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Health condition · Clinically reviewed

Hirsutism, hormonal roots, cosmetic options and the anti-androgens that work.

Male-pattern hair growth in women is common, often driven by polycystic ovary syndrome, and treatable with a considered mix of hormonal medication, laser and topical care.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against Endocrine Society, NICE and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including combined hormonal, anti-androgen and laser approaches.

Key facts

Hirsutism at a glance.

The essentials, in plain English - what it is, what it is not, and how modern UK care approaches it.

  • What it is

    Excessive terminal hair in a male-pattern distribution in women - face, chin, upper lip, chest, back, abdomen and thighs.

  • Not the same as

    Hypertrichosis is androgen-independent generalised hair growth - a different condition with different causes and treatments.

  • How it is scored

    The modified Ferriman-Gallwey score rates nine body sites; a total of 8 or more is significant in most UK populations.

  • Most common cause

    Polycystic ovary syndrome accounts for up to 80% of hirsutism seen in clinic - see our guide to female fertility assessment.

  • Rare but important

    Rapid onset with virilisation - deep voice, clitoromegaly, temporal hair loss - needs urgent endocrinology to rule out an androgen-secreting tumour.

  • Treatment mix

    Lifestyle, cosmetic hair removal, hormonal medication and, where appropriate, anti-androgens - usually combined and given time to work.

Why this guide matters

A hormonal condition with a cosmetic face.

Hair growth is what patients notice; androgens are what drive it. Treating both together works far better than treating either alone.

  • Find the driver

    PCOS is by far the commonest cause - but drug review, adrenal screening and, rarely, tumour work-up all matter.

  • Treat the hormone, treat the hair

    Combine a hormonal or anti-androgen approach with laser or IPL - the two together give the most reliable long-term result.

  • Do not miss the red flags

    Rapid onset with virilisation or markedly raised androgens deserves urgent endocrinology - not another cosmetic session.

How the diagnosis is made

From first appointment to a settled plan.

The steps a UK GP, endocrinologist or dermatologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and drug review

    Age of onset, cycle pattern, weight change, family history and a careful look at any drugs - androgens, phenytoin, minoxidil and ciclosporin can all drive hair growth.

  2. 02

    Assessing

    Score the pattern

    A modified Ferriman-Gallwey score gives a shared reference point for severity and for tracking response to treatment.

  3. 03

    Assessing

    Look for virilisation

    Deep voice, clitoromegaly, temporal balding, breast atrophy and rapid onset are red flags for a significant androgen source.

  4. 04

    Confirming

    Androgen and metabolic bloods

    Free and total testosterone, SHBG, DHEA-S, 17-hydroxyprogesterone, fasting glucose, HbA1c, insulin, TSH and prolactin - guided by specialist endocrinology.

  5. 05

    Confirming

    Pelvic ultrasound

    A transvaginal ultrasound scan looks for the polycystic ovary morphology and rules out an ovarian mass.

  6. 06

    Confirming

    Adrenal imaging where indicated

    When adrenal androgens are markedly raised, a private MRI scan or CT of the adrenals is arranged through endocrinology.

  7. 07

    Planning

    Plan with the right specialist

    A settled plan usually involves endocrinology and dermatology, and gynaecology if fertility or menstrual issues sit alongside.

Typical timeline: a first visit to a settled plan within weeks, once bloods and imaging are complete.

Symptoms

What hirsutism actually looks like.

The classic mix of coarse terminal hair in a male-pattern distribution - plus the metabolic and menstrual signals that often travel with it.

  • Coarse dark facial hair

    Chin, upper lip and jawline - the most visible sites and the ones most patients present with.

  • Chest and abdominal hair

    A midline strip from the umbilicus, hair between and around the breasts, and lower abdominal growth.

  • Back and shoulder hair

    Upper back, shoulders and sacrum - often the last areas to respond to treatment.

  • Thigh and buttock hair

    Inner thigh and buttock hair growth in a pattern more typical of male distribution.

  • Acne and oily skin

    Androgen excess drives sebum - see our acne guide - so hirsutism and adult acne often travel together.

  • Menstrual irregularity

    Long or absent cycles point to polycystic ovary syndrome as an underlying driver.

  • Acanthosis nigricans

    Velvety dark skin at the neck and axillae suggests insulin resistance - a treatable factor.

  • Red flag - virilisation

    Deep voice, clitoromegaly, temporal balding or rapid onset - urgent endocrinology to exclude a tumour.

Treatment

How hirsutism is treated in the UK.

Lifestyle and cosmetic care first, hormonal contraception and anti-androgens for those who need more, and laser or IPL for lasting cosmetic reduction.

  • Lifestyle and weight

    Where insulin resistance and PCOS coexist, weight loss and specialist dietetics reduce androgen levels and hair growth over months.

  • Cosmetic hair removal

    Shaving, waxing, threading, depilation and electrolysis remain useful daily options and do not worsen hair growth.

  • Eflornithine cream

    Topical eflornithine (Vaniqa) slows facial hair growth - best combined with laser or IPL, not a stand-alone cure.

  • Laser and IPL

    Our laser hair removal clinic offers the most durable cosmetic reduction - skin phototype guides device choice and specialist input matters.

  • Combined hormonal contraceptive

    A pill containing drospirenone or cyproterone acetate lowers ovarian androgens and improves hirsutism over three to six months.

  • Spironolactone

    An anti-androgen used at 50 to 200 mg daily - contraception is essential due to teratogenicity risk in a male fetus.

  • Finasteride or flutamide

    Second-line anti-androgens under endocrinology or dermatology - counselling on teratogenicity and, for flutamide, hepatotoxicity is required.

  • Metformin and specialist care

    Metformin helps insulin resistance; corticosteroids are used in congenital adrenal hyperplasia; surgery is reserved for confirmed tumours.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or endocrinologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • Endocrine Society. Evaluation and treatment of hirsutism in premenopausal women (clinical practice guideline).

  • NICE Clinical Knowledge Summaries. Hirsutism.

  • British Association of Dermatologists. Patient information leaflets on hirsutism and hair growth.

  • MHRA. Cyproterone acetate: risk of meningioma - dose-related risk minimisation.

Red flags

When hirsutism needs urgent attention.

Most hirsutism is manageable in primary and secondary care. These are the situations where a specialist opinion should not be delayed.

  • Rapid onset over months

    Sudden coarse hair growth developing over weeks or months, rather than years - warrants urgent hormonal work-up.

  • Virilisation

    Deep voice, clitoromegaly, temporal hair loss or breast atrophy suggests a significant androgen source and needs same-week endocrinology.

  • Markedly raised androgens

    Total testosterone more than twice the upper limit, or a raised DHEA-S, prompts urgent imaging of the ovaries and adrenals.

  • Cushingoid features

    Central weight gain, purple striae, thin skin, easy bruising or proximal weakness alongside hirsutism - screen for Cushing syndrome.

  • Family history of CAH

    A relative with congenital adrenal hyperplasia raises the pre-test probability - specific 17-hydroxyprogesterone testing is indicated.

  • Drug-induced growth

    Any new hair growth after starting androgens, phenytoin, minoxidil or ciclosporin needs a medication review with the prescriber.

  • Anti-androgen therapy in pregnancy

    Spironolactone, finasteride and flutamide are teratogenic - two forms of contraception and counselling before starting are essential.

  • Persistent flutamide use

    Rare but serious hepatotoxicity has been reported - liver function monitoring under specialist care is mandatory.

  • Cyproterone dose and duration

    MHRA guidance restricts higher-dose cyproterone use because of a dose-related meningioma risk - a specialist conversation is needed.

Living with it

A treatable condition, with a long horizon.

Four things that make the biggest difference over the year that follows a diagnosis - patience, combined care, tracking and mental-health support.

A quiet reminder

Steady months, not miracle weeks.

Hair follicles respond slowly. The women who do best treat hirsutism as a year-long project, not a week-long fix.

  1. 01 Patience

    Give it six months

    Hormonal treatments and laser both take months to show their full effect - judge progress at six months, not six weeks.

  2. 02 Combine

    Combine mechanisms

    Hormonal medication, laser or IPL, and topical eflornithine complement each other - together they outperform any one alone.

  3. 03 Track

    Score and photograph

    Repeat the Ferriman-Gallwey score every three to six months and take standardised photos - progress can be steady but invisible day to day.

  4. 04 Support

    Ask for mental-health support

    Hirsutism carries a real psychological weight - talk to your team about counselling or peer support if it is affecting mood or confidence.

Frequently asked

Everything we get asked about hirsutism.

Quick answers on causes, scoring, laser, hormonal options and anti-androgens.

  • What is hirsutism?

    Hirsutism is excessive terminal hair growth in a male-pattern distribution in women, driven by androgens. It affects the face, chin, upper lip, chest, back, abdomen and thighs, and is scored using the modified Ferriman-Gallwey system with a total of 8 or more considered significant in most UK populations.

  • How is hirsutism different from hypertrichosis?

    Hirsutism is androgen-dependent and follows a male-pattern distribution. Hypertrichosis is generalised excess hair anywhere on the body, is not androgen-driven, and has a different set of causes including genetic conditions, some medications and, rarely, underlying malignancy. The treatment approaches differ, which is why the distinction matters.

  • Is hirsutism always caused by polycystic ovary syndrome?

    No, but PCOS is by far the most common driver and accounts for up to 80% of cases seen in clinic. Other causes include idiopathic hirsutism, congenital adrenal hyperplasia, Cushing syndrome, androgen-secreting tumours of the ovary or adrenal, some medications, hyperprolactinaemia and menopausal hormonal shifts.

  • When does hirsutism need urgent investigation?

    Rapid onset over weeks or months, alongside virilisation - deep voice, clitoromegaly, temporal balding or breast atrophy - or a markedly raised testosterone or DHEA-S needs urgent endocrinology and imaging to exclude an androgen-secreting tumour. These features are uncommon but important not to miss.

  • Does laser hair removal work for hirsutism?

    Yes - laser and IPL give the most durable cosmetic reduction and are usually combined with hormonal treatment for the underlying cause. Skin phototype guides device choice and specialist input helps get the best result while avoiding pigmentary side effects, particularly in darker skin.

  • Are anti-androgens safe long-term?

    Spironolactone is generally well tolerated at doses used for hirsutism, but reliable contraception is essential because of the risk of feminising a male fetus. Cyproterone acetate has an MHRA-flagged dose-related meningioma risk, and flutamide requires liver-function monitoring. These are specialist prescriptions with clear counselling.

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