenal glands, and also peripherally in your fat tissues. From there, they are transported throughout the bloodstream to your hair follicles, where testosterone is converted into its more potent, follicle-active form. More “sensitive” hair follicles can spend a longer time in the anagen, or active, phase of hair growth.

If you have higher-than-usual levels of free testosterone, or your hair follicle receptors have become hypersensitive to androgens, excess or unusual hair can grow anywhere on your body — even on the palms and soles of the feet. Increased facial hair, for example, commonly develops in menopausal women, and is sometimes said to be caused by “unopposed androgen.” But for most women, hirsutism is typically identified in the moustache, beard, chest (usually between the breasts or around the nipples), and genital regions.

What causes hirsutism?

Hirsutism is a lot more common than most people think. At least one in 20 women in America has this kind of hair growth, with a range of possible causes depending on the person. Hirsutism is not a disease but rather a natural expression of a woman’s hormonal makeup, which may or may not be in its optimal state. Many factors influence our hormones and hair growth, some of which we can influence through diet and lifestyle. But hirsutism is usually linked to one or more of the following:

Genetics. In most cases, the specific cause for hirsutism is genetic. The underlying blueprint for how much hair we have is linked to our familial heritage. It can also be caused by relatively rare, yet “normal” genetic variants called atavisms. These are throwbacks to an earlier time in human evolutionary history — in this case, to a point when our ancestors were much hairier creatures than we are.

Drugs, hormones and other growth factors. In some women, hirsutism may be related to past or present use of drugs or growth factors, or exposure to toxins that increase androgen production or disrupt the way hormones are metabolized. These are factors that we do have some control over, and include the following:

• phenytoin sodium, carbamazepine or Tegretol (anti-seizure medications)
• minoxidil (Rogaine, Regaine)
• glucocorticoids or steroids like cortisone
• danocrine or Danazol
• cyclosporine
• diazoxide or Proglycem
• metyrapone or Metopirone (given to treat Cushing’s disease)
• bFGF (basic fibroblast growth factor)
• PDGF (platelet-derived growth factor)
• IGF-I (insulin-like growth factor I)
• insulin
• birth control pills (which can also decrease hair growth)

Insulin Resistance: In some women, chronically elevated levels of insulin due to diets high in sugar and fat can lead to insulin resistance. The body essentially requires higher levels of insulin to absorb dietary sugars. Having too much insulin in turn stimulates excess ovarian androgen hormone production. All of these factors can trigger an excessive level of androgens in the body. But with androgens, just having an excess won’t necessarily mean that a woman will experience hirsutism.

As explained above, some women with hirsutism have hair follicles that are extra-sensitive to normal amounts of androgens combined with higher-than-normal circulating androgen levels, while others have decreased metabolism, or enhanced receptor bindings. So both too much androgen and too little are possible causes of hirsutism. There is also the idiopathic variety, meaning the medical profession can’t find a cause. So why hirsutism is occurring can be a real mystery until you meet with your healthcare practitioner.

Am I “hirsute” or just a little hairy? Talking about hair growth with your healthcare practitioner

If you experience a marked change in your hair growth over several weeks or months, then it’s a good idea to have your hormonal profile checked. The speed and amount of body hair growth matter. It could be just the expression of your genetic heritage, or where you are in relation to your hormonal or life cycle. If it’s the latter, it’s best not to think about this hair growth as one piece of your current whole hormonal expression.

Ask yourself the following questions:

• Is the amount of hair growth unusual, given my past or family hair history?
• Do I have other unusual symptoms, such as irregular periods, weight gain/loss, or acne?
• Is the hair growth sudden or gradual?
• Is the hair growth appearing in an “uncommon” place?
• Have I recently experienced an emotional change in my life?

Knowing those answers will help your healthcare practitioner identify whether this unwanted hair is genetic, a symptom of hormonal imbalance, or a signal of something more serious, like PCOS or insulin resistance. It can also help to isolate exactly where you see more hair than usual, in order to know if you’re hirsute, or just a little hairy.

The body areas to look first for androgen sensitivity are the places where terminal hair usually grows on women. Here they are in descending order of sensitivity:

• pubic area
• underarms
• perianal area
• sideburns
• upper lip
• periareolar (around the nipple) areas
• the chin and “beard” region
• arms and legs
• between the breasts
• shoulders
• buttocks
• back
• abdomen

If hair is growing in any of the above areas and it’s coming in more heavily or earlier than normally seen, such as in puberty, it can be a sign of androgen excess. If caught early enough, it can often be treated relatively easily by returning hormones to their regular healthy levels. To know whether unwanted hair growth is something you should bring up with your healthcare practitioner, you can evaluate your hair growth first with a scoring tool known as the Ferriman–Gallwey score.

This test measures the degree of hairiness or hirsutism a woman is experiencing.You can look at the images and gauge where your hair growth ranks from 0 (no terminal growth) to 4 (maximal growth). Print the chart and bring it in to your healthcare practitioner to talk about what’s normal for your own personal hair growth versus what’s been happening lately. Although the results can vary women with scores higher than “3” are considered to have hair growth outside the norm.

The last step is making sure that the hair you’re seeing is truly unusual for you. Dramatic events in our external lives can sometimes trigger changes in how we perceive ourselves, as well as how we think others perceive us.

Self-perception: emotions and our hair

Confidence about our bodies often mirrors our inner emotional lives. Major transitions can cause huge emotional shifts, like a partner entering or leaving your life, that triggers an emotional “earthquake,” and, yes, menopause qualifies. With such events, the hair on our bodies may or may not have changed much, but the way we see ourselves has. If you feel that the excess hair is needs to be “fixed,” ask yourself first whether this growth is sudden, or has happened gradually over time. And also determine if there really a difference in your hair growth, or if you are you looking at yourself differently these days.

For a woman who has had heavy hair growth much of her life, hair growth usually isn’t indicative of a serious physical problem. If the heavy hair growth is sudden, speak with your healthcare practitioner about your hormone status.

So what can I do about it? Solutions for unwanted hair growth

Most women who deal with their extra hair on a regular basis have some sort of system in place: they shave (and No, shaving does not cause hair to grow faster or coarser), pluck, tweeze, or apply creams or wax for immediate hair removal. Women with sudden, rapid hair growth or other signs of hormonal imbalance can get started with these suggestions:

• Learn your hormonal profile. Remember that removing the unwanted hair is not as important as identifying if the condition is common or uncommon, and if uncommon, finding the right treatment. This includes speaking with a practitioner about your own personal hormonal profile to see if you have insulin resistance; or seeing a specialist to check for an imbalance of androgens or androgen metabolites.
• Reverse insulin resistance. You can facilitate your body’s natural healing pathways with dietary and lifestyle changes that reduce insulin resistance. Regular gentle exercise, along with meals and snacks that have a low glycemic load, can bring insulin and androgen production, regulation and metabolism back into balance.

For advanced insulin resistance you can work with a practitioner of functional medicine when using medical foods to support insulin and glucose stabilization. Studies have shown that the specific phytonutrients in these products work by modulating insulin signaling and actions. The nutrients can help heal your metabolism without the unwanted side effects associated with drugs. Best of all, healing your metabolism may not only help diminish unwanted hair growth, but will also bring you better balance on every other level.

• Drink spearmint tea regularly. New studies in the journal Phytotherapy Research show that drinking spearmint tea twice a day reduces the effects of the levels of androgens that can cause hirsutism. Hot spearmint tea with a dollop of honey is very soothing and satisfying after meals, and chilled spearmint tea is delicious, too.
• Laser or electrolysis treatments. Laser therapy is chosen by more and more women as an alternative to the skin irritation, scarring, messiness, re-growth, and inconvenience of older methods of hair removal. Laser technology has become more available and more affordable. It can leave your skin feeling smoother, with longer lasting results than electrolysis or the painful, at-home removal techniques. Laser hair removal has also been shown to help women who have genuine anxiety, depression, or frustration about their extra hair.
• Try a prescription medication. While there are no FDA–approved medications for hirsutism at this time, some drugs, like spironolactone or aldactone, bind to the hormone receptors that react with androgens — and that can decrease unwanted hair growth. Metformin, a treatment for PCOS and diabetes, does seem to reduce testosterone, and thus decrease hair growth. But this is also our least favorite solution for general treatment. Many anti-androgen medications take a long time to work (over a year) if they work at all, and once you stop, the hair growth comes back. They also have some undesirable side effects, like nausea and diarrhea, or sexual dysfunction.

The Women’s Health Network approach

How much hair you choose to keep and where you keep it are personal decisions. Many studies have shown that natural hair growth ranges widely in amount and thickness, largely due to our genetic makeup, and where our ancestors came from. Whether you accept your natural hair growth or if you feel more confident without it, making the choice yourself can be liberating.

If you have a rapid amount of sudden hair growth, especially alongside other health concerns, speak with your healthcare practitioner about a possible underlying hormonal and chemical imbalance. It’s another opportunity to improve your total health — and to feel beautiful, inside and out.