Hirsutism and Hyperandrogenism in Women
What is Hirsutism and Hyperandrogenism in Women?
Hirsutism is excess hair growth in women in areas where men typically grow hair. This includes the face, chest, back, and abdomen. The hair is usually dark and coarse rather than fine and light. Hirsutism affects about 5 to 10 percent of women of reproductive age.
Hyperandrogenism means having too much androgen, which is a male hormone like testosterone. Women naturally produce small amounts of androgens. When levels get too high, it can cause hirsutism along with acne, hair loss on the scalp, and irregular periods. The most common cause is polycystic ovary syndrome, or PCOS, which affects up to 1 in 10 women.
Sex Hormone Binding Globulin, or SHBG, is a protein that binds to testosterone in your blood. When SHBG is low, more testosterone floats freely in your bloodstream. This free testosterone can cause the physical signs of hyperandrogenism. Measuring SHBG helps doctors understand how much active testosterone is affecting your body.
Symptoms
- Excess facial hair, especially on the upper lip, chin, and jawline
- Coarse dark hair on the chest, back, or abdomen
- Acne that persists beyond teenage years
- Thinning hair on the scalp or male-pattern baldness
- Deepening of the voice
- Increased muscle mass
- Irregular or absent menstrual periods
- Difficulty getting pregnant
- Weight gain, especially around the abdomen
- Darkened skin patches in body folds
Some women have mild symptoms that develop slowly over years. Others notice rapid changes. Hair growth patterns vary by ethnicity, so what seems excessive depends on your background. Not all women with hyperandrogenism develop visible hirsutism.
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Causes and risk factors
Polycystic ovary syndrome causes about 70 to 80 percent of hirsutism cases. PCOS creates hormonal imbalance that raises androgen levels and lowers SHBG. Insulin resistance plays a key role because high insulin tells the ovaries to make more testosterone. Other causes include congenital adrenal hyperplasia, tumors of the ovaries or adrenal glands, and certain medications like steroids or hormonal treatments.
Risk factors include family history, obesity, and insulin resistance. Extra body fat produces hormones that lower SHBG and increase free testosterone. Chronic stress raises cortisol, which can disrupt the balance of sex hormones. Some ethnic groups, including women of Mediterranean, Middle Eastern, and South Asian descent, naturally have more body hair but may still develop true hirsutism from hormonal issues.
How it's diagnosed
Diagnosis starts with a physical exam and medical history. Your doctor will assess your hair growth pattern using a scoring system. Blood tests measure hormone levels including testosterone, SHBG, and other androgens. The free androgen index, calculated from total testosterone and SHBG, shows how much active testosterone is in your system. Low SHBG means more free testosterone is available to cause symptoms.
Rite Aid offers testing for SHBG as part of our flagship panel. You can get tested at over 2,000 Quest Diagnostics locations nationwide. Additional tests may check for PCOS, thyroid problems, or adrenal disorders. Pelvic ultrasound can look for ovarian cysts. Early detection helps you address root causes before symptoms worsen.
Treatment options
- Weight loss of just 5 to 10 percent can improve insulin sensitivity and lower androgen levels
- Low-glycemic diet reduces insulin spikes that trigger testosterone production
- Regular exercise improves insulin resistance and helps balance hormones
- Stress management techniques lower cortisol and support hormonal health
- Hair removal methods including shaving, waxing, laser therapy, or electrolysis
- Birth control pills reduce androgen production and raise SHBG levels
- Anti-androgen medications like spironolactone block testosterone effects
- Metformin improves insulin sensitivity in women with PCOS
- Topical creams can slow facial hair growth
- Treatment of underlying conditions like thyroid disorders or tumors
Concerned about Hirsutism and Hyperandrogenism in Women? Get tested at Rite Aid.
- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
Hirsutism means dark, coarse hair growing in male-pattern areas like the face, chest, and back. Normal female body hair is usually fine and light. The Ferriman-Gallwey score helps doctors measure hair growth in 9 body areas. A score above 8 typically indicates hirsutism, though this varies by ethnicity.
Yes, many women see improvement with lifestyle changes. Weight loss and low-glycemic eating can lower insulin and androgen levels within 3 to 6 months. Exercise improves insulin sensitivity. These changes can slow new hair growth but may not remove existing hair. Existing hair often requires physical removal methods.
SHBG binds to testosterone in your blood, making it inactive. Only free, unbound testosterone causes symptoms like excess hair and acne. When SHBG is low, more testosterone remains free and active. Measuring SHBG helps calculate your free androgen index, which shows true androgen exposure.
No, though PCOS causes 70 to 80 percent of cases. Other causes include congenital adrenal hyperplasia, ovarian or adrenal tumors, Cushing syndrome, and certain medications. About 5 to 20 percent of cases are idiopathic, meaning no clear cause is found. Proper testing helps identify the specific cause.
Hair growth cycles take time to change. Birth control pills and anti-androgen medications usually show results in 6 to 12 months. You may notice less new growth before existing hair improves. Lifestyle changes can improve blood markers within weeks but visible changes take longer. Patience is important because hair follicles respond slowly.
Yes, but it may be more difficult. High androgen levels often cause irregular ovulation. Many women with PCOS and hyperandrogenism do conceive with treatment. Weight loss, metformin, and fertility medications can restore ovulation. Managing insulin resistance is key because it affects both androgen levels and egg quality.
Key tests include SHBG, total testosterone, and free androgen index. Some doctors also check DHEA-S, androstenedione, and 17-hydroxyprogesterone. SHBG is especially important because it determines how much testosterone is biologically active. Rite Aid tests SHBG as part of our core panel at Quest Diagnostics locations nationwide.
Hirsutism itself does not cause cancer. However, the underlying hormonal imbalances may increase certain risks. Women with PCOS have higher risk of endometrial cancer due to unopposed estrogen from irregular periods. Treating the root cause and managing menstrual regularity helps reduce this risk. Regular monitoring is important.
Yes, certain foods support hormonal balance. Spearmint tea may reduce free testosterone in some studies. Flaxseeds contain lignans that can increase SHBG. Low-glycemic foods prevent insulin spikes that trigger androgen production. Omega-3 fatty acids from fish reduce inflammation. These foods support treatment but should not replace medical care.
This depends on the underlying cause and treatment type. Symptoms often return when medications are stopped because the hormonal imbalance remains. Lifestyle changes that address root causes like insulin resistance may have longer-lasting effects. Permanent hair removal methods like electrolysis provide lasting results. Ongoing management is usually needed for chronic conditions like PCOS.