How To Treat Hirsutism

Hirsutism is not a disease and it is rarely caused by a serious illness. Unfortunately in our society, excess hair growth in woman is considered abnormal and this can cause distress or embarrassment. At least 25% of normal middle-aged women have unwanted facial hair and many women do not realise the treatment options that are available.

In some cases, hirsutism may be as a result of an underlying medical disorder. This can easily be ruled out with a medical history and some simple blood tests. The treatment of hirsutism begins with a detailed description of the problem and ensuring that the patient does not lose their femininity. Then, direct intervention, if possible, is instituted for the underlying disorder.

In some cases, cosmetic measures may be sufficient. In others, the slow progress of systemic therapy may necessitate more immediate cosmetic treatment. If hirsutism persists (or the patient has idiopathic hirsutism), other cosmetic or systemic treatment may be necessary. The most effective strategy is to combine a systematic treatment that contains a slow onset of effectiveness, with mechanical hair removal (shaving, plucking, waxing and depilatory creams) or light-based hair removal (laser or pulsed light).

Hirsutism requires careful evaluation, systematic and rational approach to clinical treatment. Throughout this process, the patient must understand that even if the diagnostic tests can be a waste of time (and inconclusive), it is sometimes necessary to identify effective interventions. In other cases, it may be counseling and education all that is necessary. For the patient who wants treatment, a wide range of pharmaceutical strategies are available. 

As the current treatment system is not perfect it is very important for the patient to give informed consent after a complete explanation of the potential benefits and risks of a particular treatment and alternative approaches.  


Who should see a doctor?
Any woman experiencing difficulties in controlling body or facial hair by cosmetic methods should discuss this with a General Practitioner, as referral to an Endocrinologist (Specialist interested in hormone problems) may be beneficial. An Endocrinologist can provide reassurance, arrange appropriate investigations and discuss the options for treatment. 

What investigations may be needed? Blood tests can be done to check the levels of male and female hormone levels. These can usually be done at the time of visiting the outpatient clinic. Occasionally more sophisticated hormone tests are needed and these can be arranged as an outpatient at the Clinical Investigation Unit. An ultrasound of the ovaries and CT scan the adrenal glands may also be necessary in some patients.

What treatmentsare available?

1. Cosmetic

• Bleaching makes the excessive hair less obvious.
• Depilatory creams
• Shaving: contrary to popular opinion, shaving does not make the hair grow more thickly! Electric shavers are probably better than wet type, as there is less tendency to irritate or damage the skin.
• Waxing pulls hairs out from the roots and needs to be repeated regularly.
• Epilady removes the hair by a combined cut and pull.
• Electrolysis may result in permanent hair loss, but takes time as a small area is treated every few weeks. Electrolysis can be expensive and unskilled treatment may cause scarring.
• Laser therapy is useful for facial hair removal in certain skin types.