Research
Ultimate Guide to PCOS Hormones and Hirsutism
Explore the hormonal causes of hirsutism in PCOS and discover effective treatment options, including medications, lifestyle changes, and cosmetic solutions.
July 19, 2025
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Explore the hormonal causes of hirsutism in PCOS and discover effective treatment options, including medications, lifestyle changes, and cosmetic solutions.
Hirsutism, or excessive hair growth in areas like the face and chest, is a common symptom of PCOS, affecting up to 75% of women with the condition. This happens because PCOS causes hormonal imbalances, particularly an overproduction of androgens (male hormones), which transform fine, light hairs into thicker, darker ones.
Key points:
Regular follow-ups and a combination of treatments tailored to individual needs are essential for managing symptoms effectively. Addressing emotional health and seeking professional support can also improve overall well-being.
PCOS hormones play a key role in excessive hair growth, and understanding how these hormones interact sheds light on why hirsutism is so prevalent among women with this condition.
The primary culprits behind hirsutism in PCOS are androgens, which are produced by both the ovaries and adrenal glands. Among these, free testosterone is the most significant, as it directly impacts hair follicles, leading to unwanted hair growth.
Another player is luteinizing hormone (LH), which prompts the ovaries to produce more androgens. This sets off a chain reaction that further increases androgen levels.
Insulin also contributes by overstimulating the ovaries to produce androgens, creating a cycle that exacerbates both the physical and metabolic symptoms of PCOS.
Together, these hormonal imbalances explain why 80% to 90% of women with hyperandrogenism have PCOS, making it the leading cause of hirsutism. These imbalances directly affect the behavior of hair follicles, leading to excessive hair growth.
Androgens influence hair follicles in specific ways, transforming fine vellus hairs into thicker, darker terminal hairs. This process unfolds through several mechanisms:
Hair follicles contain enzymes that regulate androgen activity. This helps explain why some women experience more severe hirsutism than others. Once vellus hairs become terminal hairs, the change is typically irreversible. Even if androgen levels are reduced through treatment, the terminal hairs usually remain, although they may grow more slowly.
To objectively assess hirsutism, healthcare providers use the modified Ferriman-Gallwey (mFG) scoring system, which evaluates nine androgen-sensitive areas on a scale from 0 to 4.
"The Ferriman-Gallwey scoring system has a great significance and value to establish the diagnosis of hirsutism and is an acceptable screening method."
- Besa Gacaferri Lumezi, Department of Physiology and Immunology, Medical Faculty, University of Prishtina
A total mFG score of 8 or higher typically indicates hirsutism, though the threshold can vary based on race and ethnicity. These differences reflect genetic variations in hair growth patterns.
A study on Turkish women highlighted the areas contributing most to hirsutism scores:
| Body Region | Average Hair Growth Score |
|---|---|
| Chin | 2.85 ± 1.08 |
| Thigh | 2.86 ± 1.15 |
| Upper lip | 1.99 ± 1.10 |
| Lower abdomen | 2.08 ± 1.04 |
| Chest | 1.48 ± 0.99 |
While the mFG system provides a helpful baseline, it has its limitations. The subjective nature of scoring means results can vary between healthcare providers. Additionally, scoring becomes more difficult for women who have removed hair through cosmetic procedures.
Despite these challenges, the mFG score remains a useful tool for tracking treatment progress and guiding therapy decisions.
Managing hirsutism caused by PCOS typically involves a combination of medical treatments, cosmetic procedures, and lifestyle adjustments. These approaches aim to address hormonal imbalances and reduce visible symptoms.
Medications play a key role in tackling androgen excess, which is often at the root of hirsutism. For instance, oral contraceptives help suppress ovarian androgen production, making them a common first-line treatment.
Anti-androgens are another essential option. Spironolactone, widely used in the U.S., has been shown to lower Ferriman-Gallwey scores by 19% when taken at 100 mg daily for six months. Other medications like flutamide and finasteride can reduce scores by up to 40% and 17%, respectively. Cyproterone acetate (50–100 mg daily combined with 30–35 μg ethinyl estradiol) has been found equally effective as spironolactone paired with oral contraceptives.
For more localized treatment, topical eflornithine cream slows new facial hair growth at the follicle level, though it doesn’t remove existing hair. Additionally, insulin sensitizers like metformin may improve hyperandrogenemia and ovulation, potentially reducing hirsutism as an added benefit.
It’s worth noting that visible improvements in hair growth may take up to six months, and treatment is often continued for at least two years before gradually reducing anti-androgen doses .
While medications address internal hormonal issues, cosmetic treatments focus on reducing hair growth externally. Laser hair removal has become a popular long-term solution, using concentrated light to target hair follicles. A single session can achieve a 10%–40% reduction, while repeated treatments may reduce hair growth by up to 90%. Results often last for up to 12 months .
The choice of laser depends on skin tone. Diode lasers are most effective for dark hair on fair skin, while YAG lasers are better suited for darker skin tones, as they target follicle pigments without harming surrounding tissue.
For permanent results, electrolysis is the only FDA-approved method. This technique uses electric currents to destroy individual hair follicles and works well on smaller areas like the face, regardless of hair color or skin type.
Costs vary widely. At-home IPL devices are priced around $189, while professional laser sessions can cost several hundred dollars. A full course of laser hair removal (about eight sessions) may cost approximately $225 in some markets.
| Method | Effectiveness | Duration | Best For | Considerations |
|---|---|---|---|---|
| Laser Hair Removal | High (50–90%) | 6–12 months | Dark hair, fair skin | Requires multiple sessions |
| Electrolysis | Very High (permanent) | Permanent | All hair/skin types | Time-intensive, may be painful |
| Waxing | Moderate | 2–4 weeks | Temporary solution | Can cause irritation |
| Shaving | Low | 1–3 days | Quick fix | Needs frequent repetition |
Lifestyle changes are a cornerstone for managing PCOS-related hirsutism, as they help address insulin resistance and inflammation. Even a modest weight loss of 5% can lead to noticeable symptom improvements. Regular physical activity is particularly effective in lowering testosterone levels. Experts recommend at least 150 minutes of exercise weekly, including 120 minutes of vigorous activities like brisk walking, cycling, or swimming, along with resistance training .
"If you are diagnosed with polycystic ovary syndrome, it doesn't mean that you are destined to have poor health. There is a lot you can do to take charge, minimize symptoms and keep yourself healthy." – Amanda Stathos, M.S., R.D., L.D.N.
Dietary adjustments can further enhance results. High-fiber foods, such as beans, lentils, berries, broccoli, and chia seeds, help stabilize blood sugar levels. Aim for 21–25 grams of fiber daily. Anti-inflammatory foods, including tomatoes, leafy greens, nuts, olive oil, and fatty fish, can also help reduce chronic inflammation .
Both the DASH diet and the Mediterranean diet are frequently recommended. The DASH diet emphasizes fruits, vegetables, whole grains, nuts, legumes, and low-fat dairy to improve insulin sensitivity. The Mediterranean diet, known for its variety and long-term sustainability, is another excellent choice. Limiting refined carbs, sugary snacks, fried foods, and processed meats is also advised, as these can worsen insulin resistance and inflammation .
Stress management techniques like yoga, meditation, tai chi, or pilates can improve mental well-being and hormonal balance. Together with medical and cosmetic treatments, these lifestyle changes form a comprehensive approach to managing PCOS hirsutism.
Managing PCOS-related hirsutism takes time, patience, and a clear plan. Hormonal treatments don’t work overnight, so understanding what to expect can help you stay motivated and focused on your goals.
The timeline for seeing improvements in hirsutism depends on the treatment you're using. For systemic therapies, it often takes 6 months to a year to notice significant changes. Even then, only about 50% to 75% of patients experience improvement. This delay is partly because of the natural hair growth cycle. Facial hair's anagen (growth) phase lasts around four months, so visible changes usually start around six months, with maximum improvement seen by nine months.
Different treatments vary in how quickly they show results. For instance:
It’s important to note that medications mainly prevent new hair from growing rather than removing existing hair. Setting small, achievable goals - monthly or quarterly - can help you stay encouraged. Focus on gradual progress and remember that consistency plays a huge role in success.
Regular follow-ups with your healthcare provider are essential for tracking progress and making any necessary changes to your treatment. These check-ups can help you understand your progress based on your baseline and typical ranges. For example, normal modified Ferriman-Gallwey (mFG) scores vary by ethnicity:
| Ethnicity | Normal mFG Score Range |
|---|---|
| White/Black women | Less than 8 |
| Mediterranean/Hispanic/Middle Eastern women | Less than 9–10 |
| Asian women | Less than 2 |
Your provider will use your initial score to measure changes over time. Scheduling follow-ups every 3–6 months allows them to monitor your response to treatment, assess signs of hyperandrogenism (like hirsutism, acne, or hair thinning), and manage any side effects.
To track progress between appointments, take monthly photos under consistent lighting and angles. Keeping a journal of your monthly mFG scores, treatment adherence, and any side effects can also provide a clear picture of how things are improving.
Since pharmacologic treatments work slowly, regular monitoring and adjustments are key to staying on the right track. With consistent tracking, you’ll be better equipped to achieve long-term success.
Effectively managing hirsutism caused by PCOS requires a tailored and multi-faceted approach. As experts point out, "A systematic evaluation and combination therapy yield satisfactory treatment for hirsutism".
The key to long-term results lies in blending several strategies rather than depending on just one. Medical treatments, like combined oral contraceptives or anti-androgens such as spironolactone, focus on curbing new hair growth but don’t remove existing hair. For this reason, pairing these with hair removal techniques is essential. Topical options, such as eflornithine cream, can also complement these treatments. Keep in mind that hormonal therapies typically take 6 to 8 months before producing noticeable results.
Lifestyle changes play a vital role as well. Losing just 5% of body weight, maintaining a balanced diet, engaging in regular physical activity, and managing stress can significantly enhance treatment outcomes while easing other PCOS symptoms.
Equally important is addressing emotional health. According to UCLA Health, "understanding how a woman feels about her body image and improving this perception are essential components of any management plan". Seeking support from endocrinologists, gynecologists, and mental health professionals can provide valuable guidance for tackling the challenges of PCOS.
For the best results, combination therapy works well. Initiating hormonal treatments to slow hair growth, followed by targeted hair removal methods after 6 to 12 months, often achieves the most effective outcomes.
If you're looking for ongoing support and reliable information, PCOSHelp offers detailed guides on symptoms, treatments, and self-care strategies tailored for those managing PCOS. With a consistent treatment plan, regular follow-ups, and a personalized approach, you can take control of hirsutism and enhance your overall quality of life.
Lifestyle adjustments can be an important part of managing hirsutism linked to PCOS, as they target the hormonal imbalances at the root of the condition. Focusing on a healthy weight through a combination of balanced eating and regular physical activity can enhance insulin sensitivity and reduce androgen levels, potentially easing excessive hair growth.
Adding stress-relieving practices like yoga or meditation into your routine can further help balance hormones. Cutting back on processed foods and sugary beverages may also contribute to better hormonal regulation. While these steps may not completely resolve hirsutism, they can lead to noticeable improvements over time.
Electrolysis is often seen as a long-term hair removal solution because it works by targeting individual hair follicles. That said, achieving optimal results usually requires multiple sessions spread over 8 months to 2 years, with an effectiveness rate of around 93%.
Laser hair removal, while not permanent, can lead to a 65–90% reduction in hair growth after several treatments. The effects typically last up to 12 months, after which maintenance sessions might be necessary. Deciding between these methods often comes down to factors like your hair type, skin tone, budget, and what you personally feel most comfortable with.
Hormonal treatments for managing PCOS-related hirsutism require patience, as they work in sync with the natural hair growth cycle. On average, it takes about 6 months to see noticeable changes, with the most improvement often appearing around the 9-month mark. This is because these treatments influence new hair growth rather than the hair that's already present.
To measure your progress, look for signs like slower hair growth, finer or lighter hair, and overall symptom relief. Keeping a journal or taking periodic photos can be a helpful way to track these changes. Remember, sticking to the treatment plan and giving it time is essential for achieving the best possible outcomes.
