What causes excess hair?

Friday, 27 January 2012

Excess body hairWe seem to spend huge amounts of time – and money – trying to get rid of hair on our bodies – and keep it (or plump it up) on our heads.

More than half of all women are concerned about excess body hair, according to a report published by market research company Mintel last month. In the online survey of more than 2 000 women, excess hair was rated just behind weight gain for body dissatisfaction. It’s estimated that one in ten of us suffers from excess facial and body hair. But what causes it?

‘Sometimes race or just a family tendency to be more hairy is to blame, rather than any medical problem,’ explains Dr Rina Davison, an endocrinologist from Whipps Cross University Hospital, London, with a special interest in excess hair. ‘People of South Asian or Mediterranean descent tend to have more hair than Caucasians or those with black skin, for example. It’s also possible to be quite a “hairy” family regardless of race.’

But there are other factors — from commonly prescribed drugs to poor diet and certain ailments — that could be to blame…

CAKES AND BISCUITS

Eating large amounts of sugary, refined carbohydrates, such as biscuits and cakes, may trigger excess hair. These foods have a high glycaemic index, which means they release their energy quickly and can cause insulin resistance, explains Dr Davison. Insulin is the hormone that controls blood sugar level; ‘resistance’ means the hormone becomes less effective at lowering blood sugar, so the body has to produce more of it to get the job done.

‘The problem is that a raised insulin level may trigger growth factors which make the ovaries produce too much of the “male” hormone testosterone, which can lead to excess hair,’ adds Marilyn Glenville, a women’s health expert and nutritionist.
‘Being overweight can also cause insulin resistance.’

POLYCYSTIC OVARIES

Estimated to affect 10 to 15  per cent of women, Polycystic Ovaries Syndrome (PCOS) is when the ovaries don’t work properly and are covered in small cysts. As a result, eggs are released erratically or not at all, causing irregular or missed periods, and often reduced fertility and acne. One of the most common symptoms is a high level of male hormones (androgens), which leads to hair growth.

All women produce androgens. However, sometimes women produce higher levels, or they may have normal levels, but their hair follicles are more sensitive to androgens. ‘If excess hair is due to a hormonal imbalance, then it tends to occur in areas such as the chin, upper lip, sideburns, chest and inner thighs,’ says Dr Davison.‘These are areas of the skin that are more sensitive to testosterone. The hair is also likely to be coarse and dark.’ Given the implications for fertility, women worried about excess hair should see their GP, advises Steve Franks, professor of reproductive endocrinology at Imperial College, London and an endocrinologist at St Mary’s and Hammersmith Hospitals, London. ‘There may be other problems to investigate,’ he suggests. ‘Often, excess hair is a symptom of PCOS, but it also can be indicative of less common, but potentially more serious, hormonal disorders, or tumours of the ovary or adrenal gland — the two parts of the body that produce testosterone. Many, if not most, GPs will take the problem seriously and refer to an endocrinologist if appropriate. Women should not be afraid to ask for a referral to a specialist.’

The alarm bells should ring for a GP if a woman comes in with a growth of facial hair that has developed within the past six months, he adds.

ECZEMA

‘Patients with skin problems such as eczema or psoriasis can also develop excess hair,’ says Dr Davison. That’s because these conditions are caused by inflammation, which increases the blood supply to that part of the skin, accelerating hair growth. ‘It also increases skin cell turnover — the rate at which skin cells renew themselves. With psoriasis, for example, new skin cells are produced every two to six days, rather than the normal 21 to 28 days. What’s important here is that it’s not just skin cell turnover that’s magnified, but hair growth, too.’

TESTOSTERONE GEL

‘If a woman’s partner has been given testosterone in gel form to raise his levels of the hormone, then it may inadvertently get transferred to her through skin contact,’ says Dr Davison. Not many people realise this can happen, and that it can be enough to trigger hair growth in areas such as the face. The same can also happen with testosterone prescribed to women for libido purposes.

‘Similarly, products for hair loss in men and women, such as minoxidil, can cause unwanted hair growth if they inadvertently get transferred to other parts of the skin during application,’ says Dr Davison. I have seen women develop excess hair on their forehead, fingers and backs of hands.’
Furthermore, while minoxidil is often applied to the scalp as a lotion, it is sometimes taken in tablet form as a treatment for high blood pressure and can cause unwanted hair growth, says Carole Michaelides, consultant trichologist at the Philip Kingsley clinic in London.

ANOREXIA

People suffering from anorexia will have lanugo hair — an excess of fine, downy hair that covers the body, says Dr Davison. ‘It’s not known why it happens — it’s not a hormonal issue. Unfortunately, the excess hair is unlikely to help the person’s already negative image of their body.’

STEROIDS

Corticosteroids are used to reduce inflammation in the body and are prescribed to treat conditions such as asthma and rheumatoid arthritis. They contain a synthetic version of the hormone cortisol and levels can build up in the body over time. The problem is that if the drugs are taken for more than four to six months, this can cause a condition called Cushing’s syndrome. Symptoms include weight gain, a red, puffy face and excess hair growth all over the body. The risk of developing Cushing’s syndrome is higher in people who take steroids in tablet form, although it can also affect those who use take large doses of inhaled steroids, e.g. for asthma, or steroid creams often used to treat eczema or psoriasis.

MENOPAUSE/HRT

‘As the hormone oestrogen declines at the menopause, testosterone (the ‘male’ hormone) can become more dominant,’ explains Marilyn Glenville. ‘You don’t have more testosterone, but the ratio of oestrogen to testosterone has changed, making women prone to symptoms of male pattern baldness or other male characteristics such as facial hair and acne.’

Indeed, it’s thought that about 25% of middle-aged women regularly remove unwanted facial hair. The hair may grow on the upper lip or chin — areas that are sensitive to testosterone — or sometimes also on the cheeks, chest, stomach and back. Treatment for the menopause in the form of Hormone Replacement Therapy (HRT) may also trigger excess hair. The aim of HRT is to correct the drop in oestrogen and progesterone. ‘There are two types of progestogens which can be included in HRT preparations,’ says Marilyn Glenville. The first group are analogues (meaning ‘similar to’) of progesterone (such as dydrogesterone and medroxyprogesterone) and the second are analogues of testosterone (such as norethisterone).

If your HRT contains progestogens that are similar to testosterone, this might explain excess hair growth and you need to speak to your GP about your choices. Another form of HRT is tibolone. ‘This is a synthetic steroid compound which has androgenic properties, so one of its side-effects can be increased facial hair,’ says Marilyn Glenville. Certain contraceptives, such as Yasmin, are also marketed as being hair-friendly, while the Mirena coil has been linked with excess facial hair, adds Carole Michaelides.

HOW YOU CAN TACKLE IT


‘There is a myth that shaving or plucking makes hair grow back thicker and stronger, but this isn’t the case,’ says consultant trichologist Carole Michaelides. ‘It’s more an optical illusion — rather than being long and fine, the hair is short and stumpy.’ Endocrinologist Dr Rina Davison adds: ‘There isn’t one best way to remove hair. ‘In some people, waxing might cause ingrown hairs and infections, and bleaching isn’t always an option for darker skin. ‘Laser is an effective treatment, but it is expensive and you must make sure the trigger of the unwanted hair has been rectified. ‘If it is a hormonal condition, for example, this must be treated first or you will continue to grow the hair and the results won’t be permanent.’

If the hair is triggered by a hormonal condition, the British Association of Dermatologists recommends a range of medical treatments available on the NHS. These include anti-androgens to block male hormones, eflornithine cream to slow hair growth, or the contraceptive pill.

Written by Anna Hodgekiss, and with additional reporting by Sue Lerner, this article originally appeared in the Daily Mail
IMAGE: Shutterstock.com

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