The Honest, Hairy Truth Part 1: PCOS and Hirsutism

I recently asked a number of you what you would like me to write about and what topics you would like more information on. One of the answers was Hirsutism and what we can do about it. So, this one is just for you!

I have come to realize that this is a HUGE topic and will take some time to cover, so I’m going to post it in two parts: the first one covering the basics and the second one on diet and supplement options.

Let’s be honest, infertility is painful and causes so much heartache but people won’t know unless you tell them about it. Weight is also an issue but there are many women out there who are overweight and don’t have PCOS. Excess hair, on the other hand, now that’s another story.

Nothing makes us feel more unfeminine than those thick, black ugly hairs sprouting in all manner of unsightly places. We spend thousands of dollars and hours every month dealing with this unwanted hair. But what causes women with PCOS to have excess hair and just what can we do about it?
 

It’s all about our hormones

We know that PCOS is a hormonal disorder that has far reaching consequences. One of the primary issues with PCOS is that our insulin producing cells seem to be over responsive and create too much insulin, causing hyperinsulinemia.

Our ovaries produce too much testosterone. And testosterone is the culprit!

This increase in insulin causes our ovaries to produce too much testosterone. And testosterone is the culprit! Excess androgens (testosterone and other “male” hormones) cause ovarian cysts, acne and, you guessed it, male pattern hair growth (and hair loss for that matter).

It seems that androgens act on the growth phase of the hair cycle, causing the hair to go from vellus hair (the light, thin hair that covers your body) to terminal hair (thick, dark hair). (1)

Just how bad is it?

We all suffer from hirsutism to varying degrees. One of the ways in which we can monitor and understand the extent of the problem is by using the Ferriman-Gallway Score to classify our unwanted hair growth. (2)

pcos hirsutism

Medical Management of Hirsutism

The medical community can offer drugs to manage hirsutism, some of which are already commonly used in the treatment of PCOS. These drugs fall into 3 categories:

  • Androgen receptor blockers: These drugs attach to the same site as the male hormones, effectively denying the androgen access to the receptor and causing the androgens to be ineffective. Examples of these drugs include: Cyproterone, flutamide (Eulexin), and spironolactone (Aldactone)
  • Androgen suppressing drugs: These drugs act on the body to manage the amount of androgens the body produces. Some of these drugs are: GnRH agonists (Lupron), estroprogestins (birth control pills), corticosteroids, and insulin-sensitizing agents (metformin/Glucophage).
  • 5 alpha-reductase inhibitors: These drugs act on an enzyme that converts androgens to their active form. If you limit the enzyme, you prevent the conversion of testosterone to it’s more potent form. Here are some examples: Finasteride (Proscar), eflornithine hydrochloride (Vaniqa). (3)

Many of these drugs take 6 months to make any significant difference to hair growth. Also, when you stop taking them, your hair is likely to return if you have not addressed the underlying insulin resistance in the first place.

Other ways to manage hair growth:

There are other ways to manage hair growth such as waxing, shaving, plucking or laser treatment. Each of these has its pros and cons. It is important to bear in mind that although you may be removing the hair, it is likely to be re-stimulated by those high androgen levels. (4)

  • Shaving – This is often quick and painless and your hair shouldn’t grow back darker or thicker. Irritation can occur and you may need to shave frequently.
  • Bleaching – Bleaching just lightens the hair and make it seem less noticeable. The bleach may cause irritation though.
  • Waxing, threading and plucking – ouch! This can be painful, especially if there is a lot of hair to deal with. The advantage is that it is longer-lasting than shaving or bleaching.
  • Electrolysis – Electricity is used to damage the hair follicle, destroying the hair. It can be painful and could take a number of treatments, depending on the extent of the hair. Hair can also grow back if the underlying hormonal imbalances have not been addressed. (5)
  • Laser Hair removal – A small beam of laser light is directed at the hair follicle. The melanin in the hair absorbs the light and the hair is damaged. A number of treatments are needed and hair can regrow so follow up sessions may be needed.

Let’s sum it up:

PCOS and HirsutismWe’ve basically said that hirsutism is as a result of high insulin levels causing increased testosterone and hair production. The medical community can offer drugs to manage it but they don’t treat the underlying cause. We can also manually remove the hair but this often needs to be repeated regularly and can be expensive.

In the next article, we’ll look at diet and supplements that can be used to manage hirsutism and your PCOS in general. You know I believe in the power of diet to manage PCOS so I firmly believe we can also tackle this pesky symptom through good diet and supplementation.

Until our next encounter – keep well!

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Tarryn Poulton

Tarryn Poulton

Tarryn Poulton is a PN1 Certified Nutrition Coach and PCOS expert who has been a leader in the online PCOS space for over 8 years. Tarryn has the support of leading clinicians from around the world who support her scientific approach to understanding and talking about PCOS this includes all medical journals and ongoing research. You can read more about Tarryn and the team here.

37 Responses

37 Responses

  1. Hi I just found out a week ago that I have pcos. It has caused massive breakouts and I’m also suffering from facial hair around my cheeks and chin. I have tried bleach my acne become more worse after it. Due to my acne I can’t do waxing on my face and shaving leaves shadow on your face. I have heard laser doesn’t always work well and I can’t afford it. I need advice what should I do to remove my facial hair. Should I epilator on my face?

  2. Hi Tarryn,

    Are there any supplements I should be taking to slow down hair growth on my face? Or any foods I should be avoiding? I never had neck hair or facial hair until this year 🙁 please help. Thanks so much 🙂

  3. have you heard of low carbing improving hirsutism? I’m about to start the atkins diet and really keep track of my carbs and am quite not looking forward to relying on medicines my entire life, because I’ll know it’s not naturally my body that’s restoring itself.

    Any thoughts?

  4. I really appreciate this. I was diagnosed with PCOS and Diabetes about two months ago. But I been dealing with hair problems since about 2005, it really is embarrassing just to have Hirutism and no one in my family understands what I’m going through cause they don’t have my problems. I always get extremely embarrassed around people but it’s always good to know that you are not alone. I am overweight but I’m losing , very quickly I might say. Since I changed my diet, switched out everything to low fat, no fat, organic , low sodium etc, I have been feeling much better and it’s only been two weeks! Ha, I can’t wait to see how this turns out in the next year.

  5. I never had hirsutism as a pcos symptom, but I’ve actually noticed that while on metformin I am experiencing a substantial amount of HAIR LOSS. Any suggestions to help with that??? I have seen my doctor and had my thyroid checked and my results came back normal. I use to have really thick hair but I can’t seem to wash it or brush it or run my fingers through it without handfuls of hair being left in my hand. HELP!

  6. HI Tarryn and everyone,

    I also wanted to thank you for your forum. It’s made me feel alittle less alone with my battle on hirsutism.

    Im 27 and havent been diagnosed with PCOS. Blood work came back in range, I have a regular period (not clockwork but minor variations on 30days and often corresponds with how stressful the month has been), no acne but terrible hair!!! It’s particularly bad on my face but im also not too happy with my snail trail. Its also present in the other hormonal parts of my body but they are mainly single hairs and dont upset me in the same way as the face.

    PCOS diagnoses or not, hair on my face has something serious behind it. Ive undergone so many IPL/Laser treatments over the years with it- some successful, some completely not- its also an issue for me as Ive changed my location atleast 3 times and every time it starts again. Most recently i started with electrolysis but this is super painful- rather its not so painful but takes a long time to heal so you look like youve had a huge pimple scar explosion. (You also still have hairs inbetween the dots- its a very awkward phase).

    – I just wanted to put it as a WARNING out there; I do think that the hair on my face is partially exaggerated by REVERSE IPL EFFECT. Im not sure ofcourse- but if you choose to get treatment, please read up further about it and enquire specifically about the machine that will be used on you. (They vary greatly!!)

    Anyway, so 100’s of dollars later and a battle for more than 8 years (there have been some good phases) I still have a super hairy chin/neck. So am pretty sure it cant just be hereditry even if my Eastern European, Ashkenazi Jew origins do fall into one of the groups where abnormal, non pcos hair occurs…
    I was always chubby, and when I was 19 went on this Sureslim program. Since then, I generally try and keep the carbs out (with occassional cake exceptions), am good with my good fats: linseed, almonds, fish, dont eat meet aside from chicken (not connected with sureslim btw) and aim for only 2 cups coffee a day. I also am fairly active day to do and in phases go to the gym. After reading this forum, Im beginning to think that perhaps, other PCOS symptoms arent present because I am already leading a lifestyle that helps manage that…

    But im getting desperate to resolve this hair issue! So now am adding a teaspoon of MACA Powder to breakfast and dinner and drink lots of SPEARMINT tea (unfortunately dont seem to be able to buy pure organic spearmint in NL, so have to drink a mix 50% spearmin 50% chamomile- it does mean i drink 4 cups of this a day… Ive always loved tea so for now its ok, but am working on getting some pure stuff)

    This next month Im on vacation so its not practical to start your diet Tarryn, but when i get back, I will try and also cut back on dairy and lower my carb intake again. It will also be about 6 weeks since i started with MACA and SPEARMINT so will be able to say how/if it helped my hair problem.

    GOod luck to everyone!

    1. Hy

      I would like to know if Maca and Spearmint helped you. I have the same problem. Thanks you for answer

    2. Hello,

      I also wanted to say that I got excessive hair growth after expensive laser treatment. I also got hyper pigmentation.

      If you see websites and google, you will not see any information on these cases but as I started digging I realized that lasers are having this effect on many women.

      I am looking at bleaching options.

  7. I just put PCOS into facebook just to see what happened! OK, told my ovaries were ‘a little polycystic’ when I was 21 or 22 I think, soon after I went onto depo-provera intramuscular for birth control, to help with heavy, painful periods and to help me not have to deal with ‘cleaning up’ during my time of the month as I had a damaged back and (although I didn’t know it at the time) EDS- diagnosed 5-6 years later as a kind of)

  8. thank-you so much i cant wait for the next part, your contribution in my life is much appreciated,

  9. I have been on Spironolactone and Metformin for most of the last 10 years. I got a series of 6 laser treatments on my face, with my last session being a year and a half ago. My symptoms were greatly improved. I am half asian, half caucasion – my skin is slightly tan, and my hair is really dark, almost black. I’ve been told the bigger the contrast between hair color and skin tone, the better, and it has been proven true in my case. Also, I was sure to be free of any sort of suntan, using sunscreen religiously to keep my lighter skin.

    I have noticed since slacking on my medication the last 6 months and having gained some weight (more than likely related), it seems to be slightly worse, but I am back to my medication. I hope the above information can help some of you. I think laser treatments are definitely worth the money – it has given me confidence that I didn’t have for years. One thing I should mention that might be helpful is that the esthetician that did my hair removal said that because of the significant improvement after just the first treatment, she was confident that it would work very well for me. In other words, if you don’t see any improvements within a couple sessions, do not waste your money. Also, I went to the lady I did because of a Groupon deal, so look into that because it can save you a great deal, but do your research on the service provider, too.

    Good luck to you all and Tarryn, thank you for such an awesome website. It has been very helpful and encouraging as I begin a very rigorous attempt at getting my other symptoms under control.

    1. can you please tell which laser was used on you, i have the same skin tone and my laser doc says IPL. Thanks

  10. Thanks for sharing your knowledge Tarryn. I did laser hair removal for 4 years before realizing that the hair growth was getting worse! Then I started electrolysis, and the electrologist informed me that many types of laser only work with certain pigments of hair and skin…not mine. I am still doing electrolysis 5 years later, but the hair is finally clearing.
    I have been eating quite healthy and am very active, but I just read about this no dairy business, and I am really excited to see if cutting dairy out makes a difference.

  11. Thanks for sharing your story Tarryn. I’ve struggled for years to get a cause for my hirsutism diagnosed. I was asked by my laser removal specialist to see a doctor before I came back. I did, it was overlooked I was given BC, with little explanation except at 23 that I might be in perimenopause. Well, I wasn’t and I was also told I don’t have PCOS. So, those were my answers without blood draws or even a real exam. I took pictures for the next time I go to the doctor (next week) because what my laser person saw 3 years ago was enough cause for concern that maybe the doctors aren’t understanding my grievances and it has since worsened. So, I appreciate when women can speak up about this online because sometimes you really need to self advocate when you see a doctor. And it’s hard to ask about this because it can be embarrassing. I hope I get my answers or at least a little more investigation and treatment this time.

    1. Hi JJ.

      It really can be so frustrating when you don’t get the help and support that you need! I really hope that you get some answers at your next appointment!

      Tarryn

      1. It turns out I have a Prolactinoma and PCOS. So the treatment for the Prolactinoma is medicinal to shrink it. I’ve opted out of hormonal BC but I am certainly going to take your advice on how to eat so that I’m no exacerbating the problems PCOS has caused me.

  12. I was wondering if you knew any type of androgen blocker over the counter. I found out I had Pcos in the fall at age 40-had 2 kids in my thirties and never had an issue with getting pregnant until 4 yrs ago trying for a 3rd-my RE said my age caused the pcos to go into full effect. I also don’t have the insulin resistant type I have type 1-I didn’t even know there were 2 kinds. I only have somewhat of a elevated level of androgens-but have not ovulated since some weight gain after my second child.

  13. I am so glad to have found this community of women who share the same issues as I do! I have had facial hair problems for the past 10+ years and the only solution that has worked for me is waxing. It leaves my skin very smooth and over time has slowed down the growth process. I now go every two weeks and it’s about $15 each visit. I hope this helps someone else.

  14. I would like to ask, do you have any experiences with laser treatment of hirsutism from woman with PCOS? Do you think, is it beneficial and effective or not?

    Thanks

    1. Hi Dita,

      I think women with PCOS often need more treatments than normal and your hair can grow back but I think it does help a little. I’d make sure that I’m also eating well and taking supplements to ensure that my testosterone levels are under control as increased testosterone will cause your hair to grow back thicker.

      Tarryn

    2. I don’t want to discourage anyone, but I have done four years of laser hair removal, 2 years at one center and 2 years at another, just trying to have my facial hair removed. Unfortunately, for me it has not even made a dent! 🙁 I am not about to spend another $3500 and four more years trying. That is a lot of good pairs of shoes! 😀

      1. Thanks so much for sharing your thoughts, Nichole. You’re right could be spent on loads of clothes, shoes, handbags, etc… It’s really important to get testosterone levels under control as that is often the main cause of hirsutism.

      2. thanks for sharing this, not everyone can afford such treatments and to know it wont help much to have this done is a great relive

      3. I developed a full set of pubic hair at age three. I am 57 now. I can’t imagine what my family though. In my early twenties, as a poor college student, I got dark hair on my upper lip under my nose. I went in for electrolyis which was long and painful with tears coming down my face and red sores from taking out the hairs were prominent for days- sooooo many nerves there, especially under the nose. I did see quite a bit of improvement happily for most of the rest of my adult life. I am very thin (flat as a pancake – not bad! I like it)and not diabetic (as far as I know) The later hair was across my cheeks and under my chin which laser did almost nothing for making me shave. I have had two autistic children who are great adults. Life worked out for me!

    3. I am now almost 25 years old and have extreme symptoms of my PCOS. I wasn’t diagnosed until later, but I began growing facial hair in high school. I started by just bleaching it. It was long and thick hair, so it was still noticeable, but I would trim it with small scissors and the bleach hid it quite a bit. I don’t think you noticed it unless you were really staring or if a glare from the light hit it. I did then go for laser hair removal. I had three sessions, with no results. I guess it may have helped a little, but not to where I noticed it and felt comfortable and it definitely wasn’t worth the money spent on it. Also, when you go for your treatments, you have to shave the area first. I hadn’t been shaving my face up until this point and then started solely for my treatments. I noticed that the hair was much more noticeable after this because when it grows back you either have to shave it again (starting this cycle I’m in now where I shave my entire face every single day, sometimes more than once)or let it grow out long enough to bleach or wax, which was just too embarrassing. All in all, if your hair is not as extreme as mine, it may be worth it to you, but if it is excessive, I would save your money and not even waste the time and pain. In my opinion, I would have just stuck to bleaching from the get go.

    4. Hello Dita i had laser treatment and the first thing they told me is that it will grow back sooner then if i didn’t have pcos… i hated it just my personal experience it hurt and i had swelling it took longer to grow back then my normal methods which is just a little shaver. ive tried several different methods and its more of finding something you are comfortable with and what works better for your body.

  15. Hi

    I have been managing well with my PCOS up to now. Since I was diagnosed I have been taking co-cyprindiol as a contraceptive and it seems to do the trick (it hasn’t completely stopped the hair growth but has made it much more manageable). I am now lucky enough to be in a position where my partner and I are thinking about starting a family and I am absolutely terrified about what will happen and how I will cope when I come off the pill! I can’t wait to hear any advice you may have on managing the symptoms naturally.

    Thanks

    1. Hi Gillian,

      Thanks for sharing your story!

      It is hard to make a change, particularly if what you’re currently doing is working. The key is to balance your hormones and insulin as much as possible before you go off the pill so that your body can maintain this once you’re off the pill. A good diet and exercise will really help with this!

      I’ll be posting the next article tomorrow, so stay tuned!

      Tarryn

  16. This is a fantastic, in-depth article; I have learnt a lot! Hirsutism is something I struggle with and I have tried two types of contraceptives, the latest being co-cyprindiol, as well as metformin with seemingly no effect so far. I can’t wait for your next article as I’m sure it will be opening new possibilities for me. Thank you so much for all your hard work Tarryn!

    1. Hi Katherine,

      Thanks so much for your kind comments and feedback! I’m so glad you enjoyed this post. I’ll be putting the next one up toward the end of the week…

      Tarryn