All You Ever Wanted to Know About Unwanted Hair

Much of this information was gathered from Dr. Sara Rosenthal's recent book Women and Unwanted Hair, Dr. Geoffrey Redmond's Book The Hormonally Vulnerable Woman, as well as Sheila Godfrey's Principles and Practice of Electrical Epilation.  Click on the book covers for a link to Amazon to purchase your own copies of these EXCELLENT resources.

While this information is no substitute for consulting a physician, we are dedicated to helping everyone learn about unwanted hair. This page discusses different aspects of unwanted hair and targets females.  Many men also deal with unwanted hair, we are by no means ignoring their issues.  For more information, please contact your physician.  

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Hair That Is "Not Supposed to Be There"
Excessive hair growth can be identified by many different terms.  You have probably run across the term Hirsutism, perhaps Hypertrichosis, and even superfluous hair.  In many resources these terms are used interchangeably but there are important distinctions.  

Excessive hair (key word here is excessive) on the face, especially around the chin, upper lip, breasts or chests, or basically hair on a woman that matches a male hair pattern on a female body is known as hirsutism.  Men can have hirsutism when their hair is truly excessive in hormonally dependent areas.  A diabetic woman with a full male pattern beard would be said to have hirsutism.  

Hypertrichosis is basically excessive hair on men or women that tends to be in places that are outside the pattern areas described above.   Someone who has a cast on their leg who grows unusually large patches of hair under the cast could be said to have Hypertrichosis (hyper=excessive/accelerated trich=hair).  

Superfluous hair or garden variety  “unwanted hair” is considered such whenever it appears on areas of the body that are considered to be either culturally unacceptable, or unattractive.  It isn't an abnormal amount or location when considering the makeup of the whole population, it is just undesirable for a woman to have a noticeable light mustache.  The color of the unwanted hair is also key; the darker it is, the more visible—which makes it more of a problem for dark haired women than for fair haired women.  If you are dark haired, for example, the fine hair on the upper lip or around the hairline may feel abnormal but it’s not; it’s merely visible. And even though excessive hair growth on the face or male-patterned hair growth on the body is considered “abnormal” in women, it’s actually very, very common.

Common Causes of Abnormally Excessive Hair Growth

• Too much androgen secretion:  Many women secrete too much androgen as a result of conditions such as Polycystic Ovarian Syndrome (PCOS) or Polycystic Ovarian Disease (PCOD), which affects 6-10 percent of the general female population and accounts for half of all hormonal disorders affecting female fertility.  Because androgen levels are out of whack, PCOS sufferers can develop abnormally excessive facial or body hair.  For more information on PCOS, visit  www.PCOSupport.org .
• Genetics:  Some clinicians will cite “racial” or “familial” genes as a cause of hirsutism, but this isn’t an authentic cause per se.  Having said that, if you’re of Mediterranean descent, you are more likely to experience noticeable or “unwanted” hair growth that a blonde Scandinavian woman may not.
• Stress:  In response to stress, your adrenal glands pump out “stress hormones” or catecholamines that speed up your body.  But since your adrenal glands also make androgen, increased stress can also increase circulating androgens in your bloodstream, which can cause hirsutism.
• Obesity:  Certain body types (wherein more of the weight is carried in the upper body) are more susceptible to hirsutism because they are associated with insulin resistance.  Also, fat cells can make androgen just as they can make estrogen.
• Overactive adrenal glands: This is a side effect of tumors resulting from certain pituitary diseases, such as Cushing’s Disease (for more information, visit the National Adrenal Disease Foundation at  www.medhelp.org/nadf).  Cushing’s Disease and PCOS are often accompanied by irregular periods. 
• Oversensitive hair follicles:  Some of us are genetically wired with hair follicles that are simply more sensitive to androgens.
• Side effects of certain drugs:  Many drugs can cause either androgen secretion and hirsutism, or the opposite—hair loss or alopecia.  As a general rule, when taking either a prescription or an over-the-counter drug, be sure to ask about common side effects.  Drugs that commonly cause hair growth in women include:  Dilantin (used to control seizures), Danazol (used in extreme cases of endometriosis), Cyclosporine, Steroids (used in a variety of drugs, particularly asthma medications)
• Oral contraceptives:  Certain OCs can increase circulating androgen levels, while others decrease them.   For a list, please click here to view the PDF article on drug induced hirsutism by International Hair Route Magazine or read the appropriate section in Dr. Rosenthal's book Women and Unwanted Hair.
• Insulin resistance & Diabetes: This is when your cells stop responding to the insulin your pancreas makes.  Too much insulin can actually cause hirsutism.  For more information, see The Diabetes Page located on Dr. Rosenthal's web page.
• Thyroid disorders:  Certain thyroid disorders could cause hirsutism.  Once your thyroid problem is treated, however, it’s likely no new hairs will be stimulated to grow.  
• Rare endocrine disorders:  An increase in androgen levels can result from a number of very rare endocrine diseases, such as Hyperandrogenic-Insulin Resistant-Acanthosis Nigricans (Hairan) Syndrome.

Hormonal Treatment for Unwanted Hair
Much unwanted hair growth occurs as a result of hormonal imbalances, which are correctable. Ironically, many women actually uncover a potential underlying hormonal problem during a visit with an electrologist (a person who performs electrolysis). And while hormone therapy will not make the hairs you already have disappear, it can stop the growth of new hairs. Be sure to ask your doctor about common side effects of each of the following therapies before you say “yes” to hormone therapy.

• Oral contraceptives (OCs): The most common form of hormone therapy used to treat hirsutism, OCs tend to improve what are called “androgen-related side effects,” such as acne and unwanted facial hair. That said, too much progestin, which is synthetic progesterone, can also cause these kinds of side effects. If your acne and/or unwanted facial hair predates your use of OCs, you may notice a marked improvement; however, if these “symptoms” occur after you’ve started an oral contraceptive program, you may be on the wrong pill, and should consult with your doctor about alternatives. 
• Spironolactone: This is a diuretic that appears to counteract the effects of androgen hormones in the skin. Frequently called an antiandrogen drug, spironolactone is not recommended if you’re at risk for osteporosis.
• Cortocisteroids: These will prevent your adrenal gland from making androgens, but they’re not recommended as a first-line hormone therapy for hirsutism.
• GnRH analogs: GnRH (gonadotropin releasing hormone) analogs are normally used in fertility treatment and—because they come with many menopausal-type side effects—should be reserved for more severe cases of hirsutism where OCs are not appropriate.
• Natural progesterone therapy: If birth control is not an issue, this may be an appropriate means of correcting an underlying hormonal imbalance. For more information, see Natural Progesterone: The Natural Way to Alleviate Symptoms of Menopause, PMS, and Other Hormone-Related Problems by Anna Rushton, Shirley A. Bond and John Lee.

Removing Unwanted Hair
The following are methods most people consider once an underlying hormonal problem causing excessive, unwanted hair growth has been ruled out, or dealt with.

• Tweezing: Tweezing is the cheapest method of removal, and is generally considered appropriate for eyebrows, since you may want to alter their shape from time to time and allow the hairs to grow back. "However, tweezing can cause scar tissue to form and can also stimulate the hairs to grow back stronger and coarser.  Avoid using tweezers on sparse facial hair or as a way of removing large areas of unwanted hair on the legs and underarms."--Dr. Sara Rosenthal, Women and Unwanted Hair
• “Tweezer-like” Products: Although these devices are relatively cheap and convenient, the hair removal is temporary and, like regular tweezing, stimulates the hair follicle to grow stronger hair.
• Shaving: The problem with shaving for women is where they are shaving and where, on their bodies, stubble is socially and culturally acceptable.  Shaving facial hair, for example, is stigmatizing; shaving underarm hair is not. In light of this, experts understand if women refrain from shaving the face if it doesn’t feel right, but they do not discourage shaving if the goal is to remove the hair without stimulating the roots.  And if the goal is to permanently remove the hair, shaving is a better option than waxing, tweezing or sugaring if you’re having electrolysis treatment because of the potential skin damage associated with these alternate methods.
• Waxing: Waxing is basically large scale tweezing.  It removes the hair for long periods of time without producing stubble.  With the exception of hair that has been hormonally stimulated, hair that is waxed on areas such as the lower leg or underarm, may grow back fine or sometimes finer. However, like tweezing, waxing can negatively stimulate the roots and hair follicles on areas like the chin, breast, abdomen, and upper lip.
• Sugaring: Sugaring produces the same results as waxing, but doesn’t require as much heating. It can be messy and, as a result, is not exactly convenient.  It is also a large-scale tweezing method.
• Threading: This is an ancient technique popular in places like India and the Middle East. It involves the use of a regular thread to remove hair from the surface of the skin.  It is a variation on tweezing.
• Hair Removal Creams: These creams (also called depilatories) remove surface hair but they tend to have less of an effect on the follicle than methods like tweezing.  Think of them as a chemical shave.  And while they don’t provide a permanent solution, the hair may take longer to grow back than it would if you were shaving, and hair doesn’t grow back as stubbly.
• Bleaching: Bleaching kits do not remove hair at all, but can lighten the dark, fine hairs of the upper lip or arm to conceal hirsutism.  Use with caution as on some hair colors, it make it catch the light and ends up making it more noticeable, almost shiny.  
• Home Electrolysis Kits: These tend not to live up to their claims, nor do any “patch” devices you may have come across on the home shopping network; both end up actually “tweezing” out the hairs instead of removing them via electrolysis. The good news is the DC battery that powers home electrolysis kits is not strong enough to do any real damage to your skin.  We've tried them all and none of them work.  Hair is just not a conductor of electricity, sorry.  
• Laser:  Laser treatment for hair removal is gaining popularity, but its success is really dependent on the hair and skin pigment.  If you’re a person of color, the pigment in your skin will likely interfere with the laser beam’s reach.  Similarly, if you’re fair-haired, the laser will likely be unable to grasp the pigment in your hair.  This is an adequate method if you’re fair skinned, but dark haired. However, it is extremely costly, and its permanence is not guaranteed and can not be legally represented as permanent.  It might work well in conjunction with a permanent method like electrolysis on large areas like a man's back or full beard removal.  Make sure you are having laser treatments done by a trained medical doctor, not just a "certified" technician, certification can be as simple as a 4 hour course on how to operate the machine.   Visit the FDA Laser Facts page for more information.
• Electrolysis:  Electrolysis is the only permanent way of removing hair, but it does require a time commitment.  The electrologist uses a very fine filament or needle, placing it alongside the hair shaft and into the hair follicle.  A mild electric current then destroys the hair-growth cells within the follicle.  The process is charged by units of time and, unfortunately, doesn’t come dirt cheap like shaving does.  We frequently have clients say they thought it would be much more expensive and that is why they hadn't come in sooner, it is definitely an investment you are making in yourself.  If you are dealing with unwanted hair frequently then it is very worthwhile to investigate it to see what your actual costs will be.  Compared with laser, it is an absolute bargain as far as price goes.  An hour of body waxing in our area costs a little more than electrolysis for an hour.  Remember when you are done with electrolysis, you are done with the hair.   As with any method, your results will be largely determined by the skill of your practitioner.  Shop around and don't hesitate to set up consultations at several places and decide which works best for you.  See the FAQ section of our site for tips on choosing an electrologist.

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