New Hope for Dealing With Unwanted Hair

Adolescence hit Paula D. with too much hair in all the wrong places. As a teenager, she could do little except feel bad about herself.

But once Paula had the means, she embarked on a two-year, several-thousand-dollar course of electrolysis treatments to remove hair from her bikini area and upper lip. She underwent laser treatments to clear up her arms, and still waxes her legs once a month.


Now in her 40s, Paula has her body hair under control, but those negative adolescent feelings still surface from time to time.

In a society that often sets impossibly high standards for feminine beauty, excessive facial and body hair in a woman can be a heavy burden, both psychologically and socially.

The medical term for abnormal hair growth is hirsutism, but determining what is abnormal is not always simple. Even apparently hairless skin may be covered with short, soft, usually colorless hairs, called vellushairs.

Hair growth may be considered abnormal in a woman when these fine hairs are replaced by longer, coarser terminal hairs in areas associated with male hair-growth patterns—the moustache, beard and sideburn areas, as well as the chest, abdomen, back, upper thighs or upper arms.

Why Some Women Have More Hair

Heredity and hormones determine the amount and distribution of body hair. Women of Mediterranean descent tend to have more hair than Nordic or Asian women. Even within an ethnic group, women in some families may tend to have more hair than average.

How a woman's hair-growth pattern compares to that of her sisters or other women of the same ethnicity is a key factor in diagnosing hirsutism.

Several hormones are responsible for controlling hair growth. The most important is testosterone, one of a group of hormones called androgens, which are responsible for "male" characteristics such as hair patterns and deeper voices.

Hirsutism occurs when hair follicles become unusually sensitive to normal androgen levels in the blood, or when androgen levels rise. The growth of facial hair in many postmenopausal women is due to the drop in levels of the female hormone estrogen that occurs during menopause. This decline alters the estrogen-testosterone balance, causing a relative excess of testosterone.

How Serious is Hirsutism?

Excessive hair-growth in women is neither a disease nor, in most cases, a sign of disease. Sudden or severe hirsutism, however, does require medical attention, especially if accompanied by menstrual irregularities or signs of increased androgen levels, such as baldness or a deepening of the voice.

In these cases, a doctor will look for possible underlying causes, including polycystic ovarian disease, adrenal gland disorders and (rarely) adrenal or ovarian tumors. Hirsutism can also be caused by drugs that have an androgen effect, such as the drug danazol, used to treat endometriosis and fibrocystic breast disease. If a drug cause is suspected, the doctor may prescribe an alternative medication.

Treatment Options for Unwanted Hair

Hirsutism can be treated by physically removing unwanted hair or with drugs that help reduce androgen levels. Oral contraceptives and the diuretic spironolactane are commonly prescribed for hirsutism.

Often taken together, these drugs help suppress androgen production and new hair growth, but do not eliminate existing hair. They also take up to six months to show any effects. Common side effects of spironolactone include menstrual irregularities.

In 2000, a clinical trial showed similar efficacy of other anti-androgen drugs in eliminating unwanted facial hair in women.

The other medications included finasteride and flutamide. Flutamide can cause liver toxicity in high doses. Side effects of finasteride treatment are few and include liver enzyme abnormalities. Use of these drugs should be limited to those effectively preventing pregnancy as they can have a feminizing effect on male fetuses.

In what is particularly good news for the millions of American women with unwanted facial hair, in 2000 the U.S. Food and Drug Administration approved the first topical prescription cream for the suppression of facial hair.

It works by interfering with an enzyme found in the hair follicle of the skin needed for hair growth. This slows hair growth in the treated area. The drug, called Vaniqa (eflornithine hydrochloride), may also help control hair growth in other areas and in men. Vaniqa takes up to two months to work and must be applied regularly to prevent further hair growth.

Of the nondrug treatments, shaving is probably the easiest and safest. Avoiding a stubble, however, requires daily shaving, which can irritate the skin.

Dipilatory creams dissolve hairs chemically and leave no stubble, but they too can irritate the skin. Plucking and waxing are painful. Bleaching makes hair less conspicuous but doesn't remove it. None of these methods removes hair permanently.

The only permanent hair removal technique is electrolysis, in which individual hair follicles are destroyed by electric current delivered through a needle. While permanent and effective, electrolysis is costly, time-consuming, painful and can result in infection and scarring. This treatment must be performed by a qualified electrologist.

Laser hair-removal is a faster and gentler alternative to electrolysis. Results are long-lasting, but not permanent. Patients may experience stinging during treatment and a sunburn sensation for a short period afterwards.

Skin discoloration may also occur, especially in dark-skinned patients. Laser treatments, which heat and destroy hair follicles, are not effective in removing white, gray, or light hair, which does not absorb the laser wavelength as effectively as darker hair does.

Talk to your healthcare provider about the best treatment option for you.