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Understanding Hirsutism: How PCOS Affects Hair Growth

Hello again, and welcome back to Shining Through PCOS! I’m Luciana, and today we’re continuing a topic that resonates deeply with many of us living with Polycystic Ovarian Syndrome (PCOS)—hirsutism—and how our hormone imbalances contribute to this challenging symptom.

The Hormonal Connection to Hirsutism

Hirsutism, the growth of coarse, dark hair in areas where men typically grow hair, is one of the most distressing symptoms of PCOS. While it’s not uncommon for women to experience unwanted hair growth at some point, for those of us with PCOS, it often feels like a relentless battle against our own bodies. Understanding the underlying hormonal imbalances can help us navigate this challenge with more compassion for ourselves.

Previously, we discussed how some of the conditions we deal with as a result of PCOS overlap. At the heart of hirsutism in women with PCOS are elevated levels of androgens, often referred to as “male hormones.” While everyone has these hormones to some degree, women with PCOS typically have higher-than-normal levels (Rizvi et al., 2023). This hormonal imbalance is primarily due to something called insulin resistance, a condition where the body’s cells become less responsive to insulin, leading to higher levels within the bloodstream (Barber et al., 2019). Elevated insulin can stimulate the ovaries to produce more androgens, which in turn contributes to symptoms like hirsutism, acne, and irregularities in ovulation (Rosenfield & Ehrmann, 2016).

Understanding the Role of Androgens

Androgens play a crucial role in hair growth, but not in the way we might hope. In women with PCOS, the overproduction of hormones like testosterone can lead to the development of male-pattern hair growth (Mihailidis et al., 2015). Common areas for hirsutism include the face, chest, and back, making it a source of significant emotional distress for many of us (Mihailidis et al., 2015).

I remember grappling with so much embarrassment over the abundance of body hair I dealt with as a child. I felt perpetually frustrated and humiliated in my own skin. It’s a tough battle to handle feelings of inadequacy, especially at a young age when you’re not only worried about your self-perception but also how others perceive you. Many people may tell you it’s “just body hair,” but they underestimate the toll it can take. It affects how you perceive yourself, deprives you of your femininity, and impacts your ability to relate to others and feel a sense of normalcy and autonomy. It’s so much more than just hair.

For many women, including myself, it goes beyond mere appearance; it’s about how we feel in our skin. The pressure to meet certain beauty ideals can lead to feelings of shame and isolation, particularly in visible areas where hair growth can’t be ignored. It's vital to remember that these feelings are valid, and seeking support—whether through friends, family, or professional help—can be an important step in managing the emotional toll of PCOS.

Finding Hope in Treatment Options

While hirsutism can be a challenging aspect of living with PCOS, the good news is that effective treatment options are available. Laser-Based Hair Reduction (LBHR) has emerged as a popular choice for many women looking to manage excess hair growth. However, it’s essential to remember that LBHR targets the symptoms, not the underlying hormonal imbalance. Combining this treatment with lifestyle changes and, in some cases, medications like anti-androgens can create a more comprehensive approach to managing hirsutism (Narang et al., 2018).

As a student dermal clinician, I believe it is crucial for service providers to be as transparent as possible. While LBHR is an excellent treatment for addressing the rate of hair growth, length, and density, it is not a simple fix. It becomes even more complex with how LBHR is marketed as “permanent removal” when it is, in fact, “permanent reduction.” This requires a multidisciplinary approach, which can be a lengthy process. Providers must understand when a client needs this comprehensive approach and when to refer patients for aspects of a condition that may be outside our scope of practice.

Unfortunately, patients are often taken in without understanding the complexity of their condition and are not encouraged to seek medical advice regarding their hormonal levels. It’s essential for providers to discuss all aspects of PCOS instead of offering LBHR as a mere band-aid solution.

In future posts, we’ll delve deeper into these treatment options, discussing their benefits and limitations while emphasising the importance of a tailored approach for each individual.

Luciana ᥫ᭡

References

Mihailidis, J., Dermesropian, R., Taxel, P., Luthra, P., & Grant-Kels, J. M. (2015). Endocrine evaluation of hirsutism. International Journal of Women's Dermatology, 1(2), 90-94. https://doi.org/10.1016/j.ijwd.2015.04.003

Narang, G. S., Jasleen, J., Kaur, J., & Kaur, T. (2018). Cutis vertices gyrate: A case report. International Journal of Contemporary Pediatrics, 5(4), 1693. https://doi.org/10.18203/2349-3291.ijcp20182592

Rizvi, M., Islam, M. A., Aftab, M. T., Naqvi, A. A., Jahangir, A., Ishaqui, A. A., Iqbal, M. Z., & Iqbal, M. S. (2023). Knowledge, attitude, and perceptions about polycystic ovarian syndrome, and its determinants among Pakistani undergraduate students. PLOS ONE, 18(5), e0285284. https://doi.org/10.1371/journal.pone.0285284

Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome (PCOS): The hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Reviews, 37(5), 467-520. https://doi.org/10.1210/er.2015-1104

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