Hirsutism (Facial or Body Hair)

What Is Hirsutism?

Hirsutism refers to the growth of coarse, dark hair in women in areas where such hair growth is typically more common in men — including the face (upper lip, chin, sideburns), chest, abdomen, back, and upper thighs. While it is not dangerous in itself, hirsutism can cause significant distress and is often a sign of an underlying hormonal imbalance that deserves medical evaluation.

Hirsutism affects an estimated 5–10% of women of reproductive age and is among the more visible signs of androgen excess.

What Causes Hirsutism?

The most common cause of hirsutism is elevated androgens — male sex hormones including testosterone and DHEA — which can cause hair follicles in androgen-sensitive areas to produce thicker, coarser hair. The leading causes include:

• Polycystic Ovary Syndrome (PCOS) — responsible for up to 75% of hirsutism cases
• Adrenal gland disorders (including congenital adrenal hyperplasia)
• Insulin resistance, which can stimulate androgen production
• Idiopathic hirsutism (elevated sensitivity to normal androgen levels)
• Thyroid dysfunction

Associated Symptoms to Watch For

Hirsutism often occurs alongside other signs of androgen excess. Seeking evaluation is especially important if you also experience:

• Irregular or absent menstrual periods
• Acne (particularly along the jawline or chin)
• Thinning scalp hair or hair loss
• Weight gain, especially around the abdomen
• Skin darkening in creases (acanthosis nigricans)
• Difficulty getting pregnant

How We Evaluate and Treat Hirsutism

Dr. Risher begins with a comprehensive hormonal evaluation — including testosterone, DHEA-S, SHBG, prolactin, thyroid function, fasting insulin, and other markers — to identify the specific hormonal pattern driving your symptoms. This allows her to create a targeted treatment plan rather than simply managing surface symptoms.

Treatment may include BHRT to rebalance androgen and estrogen levels, insulin-sensitizing strategies, nutritional support, and ongoing monitoring. Managing the underlying hormonal cause often also improves related symptoms like acne, irregular cycles, and fatigue.