Hirsutism in PCOS: Causes and Hormonal Links

Dealing with unwanted hair growth due to PCOS? Here's the quick breakdown you need:

• Hirsutism: Excessive growth of coarse, dark hair in areas like the face, chest, and back, often driven by hormonal imbalances.
• PCOS Connection: 65–80% of women with PCOS experience hirsutism due to elevated androgens (like testosterone) and insulin resistance.
• Diagnosis: Doctors use tools like the modified Ferriman-Gallwey (mFG) scoring system and hormone tests to assess severity and identify causes.
• Treatment Options:
  • Medical: Oral contraceptives, spironolactone, eflornithine cream, and metformin.
  • Lifestyle: Weight loss (even 5% can help), exercise, and dietary changes.
  • Cosmetic: Laser hair removal, electrolysis, or shaving for immediate results.
• Telehealth: Platforms like Oana Health offer easy access to treatments like spironolactone ($14/month) and eflornithine cream ($69/month), delivered to your door.

Key takeaway: Managing hirsutism in PCOS requires addressing hormonal imbalances, lifestyle changes, and cosmetic solutions. Early intervention and consistent treatment are essential for both physical and emotional well-being.

PCOS Facial Hair and Hair Loss | Causes, Treatments, & Natural Ways to Reduce Hirsutism & Hair Loss

What Causes Hirsutism in PCOS?

Hirsutism in women with PCOS arises from a mix of hormonal imbalances and individual biological factors. These underlying causes help explain why symptoms can differ so much between individuals. Let’s take a closer look at the key hormonal drivers behind this condition.

The Role of Excess Androgens

One of the primary reasons for hirsutism in PCOS is an increase in androgens like testosterone and DHEA-S. This happens because of consistently high levels of luteinizing hormone (LH) and insulin, which stimulate the ovaries to produce more androgens. On top of that, hyperinsulinemia - caused by insulin resistance - reduces the production of sex hormone-binding globulin (SHBG). With less SHBG, more free testosterone circulates in the body.

These elevated androgens trigger the conversion of fine, soft vellus hair into thick, coarse terminal hair. They also increase sebum production, which can lead to oily skin and acne. Additionally, these hormonal shifts disrupt ovulation and menstrual cycles. PCOS is the leading cause of hyperandrogenism, accounting for 80% to 90% of cases in reproductive-age women.

Insulin Resistance and Its Effects

Insulin resistance is another major factor that worsens hirsutism, affecting 60–70% of women with PCOS. When the body resists insulin, it compensates by producing more of it. This excess insulin further stimulates the ovaries, leading to even higher androgen levels and exacerbating PCOS symptoms. While this effect is more pronounced in women with obesity, lean women with PCOS can also experience insulin resistance, though typically to a lesser extent.

Hair Follicle Sensitivity to Androgens

Interestingly, not all hair follicles react the same way to androgens. This variability explains why hirsutism patterns differ among women. Follicles in areas like the face, armpits, pubic region, and chest are particularly sensitive to androgens because they have higher levels of androgen receptors and the enzyme 5-alpha reductase. Genetic and ethnic differences also play a role in how sensitive hair follicles are to these hormones, further influencing the severity and distribution of hirsutism.

How Doctors Diagnose Hirsutism in PCOS

To diagnose hirsutism in PCOS, doctors rely on a combination of clinical evaluations, scoring systems, and laboratory testing. These steps help identify the extent of excessive hair growth and its underlying hormonal causes.

Clinical Evaluation and Scoring

The modified Ferriman-Gallwey (mFG) scoring system is the primary tool used to assess hirsutism. It evaluates hair growth across nine specific body areas, including the upper lip, chin, chest, upper and lower back, upper and lower abdomen, upper arms, and thighs. Each area is scored from 0 to 4, based on the thickness and density of terminal hair. The cutoff score for diagnosing hirsutism varies depending on ethnicity:

• ≥8 for U.S. Black and white women
• ≥9 for Mediterranean, Hispanic, and Middle Eastern women
• ≥6 for South American women
• As low as 2 for Asian women

The scoring system also helps classify the severity of hirsutism: scores up to 15 are considered mild, while scores above 25 indicate severe cases. However, this method has its limitations. It doesn’t account for cosmetic hair removal methods like waxing or laser treatments, and it can be subjective.

"The Endocrine Society recommends treating patient-important hirsutism, which is unwanted sexual hair growth of sufficient extent to cause patient distress."

This recommendation highlights that even women with lower mFG scores may experience significant emotional distress and could benefit from treatment. A thorough medical history and physical exam are vital to understanding the patient’s concerns and ruling out other potential conditions. Once the clinical evaluation is complete, laboratory and imaging tests are used to refine the diagnosis.

Laboratory and Imaging Tests

If the mFG score indicates abnormal hair growth, doctors proceed with hormone testing to pinpoint the source of hyperandrogenism. Key tests include measurements of total and free testosterone, dehydroepiandrosterone sulfate (DHEA-S), and 17-hydroxyprogesterone. Elevated androgen levels are common in PCOS, with studies showing that nearly half of women with mild hirsutism may have increased androgen levels. The specific hormone patterns can help determine the source of the issue:

• Elevated testosterone and DHEA-S levels often point to an adrenal origin.
• Isolated increases in testosterone suggest an ovarian source.

Additional tests, such as serum prolactin and follicle-stimulating hormone (FSH), may be included to rule out other conditions. Screening for diabetes is also important due to the high prevalence of insulin resistance in women with PCOS, particularly those who are obese or show signs like acanthosis nigricans.

Imaging studies provide further diagnostic clarity. Transvaginal ultrasound is the preferred method for assessing ovarian morphology and confirming the presence of polycystic ovaries, one of the key diagnostic criteria for PCOS. Ultrasound findings in PCOS often reveal slightly enlarged ovaries with multiple small follicles arranged along the periphery. If hormone levels are significantly elevated, imaging techniques like CT or MRI may be used to exclude adrenal or ovarian tumors, which require immediate attention.

Interestingly, the severity of hirsutism doesn’t always align with testosterone levels. Both clinical evaluations and lab tests are essential for an accurate diagnosis, ensuring that treatment plans address the patient’s specific needs.

sbb-itb-6dba428

Treatment Options for PCOS-Related Hirsutism

Managing PCOS-related hirsutism effectively often involves a combination of medical, lifestyle, and cosmetic approaches. While hormonal treatments can reduce the growth of new unwanted hair, they generally don’t reverse the coarse texture or pigmentation of existing hair. This is why cosmetic treatments are often paired with medical interventions to address both the underlying hormonal imbalance and the visible symptoms.

Medical Treatments

Oral contraceptives are typically the first choice for treating hirsutism in women with PCOS. These work by lowering androgen production from the ovaries and increasing levels of sex hormone-binding globulin, which reduces the amount of free testosterone in the body. They can also be paired with anti-androgen medications for better results.

Spironolactone, a widely used anti-androgen, helps block androgen activity in hair follicles when taken at doses of 100 to 200 mg daily. Research shows it outperforms finasteride in managing hirsutism. However, users should be aware of side effects like breast tenderness, irregular menstrual cycles, and the risk of elevated potassium levels. For those interested, Oana Health offers spironolactone telehealth consultations starting at $14 per month. Generic spironolactone costs about $61 for a 50 mg dose taken twice daily.

Topical eflornithine cream is another option, specifically targeting facial hair. Applied twice daily, it works by slowing hair growth through the inhibition of a key enzyme in hair follicle function. Around 60% of users see improvement within six months. However, it can be pricey - costing roughly $46 for a 30-g tube. Oana Health provides eflornithine 12% cream for $69 monthly as an alternative.

Insulin-sensitizing medications like metformin can also help women with PCOS, especially those with insulin resistance. By improving insulin sensitivity, these medications may reduce androgen production and slow excessive hair growth.

It’s worth noting that the hair growth cycle affects how quickly results are visible, so patience is key.

Lifestyle Changes

Lifestyle adjustments play a crucial role in managing PCOS-related hirsutism. In fact, losing just 5% of body weight can lower androgen levels and reduce excessive hair growth. This is especially important since nearly half of individuals with PCOS are overweight or obese.

Exercise is a powerful tool. Engaging in at least 120 minutes of vigorous aerobic activity per week has been shown to improve insulin resistance, body composition, and testosterone levels. Aerobic workouts are particularly effective when compared to resistance training alone.

Dietary changes can also influence hormone balance. Increasing daily fiber intake to 21–25 grams and cutting back on refined carbohydrates and sugary foods are key strategies. Some research even suggests that high-protein diets may be more effective than high-carb ones for reducing androgen levels.

"PCOS is an insulin and testosterone-driven condition... if you're willing to make lifestyle changes around how you eat, sleep and move then you can balance your blood sugar, increase your sensitivity to insulin and manage your symptoms".

Additional and Cosmetic Therapies

For immediate results, cosmetic treatments can complement medical therapies. Laser hair removal can reduce hair by 50–79% within six months of treatment. Combining laser treatments with eflornithine cream has proven even more effective. Laser therapy works best for dark hair on lighter skin tones, though newer YAG laser systems are better suited for darker skin. It’s often preferred over electrolysis for larger areas since it requires fewer sessions, though maintenance treatments may be necessary.

Electrolysis, recognized by the FDA as a permanent hair removal method, is another option. It’s particularly effective for small areas and can offer lasting results. Dr. Kenneth Blank, M.D., a gynecologist with Capital Women's Care, explains:

"In PCOS, the activity of the 5-alpha reductase enzyme in hair follicles is increased. Also, the adrenal hormones alter the hair growth cycle which results in the transformation of vellus hairs into terminal ones".

Experts recommend waiting at least six months after starting medical treatments before pursuing laser or electrolysis to minimize the growth of new terminal hairs.

For temporary relief, shaving is a safe and quick option, while waxing can cover larger areas but may cause skin irritation. By combining medical, lifestyle, and cosmetic approaches, women can address both the root causes and visible effects of hirsutism, tailoring treatments to their unique needs.

How Telehealth Helps Manage Hirsutism

Telehealth has made managing hirsutism caused by PCOS much easier, breaking down barriers to specialized care. PCOS affects 5–10% of women in the U.S., yet up to 70% of cases remain undiagnosed. With telehealth, women no longer need to wait weeks for an in-person appointment. Instead, they can schedule virtual consultations from the comfort of their homes. Considering the average diagnostic delay for PCOS is 4.3 years, this convenience is a game-changer.

Through telehealth, patients gain quick access to expert care. Virtual consultations allow licensed medical professionals to conduct thorough assessments, taking into account medical history and current symptoms. Using this information, they create personalized treatment plans that address both hormonal imbalances and the visible symptoms of hirsutism. These plans often include medications such as spironolactone and eflornithine, alongside lifestyle adjustments and tailored nutritional advice.

For women managing hirsutism, platforms like Oana Health provide easy access to effective treatments. They offer spironolactone starting at $14 per month and eflornithine 12% cream for $69 monthly, prescribed by licensed professionals and delivered directly to patients' homes. This eliminates the hassle of multiple pharmacy trips, ensuring consistent and reliable treatment access. These digital tools complement the broader medical and cosmetic therapies mentioned earlier.

Telehealth also bridges the gap for women in rural or underserved areas, connecting them with specialists who understand the complex hormonal challenges of PCOS. Regular virtual check-ins allow providers to monitor progress, adjust treatments, and address side effects - crucial since hormonal therapies often take months to show visible results.

Beyond medication, telehealth platforms offer educational resources and community support to empower women in managing their condition. By addressing not just the physical symptoms of hirsutism but also emotional well-being, this approach promotes self-confidence and a sense of control.

Advanced lab testing is another benefit of telehealth. Hormone panels and other diagnostics can be seamlessly integrated into personalized treatment plans, which may include diet, exercise, and medications.

Finally, telehealth provides a private and empathetic setting for discussing sensitive issues. The privacy of virtual consultations often makes it easier to talk openly about symptoms that might feel embarrassing in a traditional clinic, leading to better communication and more effective treatment outcomes.

Conclusion: Managing Hirsutism in PCOS

Managing hirsutism in PCOS involves understanding the intricate hormonal imbalances that lead to unwanted hair growth. Factors like excess androgens, insulin resistance, and heightened hair follicle sensitivity play a major role. In fact, PCOS is responsible for 70% to 80% of hirsutism cases in women. Tackling these root causes is crucial for effective treatment.

A well-rounded approach combines medical treatments, lifestyle adjustments, and cosmetic solutions.

"The most effective treatment includes a long-term approach that reduces androgen receptor activity, thus decreasing new terminal hair development, and the removal of existing terminal hairs".

Lifestyle changes are a critical part of managing hirsutism. Weight management, for instance, can significantly influence hormone levels. Losing just 5% of body weight has been shown to lower androgen levels and reduce hair growth. A balanced diet and regular exercise also play a key role in stabilizing hormones.

On the medical front, treatments like eflornithine cream and spironolactone - both accessible through Oana Health's telehealth services - offer promising results. Eflornithine cream, for example, has shown improvement in 60% of patients after six months of use. When paired with other treatments like spironolactone or birth control pills, the outcomes can be even more pronounced.

Beyond the physical symptoms, hirsutism can deeply affect emotional well-being and overall quality of life. Early intervention is critical. As noted by ReproductiveFacts.org:

"Hirsutism is very common and often improves with medical management. Prompt medical attention is important because delaying treatment makes the treatment more difficult and may have long-term health consequences".

Consistency and a comprehensive plan are essential. While hormonal treatments may take months to deliver visible results, combining them with lifestyle changes and professional guidance offers the best chance for success. This integrated approach addresses both the physical and emotional aspects of PCOS, providing a path toward better health and improved quality of life.

FAQs

What role does insulin resistance play in causing hirsutism in women with PCOS?

Insulin resistance plays a major role in the development of hirsutism in women with PCOS. When the body becomes less responsive to insulin, it compensates by producing more of this hormone. These elevated insulin levels can cause the ovaries to release excess androgens, like testosterone, which lead to male-pattern hair growth in areas such as the face, chest, and back.

Tackling insulin resistance through lifestyle adjustments, medications, or a mix of both can help lower androgen levels and ease hirsutism symptoms. Targeting this root issue is a crucial part of managing the hormonal imbalances associated with PCOS.

What are the benefits and possible side effects of spironolactone for managing hirsutism in PCOS?

Spironolactone is a common medication prescribed to help women with PCOS manage hirsutism. Its primary function is to block androgens - those male hormones responsible for excessive hair growth. Many women start seeing a noticeable reduction in hair growth within 2 to 6 months of beginning treatment, with research showing that 60-80% of users experience improvement after consistent use.

However, like any medication, spironolactone comes with potential side effects. These may include irregular periods, breast tenderness, and in rare cases, high potassium levels (hyperkalemia). It's also crucial to avoid spironolactone during pregnancy, as it can cause birth defects. Regular check-ins with a healthcare provider ensure the treatment remains both safe and effective.

For those seeking tailored PCOS care, including solutions for hirsutism, Oana Health provides science-based, prescription treatments conveniently delivered to your door.

How can telehealth improve care for women with PCOS experiencing hirsutism?

Telehealth has made managing hirsutism for women with PCOS more accessible by providing convenient and tailored care options. With virtual consultations, patients can connect with licensed healthcare providers without leaving their homes. This eliminates the hassle of travel and cuts down on wait times, which is especially beneficial for those in rural or underserved areas.

Through these online platforms, healthcare providers can develop personalized treatment plans targeting hormonal imbalances like excess androgens, a common cause of hirsutism. These plans can be adjusted quickly based on patient feedback, ensuring they remain effective and suited to individual needs. By improving access to specialized care, telehealth helps women manage their symptoms more efficiently, leading to a better overall quality of life.

Related posts

• 7 Early PCOS Signs Women Should Know
• PCOS vs Endometriosis: Key Differences
• Hormonal Acne Treatment Checklist
• Oral Contraceptives for PCOS: Regulating Periods and More