Guide to Unwanted Facial and Body Hair: Causes, Removal, and More
Unwanted facial and body hair growth can be problematic for both men and women alike, whether a person’s hairiness is considered excessive by medical standards, an unwanted physical aspect of a male-to-female transgender patient, or simply an aesthetic preference for less hair on the face or the body. In either case, excessive hair growth is usually very easily treated, and can be reduced or eliminated in a wide variety of effective methods.
- Hair Removal Techniques
- Area Specific Treatments
- Sensitive Areas & Brazilian Waxing
- List of Sources
In normal cases of body and facial hair growth, men and women bothered by it will seek out options to control it—by shaving, waxing, electrolysis, or using other common methods of temporary or permanent hair removal. When hairiness in men and women is abnormally excessive, or when its an unwanted physical aspect of a transgender patient undergoing MTF transition, the unwanted hair can be more than just an aesthetic issue. In these cases, patients are highly encouraged to seek a medical evaluation for treatment from a professional dermatologist, endocrinologist, or another medical professional.
When excessive hairiness is a medical disorder, the diagnosis is likely to be hirsutism or hypertrichosis—two separate conditions that are often confused with one another. It can also be a factor in MTF transitions for transgender patients when a biological male’s more masculine facial hair and body hair are symptoms that are treated with hormone therapies and other hair removal methods as a part of the feminization process.
Hypertrichosis, which is known colloquially as “werewolf syndrome,” is a rare condition that is characterized by an excessive amount of hair growth that can be found all over the entire body, or in certain, localized spots, in both men and women. The hair that grows in hypertrichosis can be long, short, thick and dark, or fine and light-colored. The onset of hypertrichosis can happen at birth or can be acquired at any point in time thereafter.
Hirsutism, on the other hand, is a condition that affects mostly women. In hirsutism, the body produces an excessive amount of male hormones, which causes the abnormal growth of thick, dark, and coarse body and facial hair. The excess hair growth is normally found in areas associated with the normal male body and facial hair patterns, such as the mustache and beard area, neck, chest, back, shoulders, inner thighs, and lower abdomen. Hirsutism is also sometimes accompanied by other symptoms of virilization in women, which refers to the additional development of other masculine characteristics in the female body, due to an excess amount of androgen levels (like testosterone).
For these reasons, it is critical for those suffering from symptoms of unwanted hair growth to be evaluated by a licensed and reputable dermatologist. In most cases, unwanted hair growth—whether due to illness, a congenital disorder, hormonal imbalance, or a more serious disease—is highly treatable, and can be resolved with a dedicated medical plan designed to identify the cause, slow down the hair growth, or stop it completely.
This article will discuss the differences between the different types of unwanted facial and body hair growth in men and women, how they are treated, and what you can do to eliminate the problem now and in the future.
The Reasons and Causes of Excessive Hair Growth
The reasons for excessive hair growth in women and men are wide and varying and can range from congenital disorders present at birth to side effects caused by prescription drug medications. Here are some of the best-known causes of both hypertrichosis and hirsutism:
Hypertrichosis: While the cause of hypertrichosis is unknown, cases can be congenital (developed at-birth, most likely due to genetics), or as acquired hypertrichosis, which happens after birth. In congenital cases of hypertrichosis, experts believe that dormant genes that are responsible for excessive hair growth in our ancestors are triggered and reactivated, causing a child to be born with this condition.
Possible causes of acquired hypertrichosis include eating disorders such as anorexia nervosa, malnutrition, autoimmune diseases, skin conditions and infectious skin disorders, cell mutations in cancer patients, anabolic steroids, immunosuppressants, and certain prescription drugs and other medications.
Occasionally, hypertrichosis can appear in the area where a plaster cast was worn after a bone fracture. In most cases, hypertrichosis is caused by the side effect of a drug or medication, paraneoplastic syndromes associated with many types of cancers, systemic illnesses or diseases that affect the entire body like anorexia nervosa or HIV, or congenital disorders formed at birth. In very rare cases, hypertrichosis is caused by a genetic mutation resulting in excessive hairiness.
Hirsutism (Excessive Hairiness in Women): Hirsutism in women can be the result of genetics, and can also be caused by an increased level of androgens such as testosterone in the body. It can also be the result of oversensitivity to male hormones, which causes the hair to grow in excessive amounts in typical male pattern hair-growth areas.
Hirsutism is also a known side effect associated with a number of diseases and medical conditions like polycystic ovary syndrome and other ovarian cyst disorders. Other conditions known to be responsible for the onset of hirsutism are Cushing’s syndrome, diabetes, adrenal gland, and hCG-secreting tumors, growth hormone disorders caused by pituitary gland tumors, porphyria cutanea tarda, and others. It is also a frequent side effect during pregnancy and can be a side-effect caused by several medications including minoxidil, cyclosporin, and diazoxide, among others.
Excessive Facial Hair: Excessive facial hair is typically a female problem, which is usually due to an imbalance of androgens in the body. Specifically, female facial hair growth is caused by a shortage of estrogen and an increased production of testosterone and dihydrotestosterone, the hormone responsible for terminal hair growth on the lower face and neck areas.
In hypertrichosis, excessive facial hair can be due to drugs, congenital disorder or family genetics, or a number of diseases or medical conditions (as previously described above.)
Excessive Body Hair: Excessive hair growth in men and women is also due to higher levels of male sex hormones in the body, particularly testosterone, which is responsible for the growth of coarse, stiff, and dark body hair on the back, under the arms, and in the pubic areas. Body hair growth can be due to both hypertrichosis and hirsutism, and also genetic family traits—especially among those with Middle Eastern, South Asian, and/or Mediterranean ethnic backgrounds.
Pathophysiology of Excessive Hair Growth
In a natural hair growth cycle, there are three different hair types that cover a normal human body: lanugo, a soft, fine hair that develops in-vitro (and disappears completely after a few months after birth), vellus hair (the light, fine, unpigmented hair that covers the body), and terminal hair, which consists of the thick, coarse, dark hairs found on the face, underarms, and pubic area after puberty.
During puberty, a cocktail of androgens (dihydrotestosterone DHT, dehydroepiandrosterone sulfate DHEAS, and testosterone) in the body promote the development of thick, coarse, dark hair (terminal hair). Testosterone is responsible for its placement on the body, for example, on the underarms, chest, and pubic areas. Dihydrotestosterone, another hormone, controls the growth of this hair on the face, as well as male pattern baldness and hair loss on the scalp. Women tend to keep more vellus hair after puberty than men, due to higher levels of estrogen in the body that slow down the growth of terminal hair and encourage the growth and preservation of vellus hair on the body.
When someone is born with or develops a clinical hair growth disorder, the vellus or terminal hair follicle can deviate from the normal hair growth patterns in several ways. In hirsutism, the sudden or excessive growth of terminal hair over the face and body is due to an unusually high amount of androgenic hormones being produced in the system, or due to testosterone being converted to dihydrotestosterone by an enzyme known as 5-alpha-reductase. Androgen levels are typically (but not always) the main cause of hair changes, though other factors, including prescription drug use and other medication, congenital disorders, and others.
Signs and Symptoms of Excessive Hair Growth
Those with excessive hair growth that isn’t considered a medical problem could still just not want to have hair on their arms, legs, chest, face, or other areas of the body. While this may simply be a preference, “normal” hairiness can range from mild annoyance to intense frustration, or even stronger emotional feelings towards the perception of excessive hair growth.
For women suffering from hirsutism, patients may notice thick, textured, dark, and coarse hair growing faster than usual, or in places where women aren’t typically known to grow hair—like on the chest and back, or on the face, neck, and beard or mustache areas. In many cases, excessive hair growth due to hirsutism is often accompanied by other signs of virilization over a period of time, due to abnormally high levels of androgen. Some of these symptoms may include hair loss on the scalp or bald spots, smaller breasts, acne and facial blemishes, enlargement of the clitoris, enhanced muscle development, and a deeper voice.
Signs of hypertrichosis usually begin when noticing an unusual amount of hair growth in a particular area that’s not typical of the person’s age, sex, or ethnic background. For example, a baby born with lanugo hair that fails to fall out a month or so after birth may have hypertrichosis and will need treatment to get rid of the excess hair on the body. Sudden development or increase of vellus or terminal hair at any point after birth that is unusual will often be one of the first signs of hypertrichosis or hirsutism.
For MTF transitioning patients, excessive hair growth becomes a problem once a male has identified as transgender, and after puberty when typical male hair growth patterns begin to appear on the face and body.
Excessive hair growth symptoms should be evaluated by a medical professional to determine whether other signs of illness or disease are present. Patients should discuss any other symptoms they’ve been experiencing that might signal the presence of diabetes, cancer, eating disorders, or others that could be causing excessive hairiness.
Hair Removal Techniques and Procedures
Excessive body and facial hair, especially in women, are generally not seen as desirable traits in most societies. Fortunately, unwanted hair caused by a medical issue is typically very treatable with a proper evaluation, diagnosis, and treatment program by a reputable dermatologist, endocrinologist (in MTF transitions), or another medical professional.
In other cases where hairiness is normal and not a cause of illness, MTF transitioning, medications, congenital disorders, or other medical problems, excessive hair growth is also treatable with the following hair removal techniques and procedures:
Threading: Threading is an ancient practice in countries in the Middle East and South Asia. The technique involves the use of thread to pull individual hairs from the hair follicle in a quick and precise maneuver, usually by a highly trained esthetician.
Waxing: Waxing is a very common form of hair removal that uses hot wax, a cloth strip, hard wax, and/or other materials to pull hair from the root in one swift motion.
IPL: IPL refers to intense pulsed light, which is a technique performed in dermatology clinics to slow down the regrowth of hair. IPL works by using a high-energy light to heat the hair follicle, reducing the re-growth of hair in areas where it’s unwanted.
Laser Hair Removal: Laser hair removal is another popular procedure performed in dermatology clinics that removes unwanted hair using a concentrated beam of light. The heat from the laser damages the hair follicles, which inhibits future hair growth, delaying it from growing back for long periods of time.
Electrolysis: Electrolysis treatments use a tiny needle and an electrical current to shock and kill the hair follicle at the root, removing hair permanently. There are three methods of electrolysis: galvanic, thermolytic, and a third method which combines the two previously mentioned methods into one. All electrolysis methods are the only FDA-approved, permanent methods of hair removal on the market.
Specific Treatments for Removing Facial and Body Hair
There are various techniques used by men and women for removing hair in specific parts of the body, and most of them are most commonly performed easily and efficiently using at-home products and techniques. While these methods are not permanent hair reduction or removal solutions, they are quite effective in controlling hair growth for aesthetic or even functional reasons.
Shaving: Shaving is one of the easiest and most popular ways to quickly and efficiently remove hair from the face or the body in the comfort of your own home. While shaving can be used on all parts of the body, women tend to not use this technique on their faces to prevent the formation of stubble, or the “5 o’clock shadow”, when the hair begins to grow back one to three days later. Needless to say, this is not a permanent solution for hair growth and requires frequent shaving to keep unwanted hair at bay.
Tweezing: Tweezing or “plucking” is another common practice for hair removal that is performed at home. Tweezers are used to remove individual hairs by the hair’s root one at a time, which means that hair removal lasts anywhere from two to eight weeks. This method is primarily used to remove hair from the face, particularly around the eyebrows, the upper lip, and the chin where the hair is scarce, and not on the body—as doing so would not be considered as practical use of one’s time.
Epilation: Epilation is a hair remover device that works by pulling individual hairs out from the root, much like tweezing. The difference is that an epilation hair removal device is a machine that works to pull out many hairs at a time, making it ideal for removing hair from the legs or other hairier areas of the body. Results can last up to four weeks after a session, which can be easily performed at home by yourself.
Waxing: In contrast to professional waxing, waxing can also be done at home with a special kit. At-home waxing kits usually come in two forms: wax strips that can be heated with your hands, or a pot of wax that is melted in the microwave or on a warming device, and applied to the skin with a wooden tab and removed with a cloth.
In general, soft wax is best for use on fine facial hair, while hard wax is best for removing body hair. Look for special kits that cater to the specific use of each body area, including Brazilian waxing kits made for removing hair from the pubic area.
At-Home Laser Hair Removal: At-home laser hair removal kits are available for purchase online or in department stores, and can be a convenient choice for easy and semi-permanent body and facial hair removal at home. Devices come in a range of prices, however, with a quality machine, you can expect to control hair re-growth for up to six months at a time between treatments. Another perk of at-home laser hair removal treatments is that they can be done at any time, according to your schedule—which can be very convenient for those that don’t have the time to spend visiting a dermatologist or aesthetician for repeat treatments.
Depilatory Creams: Depilatory creams are made with chemicals that break down the protein structure of your body and facial hair, causing the hairs to disintegrate and wipe away. With chemicals like titanium dioxide in the ingredients, allergic reactions are a possibility, which can be one of the drawbacks of using this method to remove hair.
In most cases, depilatory creams are safe to use, and hair removal can last longer than it would from shaving. Depilatory creams are also available in shave gel, lotion, or other forms, and can be used to remove both facial hair and body hair, depending on the product.
Prescription Medications: The only approved medication available for excessive facial hair in women is Vaniqa® or eflornithine. Vaniqa® takes at least four to eight weeks of consistent use to see results, and hair will grow back if treatment is stopped. To see if this medication is right for you, ask your doctor about your excessive hair growth concerns and whether eflornithine medicated cream might be an option for treatment.
Other medications that can be used for reducing women’s body and facial hair are some birth control medications, which can reduce the production of androgens (male sex hormones) in the body. Anti-androgen medications are another option for treating hairiness, including Propecia (finasteride), which inhibit androgens from stimulating excessive hair growth.
Sensitive Areas and the Brazilian Body Wax
Certain areas of the body, including the nipples, pubic area, upper lip, and the underarms, can be quite sensitive to hair removal techniques. Special care and consideration should be taken when removing hair in these areas, to avoid irritation of the skin and excessive pain during and after treatment. If possible, dry skin and sensitive areas should be treated by a professional aesthetician or dermatologist. At the very least, be sure to follow instructions on at-home hair removal kit products, and to perform allergy tests prior to use and applying them in these areas of the body or the face.
One of the most sensitive areas of the body is the pubic area, and hair removal methods can be quite painful—especially when improper methods are used. One of the most comprehensive waxing techniques for this supremely sensitive area of the body is known as the “Brazilian,” or the Brazilian Bikini Wax. This method of hair removal, as opposed to the standard bikini wax that removes hair along the bikini line, is designed to completely eliminate all hair from the bikini area with wax, which can be a potentially painful process if not handled correctly.
Common Myths About Hair Removal
- Shaving Makes Your Hair Grow Back Thicker, Stronger, and Faster
Perhaps the most common myth on this list, and certainly one of the oldest and most widespread, is that shaving makes the hair grow back thicker and stronger. This myth was first disproved in a lab test as far back as 1928 when scientists debunked the theory that shaving made hair coarser, darker, or faster growing than before shaving.
This belief is perhaps due to the fact that hair above the surface of the skin has the tendency to be sun damaged or exposed to chemicals or other elements that make the hair seem weaker or lighter in hair color. Shaving the hair removes this damaged and dead section of the hair strand, which makes the live hair growing beneath the skin’s surface to seem darker, coarser, and stronger than before.
- Laser Hair Removal is Forever
Contrary to popular belief, laser hair removal in a clinic or using personal care, the at-home kit is not permanent. Instead, laser hair removal removes the hair follicle for a long and extended period of time, usually up to six months. The only hair removal procedure is electrolysis, which is done by a professional aesthetician in a clinic.
- Real Men Don’t Shave Their Bodies
Another long-held belief that has been passed around for generations is that men do not and should not shave their bodies. While body hair and even excessive body hair is substantially more accepted in men than in women, hair removal is for everyone—and the vast majority of men remove more than just their facial hair, focusing on their legs, arms, chest, shoulders, neck, and pubic areas—among other places, on a regular basis.
In fact, many men feel burdened by the body and facial hair and use depilatory creams, waxing, shaving, and other techniques for hair reduction or removal in certain areas. More and more men are choosing semi-permanent or even permanent in-clinic techniques to remove hair altogether as a part of a growing trend in male grooming.
- For a Closer Shave, Press Harder on the Razor
It might seem more productive to press down on the razor while shaving, but in actuality, applying more pressure can make it harder to get close to the hair, or even shave. In fact, less pressure is much more effective when using a razor to shave your body or facial hair, while pressing down on the razor (and the skin) can cause more nicks, cuts, and missed sections of hair.
- Electrolysis and Laser Hair Removal are Extremely Painful
Unfortunately, there is pain involved in most hair removal methods and procedures, including electrolysis and laser hair removal. The good news is that the pain you feel for either treatment will depend largely on your personal pain tolerance, and the efficiency of your dermatologist or aesthetician in providing you with the relief you need to lessen or eliminate the discomfort you feel during the procedure. In most cases, your doctor will provide you with several options for pain relief during electrolysis or laser hair removal, depending on your level of comfort once treatment begins. This could include a topical anesthetic to numb the area being treated, lidocaine injections for subcutaneous numbing of the area, or even general anesthesia by a professional anesthesiologist for hair removal on extra-sensitive skin areas, like the genitals, underarms, or other zones.
Conclusion & Consultation Tips
It is critically important to seek out the advice of a professional dermatologist or health and skincare professional when noticing signs of excessive hair growth on the body or the face. While hairiness can be a very normal (albeit bothersome) trait for some people, it can also be a warning sign of other serious underlying illnesses, diseases, and disorders, and prompt medical attention can often both relieve the symptoms and prevent them from worsening.
Depending on your symptoms, your doctor might arrange a screening to test you for hormonal issues like polycystic ovarian syndrome (PCOS), diabetes, or cancer. For MTF transgender patients, your doctor may refer you to an endocrinologist to discuss your options for beginning feminizing hormone therapy, or a dermatologist for laser hair removal or electrolysis. In other cases, these medical treatments and evaluations may not be necessary, and you’ll be presented with a list of viable options for safe and effective hair removal at home or in the clinic.
It’s extremely important to consult with a certified, reputable physician when excessive hair growth symptoms are present. Make sure that the healthcare professional you choose is an approved member of an official medical group in your country, like the American Academy of Dermatology, or the American Dermatological Association. A professional and capable physician will be able to determine the underlying cause of your excessive hair growth, and an effective solution that addresses the problem in the best interest of your general health and well-being.
List of Sources
- Understanding and Addressing Hair Disorders in Transgender Individuals.
- Feminizing hormone therapy
- MSD Manduals: Hairiness
- UCLA Health: Hirsutism
- Mayo Clinic: Hirsutism
- Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society
- MSD Manuals: Hirsutism and Hypertrichosis