PCOS Facial Hair: Symptoms, Causes And Treatment

According to the American Obstetricians and Gynecologists (ACOG), at least seven in ten women with PCOS experience excess hair growth, also known as hirsutism. Hirsutism is the excessive amount of sexual hair in a male pattern. This should not be confused with hypertrichosis which may also be seen with PCOS.¹

It is worth noting that facial hair growth is normal. However, in excess growth (hirsutism), facial hair growth in the androgen-sensitive areas, such as the mustache area, is a prominent sign of polycystic ovary syndrome (PCOS).

PCOS facial hair is a concern for most women. This article explains what causes it, its symptoms, and treatment options.

What is PCOS facial hair?

Polycystic ovary syndrome (PCOS) is the most common hormone problem in females of reproductive age. One of the common symptoms of PCOS is excessive growth of dark or coarse hair on the face, chest, or back in a male-like pattern. Therefore, in plain terms, PCOS facial hair is the excessive growth of facial hair.

Who does PCOS facial hair affect?

PCOS facial hair affects women. Women with PCOS can have excess facial hair growth caused by high androgen levels. High androgen levels can also, in rarer cases, cause hair loss and thinning hair from the scalp in women. 

How common is PCOS facial hair?

This condition affects about 70% of women with PCOS.²

How does PCOS facial hair affect my body?

PCOS facial hair doesn't affect your physical health. It can affect you psychosocially and psychologically. Some women with PCOS may experience emotional stress, depression, and anxiety.

Does facial hair mean high testosterone?

Hirsutism is the excessive terminal hair (thick and pigmented) growth arising from excess male hormones (androgens) in androgen-dependent areas such as the upper lip, chin, back, chest, linea alba, etc.

Analyzing hormone levels is vital to rule out disorders with similar symptoms. It is also utilized in the diagnostic process of PCOS; however, diagnosis of PCOS relies on the Rotterdam Consensus Criteria.

The Rotterdam criteria require the exclusion of other diseases that could lead to hyperandrogenism or ovulatory dysfunction. To diagnose it, evidence of two of the following three observations: ovulatory dysfunction, hyperandrogenism, and polycystic ovaries, must exist.

Hormone levels in women vary. Furthermore, it is possible for some women with PCOS to have hormone levels within the "normal" range while experiencing androgen-related symptoms. 

These are some of the hormones that may be implicit in PCOS.

• androgens (testosterone, DHEAS, and androstenedione)

• estradiol

• prolactin

• Luteinizing hormone (LH)

Normally, women produce male hormones in their bodies, just as males do female hormones. However, if you have PCOS, your body likely produces higher androgen amounts.

Signs of PCOS facial hair

The main sign of PCOS facial hair is dark and thick hair growth in androgen-sensitive areas.

Diagnosis

Diagnosis of PCOS depends on no single test but the Rotterdam Criteria. The National Institutes of Health's (NIH) classic criteria or the new Rotterdam criteria (Rott-PCOS) can be used to determine the presence of polycystic ovarian syndrome (PCOS) (NIH-PCOS). However, the doctor will take you through the following steps to assist in diagnosis:

1. A physical examination

2. Blood tests

3. A pelvic ultrasound to examine ovaries for cysts

4. A pelvic exam

Can PCOS facial hair be prevented?

If you're diagnosed with PCOS and receive proper treatment, it is possible to prevent the excessive growth of facial hair. Unfortunately, most people don't even know they have PCOS until the signs and symptoms, such as excess facial hair growth or irregular periods, develop.

Treatment for hirsutism with PCOS

Treating PCOS can help get rid of excess facial hair. However, as the growth cycle of hair follicles is long, this can take at least six months to nine months. Fortunately, hirsutism due to PCOS is treatable.

In most cases, treatment is mainly targeted to accomplish fertility or treat hyperandrogenism symptoms.

Lifestyle changes

Losing your body weight can reduce your androgen levels and stop excessive facial hair growth. You can change your diet, reduce sugar intake, and exercise regularly to help reduce body weight.

Medications

These include options such as:

•  Birth control pills. Contraceptives are the most common medication used to treat PCOS facial hair. They reduce androgen levels and regulate one's menstrual cycle. 

• Androgen-suppressing medication. Such drugs, including finasteride (Proscar®) and flutamide (Eulexin®), and spironolactone (Aldactone®), can treat mild cases of PCOS facial hair effectively.

• Gonadotropin-releasing hormone (GnRH) agonists. They reduce androgen production in the ovaries. It requires injections, and it can be costly. However, it is not as effective as contraceptives and is not typically used in this context.

Hair removal options

These include:

• Electrolysis. The doctor uses a tiny needle and a mild electrical zap to destroy hair roots.

• Laser hair removal. The heat from a laser is used to destroy cells that have color. Dark hair has a lot of colors, so it absorbs the most heat easily.

Home remedies

Home remedies to treat hirsutism due to PCOS include:

• Waxing and plucking (tweezing)

• Bleaching 

• Waxing

Can estrogen stop facial hair growth?

Estrogen can help reduce excess hair. Combination birth control pills typically have both cyclic estrogen and progesterone. These pills help inhibit ovarian androgen production as well as increase hepatic production of sex hormone-binding globulin which will further decrease free testosterone and are a long-term solution for PCOS facial hair. 

Expect to notice improvements after 6–9 months of drug therapy. 

When to see a doctor

Hirsutism is usually a sign of an underlying medical problem. If you think you have excess hair on your face, talk to your doctor about treatment options.  

Although many symptoms are associated with PCOS, not all must be present for the disorder to be diagnosed. Rarely do two people experience the same mix of symptoms, and your symptoms may change as you go through different life phases. It also means no standard test exists, so each test is recommended according to your symptoms.

The good news is that PCOS can be treated, even if there is no known cure. We know that our lifestyle can make PCOS symptoms worse or better.

For instance, even a small weight loss — say, 5% of your body weight — can improve your overall well-being, boost the efficacy of your medications, and aid in treating infertility.

The lowdown

PCOS facial hair is the excess hair growth on your face. Though not painful, this condition can affect your general outlook and confidence. It is caused mainly by excess androgen levels. 

Early treatment of PCOS can reduce the growth of excess hair. The doctor can diagnose the condition and recommend the appropriate medications to help regulate your androgen levels. Ensure you visit the doctor as soon as you notice the symptoms of PCOS, including hirsutism.