How To Deal With Unwanted Hair

Illustrated by Mallory Heyer.
Many of us can attest to dealing with one embarrassing skin problem or another — from butt acne to razor bumps to unsightly scars and frustrating brown spots. One of the issues my patients regularly complain about is unwanted facial hair, which many women go to great, often painful lengths (electrolysis, laser hair removal) to remove.

Before you take any steps to get rid of your unwanted facial hair, first understand what kind of hair growth you're dealing with and why it's occurring.
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Types Of Unwanted Facial Hair
There are two medical terms for unwanted hair growth: hirsutism and hypertrichosis. Hirsutism refers to excess terminal (thick, coarse) hair growth in women that occurs in a male pattern. Hypertrichosis, on the other hand, refers to hair growth on any part of the body in excess of what would normally be present in individuals of the same age, race, or sex. Hypertrichosis can occur in both men and women, whereas hirsutism only occurs in women.

The root cause of hirsutism is abnormal androgen (male hormones) — either increased levels or an oversensitivity of the hair follicles to these hormones. In most cases, hirsutism is a primarily cosmetic concern, but there are more serious conditions that can result from it, such as Cushing syndrome or cancerous tumors, so it is imperative to get your concerns checked out by a professional.

If your hair growth is a result of hirutism, understanding the condition doesn't stop there; there are actually three types of hirsutism: endocrine-related, medication-related, and idiopathic.

Many of us have been led to believe that excess hair is not just unattractive but unacceptable.

Hirsutism
Endocrine-Related
Increased hormone levels characterize endocrine-related disorders that cause hirsutism. Polycystic ovarian syndrome (PCOS) is the most common and well-known of the endocrine disorders, but there are also enzyme defects, benign growths, and even cancers that can cause this excess hair growth. Because of these varied and potentially dangerous conditions, your doctor should evaluate any excessive hair growth.

Medication-Related

Medication-related hirsutism tends to be a result of medications that have androgenic effects, such as hormone treatments, some birth control pills, and steroids. I have seen a number of women who take certain birth control pills and experience hirsutism — and their hirsutism improved simply by switching to a less-androgenic pill.

Idiopathic

Finally, idiopathic hirsutism is hirsutism for which there is no known cause, although it may be associated with obesity and insulin resistance. It usually starts around puberty and is often familial. Individuals with idiopathic hirsutism tend to have normal hormone levels; therefore, increased hormone sensitivity may play a role.

Hypertrichosis
As mentioned above, hypertrichosis can occur in both men and women. Hair growth in hypertrichosis may be fine (vellus) hair or thicker, coarse hair. The age of onset of hypertrichosis varies. It may begin at birth or in a person's first few years, and it may be genetic.

Other forms of hypertrichosis that occur later in life may be hereditary, but there are medications and medical conditions (anorexia nervosa, some cancers) that can be linked to hypertrichosis. Unlike hirsutism, hypertrichosis is not hormone-driven. But like hirsutism, hypertrichosis should be evaluated immediately — especially if it's of recent onset.
Illustrated by Mallory Heyer.
Regardless of the cause, hairiness can cause significant psychological stress. In general, society considers excessive hair (on the face and body) a more masculine feature, and from a very early age we are bombarded with images of the ideal, beautiful, sexy woman with smooth skin. Many of us have been led to believe that excess hair is not just unattractive but unacceptable.

Treatment Options
You shouldn't be embarrassed by hair growth, on the face or otherwise. But if you are determined to get rid of it, there are number of treatment options available. You should, of course, first address any underlying conditions (for example, if a medication is a culprit, discontinue its use, if possible), but the good news is that we've become quite advanced with hair-removal procedures. You can choose from short-term solutions (depilatories, shaving, waxing, threading, dermaplaning, and more) or more long-term ones (electrolysis, laser hair removal).
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If you're reluctant to opt for a physical hair-removal procedure, you might consider an oral treatment; these are aimed at reducing androgenic hormone levels or actions. Commonly used oral treatment options include spironolactone and some birth control pills — for example, those that contain drospirenone (Yaz/Yasmin), desogestrel (Desogen), or norgestimate (Ortho-Tri-Cyclen) are all said to help eliminate hair growth. Finasteride, flutamide, and insulin-lowering medications have also been used to treat hirsutism. Vaniqa, a prescription cream, is a helpful adjunctive treatment that works by slowing down the hair growth cycle.

Hirsutism and hypertrichosis have a number of causes, some of which may be serious; therefore, a thorough evaluation is necessary. Luckily, most of the time the cause is not dangerous and the hair is primarily a cosmetic concern that can be reversed by addressing the underlying condition or with the treatments noted above. Because it is often cosmetic, there is also no shame in just leaving it.
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