It should come as no surprise to the many women affected by excessive facial hair growth that the unwanted hair is only one part of the challenge. Dealing with Unwanted Facial Hair (UFH) can involve much more than simply the efforts to remove the hair. UFH can be emotionally distressing for some women. In fact, in a recent survey, the vast majority of UFH sufferers surveyed (91%) agreed that UFH can have a negative effect on someone's quality of life. Many women with UFH feel extremely self-conscious about having UFH and are even uncomfortable discussing it with others including their own family doctor or other healthcare professional.

Your dermatologist and family physician will appreciate if you are open and honest about how you feel, not only physically, but emotionally, socially and psychologically. He or she will be able to confirm what you have is a common condition and that you are not alone. Most importantly, they will be able to help you to understand that your feelings are in fact valid. Studies report the anxiety and depression associated with excessive facial hair can affect quality of life in much the same way as a diagnosis of gynecological or breast cancer. Taking steps to treat UFH has been shown to help restore confidence and contribute to the overall well-being of those who are affected by it. Speak up: take charge of your overall health by addressing the issues, like UFH, that affect your day-to-day happiness. You are your best health advocate.

Preparing a list of questions will help you make the most of your time with your doctor. For Unwanted Facial Hair (UFH), some basic questions to ask your doctor include: 

• What is likely causing my symptoms or condition?
• What are other possible causes? 
• Is it normal that my UFH is impacting my self-confidence and overall happiness? 
• What kinds of diagnostic tests do I need?
• What are my treatment options? 
• If the first treatment I try isn't effective, what will we try next? 
• How much will treatment improve my physical signs and symptoms? 
• Will I need to be treated long term? 
• What are the possible side effects of the medications you're recommending? 
• Will the medications you're recommending affect my ability to have children? 
• How will you monitor my response to treatment over time? 
• Are there alternatives to the primary approach you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions I need to follow?
• Should I see a specialist? 
• Are there brochures or other printed material that I can take home with me? What websites do you recommend?

Don't hesitate to ask your doctor any other questions you have about your condition.   

The amount of body hair you have is largely determined by your genetic makeup and varies widely among women. Usually, a woman will only grow fine hair (peach fuzz) on her lips, chin, chest, abdomen, or back. However, when women grow coarse, dark hairs in these areas, typical of male hair growth, this is a sign of a common yet frustrating condition called hirsutism (HER-soot-iz-um).

While hirsutism can present itself in many areas of the body, this information guide focuses specifically in equipping women with the knowledge to tackle hirsutism on the face or neck also known as unwanted Facial Hair (UFH).

UFH is a medical condition that causes too much hair to grow on a woman’s face and neck. It typically begins to develop during puberty, however, an inherited tendency, hormonal imbalance, or various medications can cause it to appear at any age. Sometimes, the cause remains unknown (idiopathic hirsutism). Regardless of the cause, excess hair, especially on the face, can be a source of great distress for most women, leading to anxiety, depression and reduced quality of life.

There are, however, various strategies to help you effectively manage your UFH. Once a medical diagnosis of UFH is made, you and your physician can explore the treatment options available to you. It is, however, important your physician first rule out any underlying medical conditions.

What are the causes of unwanted facial hair?

Unwanted Facial Hair (UFH) growth in women can be caused by a number of issues. Most commonly, these issues are related to either a hormonal imbalance or the impact of various medications. Sometimes, however, the cause remains unknown (idiopathic hirsutism).

Hormonal Imbalance

All women normally produce low levels of male hormones (androgens). Unwanted Facial Hair (UFH) growth in women may occur when the body makes too much male hormone. Conditions that can cause high androgen levels include:

Polycystic Ovary Syndrome (POS)

POS is one of the most common identifiable causes of hirsutism.  This condition is caused by an imbalance of sex hormone levels in a woman’s body that may result in irregular periods, acne, obesity, infertility and sometimes multiple cysts on the ovaries.

Cushing’s Syndrome

This is a condition that occurs when your body is exposed to high levels of the hormone cortisol, a steroid hormone involved in your body’s response to stress. It can develop when your adrenal glands – small hormone secreting glands located just above your kidneys – make too much cortisol, or it can occur from taking cortisol-like medications over a long period of time.

Increased cortisol levels disrupt the balance of sex hormones in your body,  which can result in UFH.

Congenital adrenal hyperplasia

This inherited condition is characterized by abnormal production of steroid hormones, including cortisol and androgen, by your adrenal glands.

Menopause

As hormone levels, and even weight, change during and after menopause, some women may find they develop UFH.

Other rare conditions

Rarely, tumours in the ovaries or adrenal gland, formed when abnormal cells grow out of control and clump together may cause UFH.

Medication

Some medications can cause UFH. These medicines include hormones, anabolic steroids and some immunosuppressive drugs.

Idiopathic

Sometimes, there is just no identifiable cause. Excessive facial hair growth in women with normal androgen levels, regular menstrual periods and no other underlying conditions is called idiopathic hirsutism. This occurs more frequently in certain ethnic populations, such as women of Mediterranean, Middle Eastern and South Asian ancestry.

Remember that before starting any treatment regime it is important to first rule out any underlying medical condition. If you are experiencing a rapid increase or sudden onset of facial hair growth, and signs of increased male characteristics, make sure to first see your physician.

Prevention

While Unwanted Facial Hair (UFH) generally isn't preventable and tends to be a long-term issue, a logical starting point is to determine if there are ways to control it. If you are overweight, losing weight will be key to reducing the amount of hormones in your body that are associated with increased facial hair growth.

Treatment

There are numerous ways to remove or treat UFH. Available options can vary in effectiveness, degree of discomfort and cost. Treatment for UFH most often involves a combination of hair removal methods and medications. Therefore, a solid understanding of the various pros and cons of each treatment is a worthwhile exercise as part of your decision-making process. This guide will provide you with an overview of the various treatments available by grouping them into the following categories:

1. Hair Removal Methods

2. Prescription Therapy 

Hair removal methods to deal with Unwanted Facial Hair (UFH) include depilatories, which remove hair above the surface of the skin and epilatories, which remove the entire hair including the part below the skin. Here are some examples:

Depilatories:

• Shaving. Shaving is quick and inexpensive, but it needs to be repeated regularly since it removes the hair only down to the surface of your skin.
• Chemical depilatories. Generally available as gels, lotions or creams that you spread on your face, chemical depilatories work by breaking down the protein structure of the hair shaft. Some people are allergic to the chemicals used in depilatories. 
• Bleaching. Instead of removing UFH, some women use bleaching agents. Bleaching removes the hair colour, making the hair less visible against some skin tones but potentially more noticeable on darker skin. Bleaching may cause skin irritation, so test the bleach on a small area first.

Epilatories:

• Plucking. Also referred to as tweezing, plucking is a good method to remove a few stray hairs, but is not useful for removing a large area of hair. While plucking may hurt a little and doesn't last forever, it is the most common method women use to get rid of UFH.
• Waxing. Waxing involves applying warm wax on your skin where the unwanted hair grows. Once the wax hardens, it's pulled back from your skin against the direction of hair growth, removing hair. Waxing may sting temporarily and sometimes causes skin irritation and redness. Results usually last a few weeks.
• Threading. This is an ancient method of hair removal originating in the Eastern world. Practitioners use a pure, thin, twisted cotton thread which they roll over areas of unwanted hair, plucking the hair at the follicle level. Unlike tweezing, where single hairs are pulled out one at a time, threading can remove an entire row of hair, resulting in a straighter line. As a larger area of hair is removed at once, however, it can be relatively painful.
• Sugaring. This is used in much the same way as traditional waxing for removing UFH although the ingredients used are few in number and all-natural, typically consisting of sugar, lemon and water. Proponents of sugaring say that it can be done more frequently than waxing with the same benefits and that it causes less skin irritation, among other benefits. 
• Home electrolysis. These tools work by applying an electric current through a pair of tweezers. They are good for small areas, and are quick but can be painful. Results may last for many weeks or months. These kits can be costly and may produce skin discoloration.

Other facial hair removal treatments can offer numerous advantages and, although they tend to be expensive, their popularity has made them more widely available with many estheticians and spas. The risk is that the level of expertise and competence of the practitioner is sometimes questionable. Not all laser treatments need to be performed by a doctor but it is advisable that the treatment be administered in a facility when there is a doctor present on-site to supervise the therapy and to ensure that any adverse effects are properly dealt with. The most common facial hair removal therapies include:

• Electrolysis.  This type of therapy involves inserting a tiny needle into each hair follicle and emitting a pulse of electric current to damage and eventually destroy the follicle. Electrolysis results in permanent hair removal, but the procedure can be painful. Some numbing creams may be spread on your skin to reduce this discomfort. Side effects include lightening or darkening of the treated skin and, rarely, scarring. As one hair is treated at a time it is a very slow process that requires many repeat treatments. It is best used for small areas. 
• Laser Therapy.  Laser therapy is a procedure in which a beam of highly concentrated light (laser) is passed over your skin to disable the hair follicles and prevent hair from growing. With laser, there is permanent hair reduction and in some cases permanent removal. Lasers work best for those with fair skin and dark hair. Individual sessions can last from a few minutes to a few hours, depending on the size of the area being treated. Hair on the upper lip and particularly on the chin may need many treatments as they are in very hormone sensitive parts of the skin.  However, a treatment for the upper lip takes only about a minute. After treatment, some people experience long periods without hair re-growth, while others may need occasional touch-ups to remain hair-free. In between treatments, the hair is trimmed or shaved as the melanin target, which is the hair root, has to be present for the laser light to be absorbed. Laser therapy can be uncomfortable, it may cause redness and swelling and can, in rare cases, cause burns or colour changes in your skin.  This can be minimized by not treating the skin if it is tanned. While the cost of laser treatment can be high, it may in many instances be more cost-effective due to the longer-term benefits. The most important thing is that the correct laser is used in the right situation and at the appropriate power setting. Make sure to do your research and select a facility with a great reputation and experienced staff.

Prescription Therapy

Two classes of prescription therapies, used to treat hormonal issues, are also used to help manage Unwanted Facial Hair (UFH). The first are hormone blockers, which are drugs that inhibit androgens (male hormones) from working on hair growth. The second are growth inhibitors, which are drugs that block enzymes in the hair itself to inhibit growth.

Hormone Blockers

• Oral contraceptives. Birth control pills, or other hormonal contraceptives, containing the hormones estrogen and progestin, treat UFH by inhibiting androgen production by your ovaries. Oral contraceptives are a common treatment for UFH in women who don't want to become pregnant. Possible side effects include dizziness, nausea, headache, and stomach upset.
• Anti-androgens. These types of drugs block androgens from attaching to their receptors in your body. The most commonly used anti-androgen for treating UFH is spironolactone. Anti-androgens usually take at least three to six months to work. They can decrease the amount of new hair growth, but they are less likely to change the amount of hair you already have. Possible side effects include drowsiness, nausea, irregular menstrual periods, electrolyte disturbances and diarrhea. Because these drugs can cause birth defects, it's important to use good contraception while taking them. Do not take this drug if you think you are or may become pregnant.
• Anti-diabetic. Metformin, a drug normally used in the treatment of diabetes, has in recent years shown to be beneficial in women with polycystic ovarian syndrome, a key cause of UFH.

Growth Inhibitors

• Eflornithine hydrochloride. A topical cream which is applied to the skin, called eflornithine hydrochloride, is the first topical prescription medication that has been approved by Health Canada specifically for slowing the growth of UFH in women. It is indicated for use along with other hair removal techniques. Eflornithine hydrochloride is not a depilatory and does not permanently remove hair or "cure" UFH. What it does is reduce or slow down the hair growth to improve the condition. It is applied twice a day to the area to be treated and, when combined with other hair removal techniques, such as the ones described above, enhances the overall effectiveness of other treatment types.  

The major sign of Unwanted Facial Hair (UFH) is thick, dark hair appearing on a woman’s face. This hair is typically coarse and pigmented and is different from the hair that some women have on their upper lip, chin, breasts or stomach, or the fine ‘baby’ hair all over their body.

While stray hairs on your face and neck may be not a cause for concern, your doctor can help you understand when UFH is a result of an underlying medical condition.

It is important to pay attention to the development of other signs and symptoms in addition to UFH. Here are a few simple questions that may help you determine whether you are experiencing symptoms that require you to seek medical advice.

 
Answer ‘yes’ or ‘no’ to the following questions:

• Do you notice rapidly growing, unwanted hair on places such as your upper lip, cheeks, chin, neck, mid-chest, inner thighs, abdomen, or low back?

• Do you notice unwanted hair growth associated with irregular menstrual periods?

• Are you experiencing hot flashes?

• Do you notice an increase in the amount of acne on your face or body?

• Do you suspect there are physical issues affecting your fertility or limiting your ability to conceive?

• Do you notice any unwanted hair growth that appears to be worsened from a medication?

 
If you answered ‘yes’ to any of the above questions, make sure to see your healthcare professional to discuss your symptoms so that you can be properly diagnosed, rule out any other underlying medical conditions, and help you to decide the best treatment approach for you.

A number of healthcare professionals may be involved in the diagnosis, treatment and management of Unwanted Facial Hair (UFH), including:
• General practitioners/family doctor
• Dermatologists
• Gynecologists
• Endocrinologists

In order for your doctor to make a diagnosis of UFH you will first need to discuss your medical history. Your doctor may ask you about your menstrual cycles, the time of onset of your symptoms, whether you're taking any medications and whether you have a family history of certain conditions. Your doctor is likely to:  

1. Perform a physical exam.  Your doctor will examine your face. He or she may also conduct a physical examination to check for other signs of androgen excess and for conditions that can result in a hormonal imbalance.
2. Order blood tests.  Tests that measure the amount of certain hormones in your blood, including testosterone, may help determine whether your UFH is caused by elevated androgen levels.
3.  Further testing.  The extent of further testing you'll undergo depends on the severity of your UFH and any other associated symptoms. If androgen levels in your blood are elevated, you may undergo imaging tests. These may include:
• Ultrasound. This imaging test uses high-frequency sound waves to produce pictures of your body's internal structures. An ultrasound of the ovaries or adrenal glands may be performed to check for tumours or cysts.
• Computerized tomography (CT) scan. A CT scan is a type of X-ray test that provides cross-sectional images of your internal organs. A CT scan of your body may be used to evaluate the adrenal glands.