Why PCOS Causes Excess Hair Growth—And How to Stop it

Hirsutism is a condition characterized by excessive hair growth in areas where women typically have little to no hair, such as the face, chest, back, and abdomen. This can be distressing and impact self-esteem, especially for women with PCOS, where hirsutism is one of the most common symptoms.

Studies estimate that between 70-80% of women with PCOS experience some degree of hirsutism. This is because PCOS is driven by hormonal imbalances, particularly high insulin levels and excess androgens (male hormones like testosterone). While hirsutism itself is not harmful, it is a sign of underlying metabolic and hormonal issues that need to be addressed for overall health.

How Does Hirsutism Develop in PCOS?

The connection between PCOS and hirsutism comes down to insulin resistance and hormone imbalances.

1. Insulin resistance leads to high insulin levels.

   • Insulin is a key hormone in the body, but when levels are too high, it has effects beyond blood sugar regulation.
   • In PCOS, the ovaries and adrenal glands become overstimulated by insulin, causing them to produce excess androgens (like testosterone).

2. Excess androgens trigger hair growth in unwanted areas.

   • Hair follicles in certain parts of the body (like the face, chest, and back) are more sensitive to testosterone.
   • When testosterone levels are high, these follicles are stimulated to grow thick, coarse hair.
   • At the same time, high androgens contribute to scalp hair thinning (female pattern hair loss), creating an imbalance in hair growth.

3. Inflammation and high insulin levels worsen the problem.

   • Chronic inflammation, which often accompanies insulin resistance, can further disrupt normal hair follicle cycles.
   • The combination of insulin resistance, inflammation, and excess androgens leads to persistent hirsutism.

How to Slow or Reverse Hirsutism

The good news is that hirsutism can be slowed and, in some cases, reversed. However, hair follicles have their own growth cycle, and it takes about six months for noticeable changes to occur. Patience and consistency are key.

Here’s what you need to know:

• Lowering insulin levels is the most important factor.
  Since insulin resistance is the root cause of excess androgens, addressing insulin levels will help bring hormone levels back into balance.

• Existing hair won’t just fall out.
  Any coarse hair that has already developed will need to be removed through methods like laser hair removal, electrolysis, or waxing. Once hormones are balanced, fewer new hairs will grow back.

• New hair growth can become finer and slower over time.
  As androgens decrease, hair follicles will become less active, and any new hair that grows may be finer, lighter, and easier to manage.

Pharmaceutical Treatment Options for Hirsutism

While lifestyle changes are the foundation for treating hirsutism, some women choose to use medication for additional support. Here’s a look at common pharmaceutical options, along with their advantages and drawbacks.

1. Spironolactone (Aldactone)

• How it works: Blocks androgen receptors, reducing the effect of testosterone on hair follicles.
• Pros: Can slow hair growth and improve acne caused by excess androgens.
• Cons: Takes several months to show results, may cause dizziness, fatigue, or electrolyte imbalances. Not safe for pregnancy.

2. Birth Control Pills

• How they work: Lower ovarian androgen production and regulate hormones, especially those with drospirenone as the progestin.
• Pros: Can help reduce hirsutism and regulate menstrual cycles.
• Cons: Does not treat the underlying insulin resistance, and symptoms often return when stopped.

3. Finasteride (Propecia)

• How it works: Blocks the conversion of testosterone into its more potent form (DHT), which contributes to hair growth in unwanted areas.
• Pros: May help slow hirsutism progression.
• Cons: Less commonly prescribed due to potential side effects, including birth defects if taken during pregnancy.

4. Metformin

• How it works: Improves insulin sensitivity, indirectly lowering androgen levels over time.
• Pros: Treats the underlying insulin resistance, reducing the root cause of hirsutism.
• Cons: Takes months to show effects on hair growth. Can cause digestive upset in some people.

Topical Metformin for Hirsutism

One lesser-known but promising option is topical metformin, which can be applied directly to areas affected by hirsutism. I know it sounds surprising, but research studies have shown impressive results with topical metformin for reducing hirsutism.

How Does It Work?

• Topical metformin helps reduce insulin’s impact directly on the skin and hair follicles.
• It works by lowering local androgen activity, helping to slow hair growth in problem areas.
• Since it’s applied directly to the skin, topical metformin bypasses the digestive system, avoiding the gastrointestinal side effects common with the oral form. However, it still enters the bloodstream, making it an effective alternative for those who struggle with the pill.

How to Get It

• Topical metformin is not widely available in pharmacies, but it can be prescribed by a doctor and compounded at specialty mail-order pharmacies. Some options include ChemistryRx and BayviewRx.com, but check your local area.
• It may take several months of consistent use before results are noticeable.

Electrolysis: Why It’s Not a Long-Term Fix

Electrolysis is often marketed as a permanent hair removal solution, and while it can effectively destroy individual hair follicles, it doesn’t address the root cause of excessive hair growth in PCOS: high insulin and androgen levels.

Each hair follicle must be treated one by one, making the process time-consuming, expensive, and often painful. More importantly, because the underlying hormonal imbalance isn’t being corrected, new hair follicles can continue to be stimulated, leading to ongoing hair growth over time. This means that even after multiple electrolysis sessions, new unwanted hair can still appear.

For long-term results, the key is to lower insulin levels and regulate hormones. By addressing the underlying insulin resistance that’s fueling excess androgen production, you can slow and even reverse hirsutism at the source, making any hair removal methods far more effective in the long run.

A Low Insulin Lifestyle for Hirsutism

While medications can help, the most effective way to treat hirsutism at the root cause is by lowering insulin levels through a Low Insulin Lifestyle.

• High insulin levels are the driving force behind excess androgens, so stabilizing insulin naturally helps rebalance hormones.
• Lower insulin leads to lower testosterone, which reduces stimulation of hair follicles over time.
• Improved insulin sensitivity also reduces inflammation, another contributor to excessive hair growth and poor skin health.

Because hair follicles take time to respond, it typically takes about six months of consistently maintaining low insulin levels before you’ll see changes in hair growth. This is why it’s important to stay consistent and trust the process.

Hirsutism can be frustrating, but understanding the connection between PCOS, insulin resistance, and excess androgens is the first step toward regaining control.