Understanding Hirsutism in Females

Photo Credit: Medscape

Hirsutism is derived from the root word hirsute which has its origin from the Latin word ‘hirsutus’. The word connotes “hairy, rough, shaggy, and bristly.”

According to Merck Manuals online medical Library, 2011, Hirsutism is the excessive growth of thick or dark hair in women in locations that are more typical of male hair growth patterns (e.g., mustache, beard, central chest, shoulders, lower abdomen, back, inner thigh).

The basis

Understanding the background phenomenon in hirsutism is of paramount importance in discerning any previous misconception.

Normally prior to puberty, the human body is generally covered by a form of hair described as vellus hair which is characteristically fine and lightly pigmented. However, as puberty gradually sets in, this vellus hair is converted to a darker and coarse one referred to as terminal hair. This transition usually occurs under the influence of an androgenic hormone- dihydrotestosterone- which is a male hormone. This hormone, derived from testosterone after being acted upon by an enzyme called 5-alpha-reductase, is locally present in hair follicles and also circulates in the blood stream( produced by the ovaries and an organ situated on the kidneys-adrenal glands).

Hirsutism therefore occurs when there is inordinate exposure of hair follicles to dihydrotestosterone. hirsutism in female

Hirsutism is a medical condition that is relatively common among females that have reached puberty. It occurs in about 5-15% of all women across all ethnic backgrounds – Azziz R (May 2003). The severeness of hirsutism is largely dependent on the level and continuance of exposure to the hormone and also the intrinsical predisposition to androgen action.

Causes of Hirsutism?

  • Polycystic ovarian syndrome (PCOS) – Putting it in lay man terms, it is a condition common in women of reproductive age group. It is characterized by collection of a host of fluids called follicles in the ovary as a result of hormonal imbalance (oestrogen and progesterone). Such women have redundant male hormones (androgen) and irregular menstrual periods. PCOS is the commonest cause of hirsutism. This condition is also associated with obesity, diabetes mellitus, infertility and high cholesterol levels.
  • Idiopathic – Hirsutism arising from unknown or identifiable grounds is the 2nd commonest cause of abnormal hair distribution in females. This is the only feature in women in this category. Hence, they have normal menstrual periods.

Less commonly, hirsutism also results from:

  • Cushing’s syndrome– hormonal disarray resulting in fulminant weight gain and bloating around the face and neck.
  • Acromegaly– a disease state whereby the body produces overabundance of growth hormone.
  • Tumours of the ovaries or adrenal glands that stimulate the increased production of androgens
  • Drugs such as anabolic steroids (used in muscle building); drugs used for bipolar disorder, epileptic seizures, schizophrenia, migraine headaches; estrogens and opiate medications.
  • Weight gain/ Obesity
  • Cessation of use of oral contraceptives
  • Pregnancy

It is indeed worthy of note that there is strong genetic penchant for hirsutism principally due to underlying endocrine disorders (like Polycystic ovarian syndrome) or factors/ enzymes modulating the development of hair growth.


The most prominent presentation in women with hirsutism is abnormal and excessive presence of hair following a male pattern around the face, neck, chest,hirsutism in female upper and lower back, tommy, arms, thigh, legs and buttocks.

Other symptoms include:

  • Oily skin
  • Acne
  • A deep voice
  • Receding scalp line
  • Enlarged clitoris
  • Irregular menstrual periods or no periods at all
  • Infertility
  • Loss of feminine body shape

Asides the aforementioned symptoms, females experiencing hirsutism do undergo emotional disturbance due to negative body image that results in low self-esteem and depression.

What to do

Any woman experiencing hirsutism with or without any of the aforementioned associated symptoms should see a Healthcare professional for exhaustive systemic clinical and emotional evaluation.


This article is strictly for educational purposes. Hence treatment options for hirsutism are intentionally excluded to avoid self-medication. Thus, females with symptoms similar to those described are strongly encouraged to see a PROFESSIONAL HEALTHCARE PROVIDER.

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