In this article, discover what PCOS facial hair is exactly, what drives it and how to manage it naturally.
Hair growth on the face is a common symptom of PCOS and can be really frustrating, affecting confidence and self esteem. But don’t worry, we are here to help! By addressing the root cause, we can help prevent and reduce PCOS facial hair.
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What is PCOS facial hair?
PCOS stands for polycystic ovary syndrome and is a hormone and metabolic condition that affects up to 20% of women worldwide.
When we talk about PCOS hair growth, we’re referring to vellus hair follicles on the face (also known as ‘peach fuzz’), which develop into terminal hair. This terminal hair is larger, darker and more visible, and is often found on the face, the chest, torso and upper thighs in women with PCOS. This is sometimes referred to as hirsutism.
PCOS hair growth, like all PCOS symptoms, is a result of the hormonal imbalance of androgen excess and the metabolic dysfunction associated with PCOS.
How common is PCOS facial hair?
PCOS facial hair, also known as hirsutism, can be seen in around 70 to 80% of PCOS women (compared to 4-11% of women in the general population).
Facial hair can also be seen in hypothalamic amenorrhea (HA) which is a different condition from PCOS but with the same symptoms and will need to be treated differently (see PCOS vs hypothalamic amenorrhea).
Facial hair can be caused by other factors than PCOS including diabetes, Cushing syndrome, late-onset conngenital adrenal hyperplasia, significant weight gain or loss, medications and coming off the contraceptive pill.
Reminder: PCOS is a condition involving high levels of androgens (sometimes incorrectly referred to as ‘male hormones’), which suppress ovulation. In fact, our preferred term at FUTURE WOMAN for PCOS is “anovulatory androgen excess” as this classifies PCOS as a condition which must have both androgen excess AND irregular cycles present. You cannot diagnose PCOS through ultrasound alone.
The main causes of PCOS facial hair
High androgens
The main driver of PCOS facial hair and other PCOS symptoms is elevated androgens.
Excess androgen production can lead to virilization: the development of masculine characteristics. This can include hair growth in areas such as chin, chest and torso.
Why does this happen?
Elevated androgens can contribute to PCOS facial hair by acting on androgen receptors at the hair follicle. When androgens bind to their receptors they can cause changes in the way the hair follicles behave – from inhibitory to stimulatory. Hair follicles are very sensitive to androgens.
Androgens have a stimulatory effect on hair follicles in places like the face and chest but have an inhibitory effect on the hair follicles in the scalp, leading to head hair loss.
What are androgens?
You may be familiar with the androgen, testosterone, but there are other androgens too! All (and any) of these androgens can be raised in women with PCOS, leading to symptoms like facial hair.
In addition, testosterone can also be metabolised in a way which increases the severity of PCOS. If your testosterone prefers the 5a pathway then you are likely to have more severe symptoms of PCOS like facial hair. That’s because this pathway converts testosterone into 5a DHT, which is THREE times more potent than testosterone.
Even clients with normal androgen levels, can experience PCOS facial hair as a result of a preference for the 5a pathway, which is why testing your hormones via urine not just a blood test is so important.
You can test all androgens and your androgen metabolism with the Advanced Hormone Test.
Check your PCOS symptoms now
6 other causes of PCOS facial hair
High androgens aren’t the only driver of PCOS facial hair. Let’s have a look at some other drivers which we assess in the Advanced Hormone Test.
- Low estrogen and progesterone. The effects of testosterone and androgen metabolites can be intensified when estrogen and progesterone levels are low, creating a feedback loop for facial hair growth.
- Insulin resistance. The majority of women with PCOS (50%-90%) are insulin resistant. Cells become less responsive to insulin so glucose will not be taken from the blood effectively. This causes the pancreas to release more insulin which can stimulate the ovaries to release more androgens and therefore results in increased facial hair and other PCOS symptoms.
- Inflammation – PCOS is associated with chronic low-grade inflammation in the body. Chronic inflammation causes the ovaries to release more testosterone which can result in androgen excess and this disrupts normal hormonal regulation and contributes to PCOS facial hair.
- Stress – Stress causes the release of cortisol (a stress hormone) which can increase blood sugar levels, insulin resistance and inflammation, all of which can contribute to an excess of androgens and possible stimulation of PCOS facial hair growth.
- Gut dysbiosis- higher levels of bacteroides and gram negative bacteria (LPS toxins) have been seen in women with PCOS and are linked to an increased risk of insulin resistance, inflammation and increased androgens all of which can lead to PCOS facial hair.
- Oxidative stress (OS)- is the imbalance between oxidants and antioxidants which produces excessive amounts of reactive oxygen species (ROS). OS markers are significantly increased in patients with PCOS compared with those without PCOS. Increased OS can create an inflammatory environment that further increases insulin resistance and contributes to hyperandrogenism- which in turn can cause increased facial hair.
We assess your sex hormones, stress hormones, inflammation, gut dysbiosis and oxidative stress in our Advanced Hormone test to understand what is driving your PCOS and facial hair growth.
How we approach treatment of PCOS facial hair at FUTURE WOMAN
Do I actually have PCOS?
First of all, it’s important with PCOS facial hair to determine that you definitely have the condition. Many women with PCOS have received a PCOS diagnosis based on ultrasound alone, without a test to confirm elevated testosterone or other androgens. This leads to a lot of overdiagnosis of PCOS.
Testing with our easy at home urine-based Advanced Hormone Test will help to determine if your androgens or androgen metabolites are raised, and if not, whether something else is driving your symptoms. We assess all androgens in the Advanced Hormone Test, including the androgen metabolite 5a DHT, which can be three times more potent than testosterone, and is only detectable in urine testing.
What type of PCOS do I have?
Secondly, it is important in PCOS to determine which type of PCOS you have so that your practitioner can address the underlying root causes of your PCOS facial hair. For example, insulin resistance is the most common PCOS type, and we would treat this differently to Inflammatory PCOS (driven by inflammation) or adrenal PCOS (driven by stress).
The Advanced Hormone Test assesses the full range of adrenal hormones, like cortisol, as well as many markers for inflammation to help us determine your PCOS type.
What other factors are contributing to my PCOS facial hair?
As we’ve seen above, there are many factors that could be driving your PCOS symptoms, including PCOS facial hair. In the Advanced Hormone Test, we assess both free and metabolised cortisol and cortisone for a comprehensive assessment of your stress response and HPA (hypothalamus pituitary adrenal) axis functioning. This is especially important in PCOS as increased cortisol can increase overall inflammation in the body, which in turn increases androgen production resulting in the worsening of symptoms. Estrogen and progesterone are also measured as these impact facial hair growth too.
Other possible root causes of PCOS facial hair that would show up in functional testing include gut dysbiosis and oxidative stress/inflammation.
PCOS facial hair and supplementation
Once we establish the drivers of your PCOS facial hair through testing, one of our expert nutritionists will create a personalised healthplan for you. This will include evidence based supplement, diet and lifestyle recommendations to address your unique drivers and symptoms.
Supplements can be helpful for PCOS in general but only if they are right for you. For example the supplement myo-inositol has been shown to be hugely beneficial for insulin resistant PCOS but may worsen hormonal symptoms for people who do not need it. That is why it is so important to test first and determine which supplements and dietary changes are right for you.
3 tips to help banish PCOS facial hair for good
To bring about lasting change with PCOS facial hair, here are our top 3 recommendations.
- Confirm if you really have PCOS by testing. We see many women who have been misdiagnosed with PCOS based on ultrasound alone. You need irregular or non ovulatory cycles AND raised androgens to confirm if you have PCOS.
- Test ALL androgens and androgen metabolites. It’s not just about testosterone! PCOS can be present if ANY of your androgens or androgen metabolites are raised. Metabolites can only be tested in urine, not blood serum.
- Check other hormonal drivers of your PCOS facial hair. Every woman with PCOS is different. As we’ve covered in this article, there are many possible hormonal drivers of PCOS facial hair. Testing with the Advanced Hormone Test can help you understand your unique hormone picture and we can then address those drivers in your free personalised plan.
References
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Grymowicz, M., Rudnicka, E., Podfigurna, A., Napierala, P., Smolarczyk, R., Smolarczyk, K., & Meczekalski, B. (2020). Hormonal Effects on Hair Follicles. International journal of molecular sciences, 21(15), 5342. https://doi.org/10.3390/ijms21155342
Keen, M. A., Shah, I. H., & Sheikh, G. (2017). Cutaneous Manifestations of Polycystic Ovary Syndrome: A Cross-Sectional Clinical Study. Indian dermatology online journal, 8(2), 104–110. https://doi.org/10.4103/2229-5178.202275
Spritzer, P. M., Marchesan, L. B., Santos, B. R., & Fighera, T. M. (2022). Hirsutism, Normal Androgens and Diagnosis of PCOS. Diagnostics (Basel, Switzerland), 12(8), 1922. https://doi.org/10.3390/diagnostics12081922
Unluhizarci K, Hacioglu A, Taheri S, Karaca Z, Kelestimur F. Idiopathic hirsutism: Is it really idiopathic or is it misnomer? World J Clin Cases 2023; 11(2): 292-298 [PMID: 36686351 DOI: 10.12998/wjcc.v11.i2.292]
