Excess hair growth on the face or body affects around 7 in 10 women with PCOS and comes from too many male hormones (androgens). This excess hair in a male pattern is called hirsutism. It is one of the clearest visible signs of PCOS, and often one of the most distressing.
I notice that hirsutism has a big impact, while it is rarely talked about. Women often remove hair for years without knowing the cause. Below you read what hirsutism is, why it arises, which hormones say something about it and what you can do.
What exactly is hirsutism?
Hirsutism is excess, dark and coarser hair growth in places where women normally have little hair. Think of the upper lip, chin, jawline, chest, belly or back. It differs from the fine vellus hairs everyone has.
So it is about a pattern that resembles male hair growth, in typical androgen-sensitive places.
Common places in hirsutism:
- Upper lip and chin
- Jawline and neck
- Chest and around the nipples
- Lower belly and back
Why does PCOS cause excess hair?
In PCOS the body often makes more androgens, including testosterone. Those androgens stimulate the hair follicles in androgen-sensitive places, so fine vellus hairs turn into coarser, dark hairs. That creates the male growth pattern.
An extra factor is SHBG, the protein that binds testosterone in the blood. In PCOS the SHBG is often low, partly due to insulin resistance. A low SHBG makes more testosterone freely available, which increases the stimulation of the hair follicles.
Sometimes part of the androgens does not come from the ovaries, but from the adrenal glands. You see that in DHEA-S. So in hirsutism you look at more than testosterone alone.
Which hormones do you test for excess hair?
No single hormone explains hirsutism on its own, but four values together give a good picture of where the androgens come from. You look at total testosterone, free testosterone, SHBG and DHEA-S. Together they show how many androgens there are and from which source.
| What you want to know | Value that gives insight | What it shows |
|---|---|---|
| The total amount of androgens | Total testosterone | The sum of bound and free testosterone |
| How much testosterone is active | Free testosterone | The part that actually acts on the hair follicles |
| Why complaints despite normal total | SHBG | A low SHBG makes more testosterone freely available |
| Whether the adrenals play a part | DHEA-S | Points to a share of androgens from the adrenal glands |
The Hormones Women panel measures these values in one draw, so you get the whole androgen pattern in view. Our separate article goes deeper into which hormones to test for PCOS and when to test best.
When is excess hair a signal to test?
A few fine hairs are normal for many women and no reason for concern. It gets more interesting if the hair growth increases quickly, becomes coarser, or goes together with other PCOS signs. Then a hormone check can give insight into the cause.
Consider a test if you recognise this:
- The hair growth has clearly increased in a short time
- Alongside excess hair you have an irregular cycle or acne
- You also notice thinning scalp hair
- The complaints fit a broader PCOS picture
A fast or severe increase should always be discussed with a doctor, because there is sometimes another cause behind it. Do you notice hair loss on your head alongside excess hair? Then also read which hormones to test for hair loss.
What can you do about hirsutism?
In many women hirsutism responds well, though it takes patience. The approach focuses on two things: the underlying hormones and the visible hair growth itself. Which combination fits depends on your complaints and your wishes.
Possible steps, in consultation with a doctor:
- Improving your insulin sensitivity through lifestyle, which can raise the SHBG
- Medication that curbs the androgens or their effect, prescribed by a doctor
- Hair removal methods such as laser or electrolysis for the visible hairs
Improvement happens gradually, because a hair cycle lasts months. Have the patience to wait several months for an effect. For the whole picture around PCOS, read our PCOS pillar on symptoms, causes and diagnosis.
Frequently asked questions
Does excess hair always mean PCOS?
No. Hirsutism has several causes and does not always belong to PCOS. Combined with an irregular cycle or acne, it can be a signal that makes a hormone check worthwhile.
Can my testosterone be normal while I still have excess hair?
Yes, that is possible. With a low SHBG there is more free testosterone available, even if the total testosterone looks normal. So alongside total testosterone you also look at free testosterone and SHBG.
How long does it take before treatment works?
Improvement happens gradually, because a hair cycle lasts months. Expect several months before you notice an effect. What suits you is something you discuss with your GP.
References
- Teede HJ, Tay CT, Laven J, et al. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University, ESHRE and ASRM, 2023.
- Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;31(12):2841-2855. PMID: 27664216.
- NHG and Thuisarts.nl. Excess hair growth (hirsutism) and PCOS. Dutch College of General Practitioners. Available via thuisarts.nl.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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