Facial hair in women is common, and the amount varies significantly from person to person. All women have facial hair, despite societal expectations suggesting a completely smooth face. Understanding the difference between normal hair growth and medically excessive growth is important. This article clarifies what constitutes typical facial hair and explains when growth may warrant attention from a healthcare professional.
The Spectrum of Normal: Understanding Hair Types and Distribution
The human body, including the face, is covered in two primary types of hair. The first is vellus hair, often called “peach fuzz,” characterized by its fine, soft, and light-colored appearance. Vellus hair is short, typically less than two millimeters long, and is present across the majority of the body. This type of hair is normal for all women and is usually barely noticeable.
The second type is terminal hair, which is thicker, coarser, longer, and generally darker, like the hair on your scalp or eyebrows. A small amount of terminal hair on the upper lip or chin can be a normal variation, influenced by several non-hormonal factors. Genetics play a substantial role; if a woman’s family members have more visible terminal hair, she is likely to exhibit this trait.
Ethnicity is another significant factor in natural hair distribution. Women of Mediterranean, South Asian, or Middle Eastern descent often have a higher incidence of more visible terminal hair due to inherited patterns. Age also affects hair growth, particularly during perimenopause and post-menopause. The natural decrease in estrogen relative to androgen hormones during this life stage can cause existing vellus hairs to convert into darker, coarser terminal hairs.
Identifying Hirsutism
Hirsutism is a medical term describing the excessive growth of dark, coarse terminal hair in a male-like pattern. This growth occurs in areas highly sensitive to androgens (male hormones), such as the upper lip, chin, chest, back, and lower abdomen. Hirsutism specifically involves the conversion of fine vellus hair to thick terminal hair in these locations.
To objectively measure and grade the severity of hirsutism, healthcare providers use the Modified Ferriman-Gallwey (FG) scale. This standardized tool assesses hair growth across nine androgen-sensitive body areas. It assigns a score from 0 (no terminal hair) to 4 (extensive terminal hair) for each region. The total score ranges from 0 to 36, and a score of 8 or higher is generally considered a clinical sign of hirsutism.
The FG score helps doctors distinguish between a normal, genetic pattern of hair growth and a pattern suggesting an underlying hormonal imbalance. This quantitative method determines when hair growth moves beyond normal variation and requires medical investigation.
Underlying Causes of Excessive Facial Hair
The development of hirsutism is linked to increased androgen levels or increased hair follicle sensitivity to normal androgen levels. Androgens, like testosterone, are present in all women but at lower concentrations than in men. When these levels are elevated or receptors are responsive, vellus hairs are stimulated to grow into terminal hairs.
Polycystic Ovary Syndrome (PCOS) is the most common cause of hirsutism, accounting for over 70% of cases. In women with PCOS, the ovaries produce excessive androgens, often driven by high insulin levels due to insulin resistance. This hormonal environment leads to hirsutism, frequently accompanied by irregular menstrual cycles, acne, and weight gain.
Other, less frequent causes involve hormonal disruption. Non-classical Congenital Adrenal Hyperplasia (CAH) is a genetic condition where the adrenal glands lack an enzyme, shunting hormone precursors into the androgen pathway. Cushing’s Syndrome, resulting from prolonged exposure to high cortisol levels, can also disrupt androgen production and lead to hirsutism.
Hirsutism can also be a side effect of certain medications, such as testosterone-containing products or anabolic steroids. In rare cases, a rapidly increasing FG score accompanied by signs of virilization (like a deepening voice or increased muscle mass) can signal a rare androgen-secreting tumor. This requires prompt medical evaluation.
Managing and Addressing Unwanted Hair Growth
Management strategies for unwanted facial hair fall into two broad categories: cosmetic hair removal and medical treatment. Cosmetic options offer immediate but temporary removal of existing hair. These methods include shaving, which is safe and simple, waxing, plucking, and depilatory creams, all requiring frequent repetition.
For longer-lasting results, women may choose professional treatments like laser hair removal or electrolysis. Laser treatment targets the pigment in the hair follicle to reduce growth. Electrolysis destroys the hair follicle with an electric current for permanent removal. A prescription topical cream, eflornithine, is also available, working by slowing the rate of hair growth.
When hirsutism is caused by an underlying condition like PCOS, medical treatment addresses the root cause and prevents new hair growth. First-line pharmacological treatments are typically combined oral contraceptives (OCs), which suppress ovarian androgen production and reduce active testosterone. Anti-androgen medications like spironolactone may be added to block the effect of androgens at the hair follicle. Patients should be aware that medical therapy is slow-acting, requiring at least six to twelve months of consistent use before significant reduction in hair growth is visible.