Hairy body or face - Treating hirsutism

Hirsutism can't be cured, but there are treatments to help control the condition. 

There are a number of things you can do yourself that may help. If you are overweight, losing weight can reduce the production of androgens. Check your body mass index (BMI) using our BMI healthy weight calculator.

Hair removal and treatment

There are a number of ways to remove or disguise excess hair. As these are considered "cosmetic" treatments to improve your physical appearance, they are unlikely to be available on the NHS.

Shaving – quick and easy, and will not make the hair grow back quicker or thicker. However, you may find you have to shave everyday, which may cause irritation. There may also be unpleasant stubble growth between shaves.

Bleaching – can make dark hair look better in the short term, but may irritate your skin and is not effective for everyone.

Waxing, plucking or threading – can reduce regrowth if done regularly, but can be painful and may cause scarring or folliculitis (inflammation of a hair follicle).

Electrolysis – when electricity is used to destroy hair cells and remove hair permanently. However, it takes many treatments over a long time; it can also be painful and may cause scarring or changes to your skin colour (check the electrologist is accredited through the British Institute & Association of Electrolysis).

Laser hair removal – involves powerful beams of light (lasers), which destroy the hair. It can last several months and is more effective on women with pale skin and dark hair.  

Your GP can discuss the different methods with you in more detail. The method that you choose will depend on:

• what works for you – if your skin becomes irritated because of one of these hair-removal methods, it can be itchy, look unpleasant and make regrowth worse
• what you can afford – electrolysis and laser hair removal may only be available in specialist clinics

If your hirsutism is mild, hair removal methods may be all the treatment you need. However, if the hirsutism is affecting your quality of life, you may require further treatment, such as medication.

Oral contraceptives  

If your hirsutism requires further treatment, you may be prescribed contraceptive pills. These are only suitable if you have not yet started the menopause (when a woman’s periods stop).

You may be prescribed either:

• a combined oral contraceptive
• co-cyprindiol

Both of these may take at least six months to work. This is because hairs that have already grown live for around six months anyway.

Combined oral contraceptive

Combined contraceptive pills that contain drospirenone, such as Yasmin, suppress androgens (male sex hormones). This means they can be used to treat hirsutism. Drospirenone is anti-androgenic, which means it prevents the androgens from working, thereby preventing excess hair growth.

Combined oral contraceptive pills are usually the first choice of treatment in premenopausal women, and are particularly useful if long-term treatment is necessary.

Co-cyprindiol

Co-cyprindiol (Dianette) contains ingredients that make it anti-androgenic (prevents the androgens from working).

It is used to treat both acne and hirsutism. It was initially used as a contraceptive, and you won't need to take another contraceptive method if you start taking co-cyprindiol for hirsutism.

Once the medication has treated your hirsutism, you should stop taking co-cyprindiol after three or four more 28-day cycles. This is because the risk of venous thromboembolism (a blood clot) is higher if you are taking co-cyprindiol than with other types of oral contraceptives.

Co-cyprindiol will not be suitable if you or anyone in your close family has a history of blood clots.

If your hirsutism returns after you stop taking co-cyprindiol, your GP may recommend starting treatment with it again. Alternatively, you can try changing to a combined contraceptive pill.

Side effects

Both combined contraceptive pills and co-cyprindiol can cause side effects, including:

• changes in body weight
• breast tenderness
• mood changes – such as irritability or a low mood
• feeling sick
• vomiting
• headache

Eflornithine

Eflornithine is an alternative medication that can be prescribed to both premenopausal women and menopausal women (women who have started the menopause). You may be prescribed eflornithine if:

• you have mild excess hair growth on your face
• hair-removal treatments alone are not effective
• contraceptive pills are either not suitable for you or have not worked

Eflornithine is a cream that can be applied thinly to your face twice a day to slow hair growth.

It should be thoroughly rubbed in and you can wear make-up on top if you wish. However, you should not wash your face for at least four hours after applying the cream. 

Eflornithine acts on your hair follicles (the small hole in your skin that an individual hair grows out of) to prevent hair growth. You should notice an effect within six to eight weeks. If no benefit is seen after four months, treatment will be stopped.

If eflornithine works you will need to continue using it, as hair growth will return around eight weeks after you stop using it.

Eflornithine is not suitable if you are pregnant or breastfeeding.

Side effects

Eflornithine can cause side effects, including:

• a burning or stinging sensation when you apply the cream 
• acne

Referral

Your GP may refer you for further treatment with a specialist, such as an endocrinologist (a specialist in hormone conditions), if:

• treatment has not worked after 6 to 12 months
• the hair growth gets worse despite treatment 

If your GP suspects an underlying cause for your condition (see causes of hirsutism), they may also refer you to a specialist. For example:

• A high level of testosterone in your blood or hirsutism that comes on quickly may indicate a tumour (growth) – your GP may therefore refer you to an oncologist, a doctor who specialises in treating tumours.
• Sudden weight gain around your face may be a sign of Cushing’s syndrome, a rare hormonal disorder – your GP may then refer you to an endocrinologist.

Further treatment

There are several other medications used to treat hirsutism. However, because many are unlicensed for the treatment of hirsutism, they will only be prescribed by a specialist, not your GP.

Unlicensed medication means manufacturers of the medications have not applied for a licence for it to be used in treating hirsutism. In other words, the medication has not undergone clinical trials (research that tests one treatment against another) to see if it is effective and safe in the treatment of hirsutism.

Many specialists will use an unlicensed medication if they think it is likely to be effective, and benefits of treatment outweigh any associated risk. If your specialist is considering prescribing an unlicensed medication, they should tell you it is unlicensed, and should discuss possible risks and benefits with you.

Some possible alternative medications are explained below.

Anti-androgens

Anti-androgens are medications that suppress androgens. This means they prevent androgens from working, which prevents excess hair growth. Possible types of anti-androgens include:

• cyproterone acetate
• spironolactone

Some of these may be prescribed in combination with contraceptive pills (see above).

One review of a number of different studies found weak evidence to suggest that anti-androgens are effective for treating hirsutism. The review also suggested anti-androgens may work best when combined with other medication, such as contraceptive pills.

Side effects were not reported in the studies that this review looked at.

Finasteride

Finasteride is a type of medication known as a 5-alpha-reductase inhibitor. It works by preventing testosterone (an androgen) from turning into a stronger form of testosterone inside your body’s cells. Finasteride is normally used in men to treat an enlarged prostate gland (a small gland, found only in men, located in the pelvis). 

When finasteride is taken for its usual purpose (to treat men) it can cause side effects, such as:

• lip and facial swelling
• itchiness
• rash
• loss of libido (sex drive)
• breast tenderness 

Few side effects have been reported when finasteride is used in women, so the above may not apply.

Insulin-sensitising medication

Insulin-sensitising medication makes your body more sensitive to insulin. Insulin is a hormone produced by the pancreas, which is a gland located behind the stomach.

A high amount of insulin in the blood (hyperinsulinaemia) is thought to play a role in causing hirsutism. Because insulin-sensitising medication makes your body more responsive to insulin, your body does not need as much insulin, so produces less of it. The level of insulin in your blood should therefore fall, and your hirsutism may improve.

Possible insulin-sensitising mediations include:

• metformin
• pioglitazone
• rosiglitazone

So far, there is only limited research into the benefits of insulin-sensitising medication for hirsutism. Some research found a small benefit, while some suggested that insulin-sensitising medication is no better than alternative medications already available. Conclusions may change in future if more long-term studies are carried out. 

Gonadotrophin-releasing hormone (GnRH) analogues

Gonadotrophin-releasing hormone (GnRH) analogues are synthetic (man-made) hormones. They are used to treat hormone-related conditions, such as endometriosis (a condition in which small pieces of the womb lining are found outside the womb).  

Possible GnRH analogues include:

• goserelin
• leuprorelin

These may causes side effects, such as:

• hot flushes
• sweating
• dryness or bleeding of the vagina 
• rashes
• itchiness

For a full list of side effects, see the patient information leaflet that comes with your medication.