Excess hair

1. Dark hair on your upper lip? Shave your legs every week? Then you may suffer from excessive hair. What is the cause and what different treatments are there?

1. There are two forms of excess hair: hypertrichosis and hirsutism. They usually occur individually, but sometimes in combination. Hypertrichosis is excessive hair growth in places where there is already some natural hair growth.

Above average hair growth

1. Fine hairs appear on the face, at the temples and at the eyebrows. Hair on the arms are longer and their number is growing. The lower legs and trunk are usually more hairy. This above-average hair growth is undesirable, but usually falls under the 'normal variation'. Hypertrichosis occurs in both men and women and develops at the end of puberty. We speak of hirsutism when female hair growth occurs in places where usually only men develop hair. A lot of hair then appears in areas where women usually only have down hair: on the upper lip, cheeks, chin and neck, around the nipples, on the chest, the back, the abdomen and in the groin area. Hair growth is also stronger on arms and legs and the hairs are somewhat thicker. Mild hirsutism in women is normal, especially after menopause. Almost all older women have to shave their "mustaches" and get hairs on the chin.

2. Fine hairs appear on the face, at the temples and at the eyebrows. Hair on the arms are longer and their number is growing. The lower legs and trunk are usually more hairy. This above-average hair growth is undesirable, but usually falls under the 'normal variation'. Hypertrichosis occurs in both men and women and develops at the end of puberty. We speak of hirsutism when hair growth occurs in women in places where usually only men develop hair. A lot of hair then appears in areas where women usually only have down hair: on the upper lip, cheeks, chin and neck, around the nipples, on the chest, the back, the abdomen and in the groin area. Hair growth is also stronger on arms and legs and the hairs are somewhat thicker. Mild hirsutism in women is normal, especially after menopause. Almost all older women have to shave their "mustaches" and get hairs on the chin.

Just bad luck

1. If the cause of the excessive hair growth is unknown, the medical term is primary or idiopathic hirsutism. Both hypertrichosis and hirsutism can occur without a clearly identifiable 'abnormality' or disease. You just have the 'bad luck' that you are quite hairy. And that usually applies to the rest of your family as well. Hair is also strongly linked to descent. Fair-skinned Northern European women usually have little noticeable body hair, while Mediterranean women have more hair. Many Eastern women epilate their facial hair weekly. In a few cases there is a clear congenital cause. Sometimes a baby already has one excessively hairy spot at birth, for example a very hairy, large birthmark (Tierfell nevus). In some families, "werewolf syndrome," a genetic predisposition to an extreme form of hypertrichosis, in which almost the entire body is covered with hair, occurs.

2. If the cause of the excess hair is unknown, the medical term is primary or idiopathic hirsutism. Both hypertrichosis and hirsutism can occur without a clearly identifiable 'abnormality' or disease. You just have the 'bad luck' that you are very hairy. And that usually applies to the rest of your family as well. Hair is also strongly linked to descent. Fair-skinned Northern European women usually have little noticeable body hair, while Mediterranean women have more hair. Many Eastern women epilate their facial hair weekly. In a few cases there is a clear congenital cause. Sometimes a baby already has one excessively hairy spot at birth, for example a very hairy, large birthmark (Tierfell nevus). Some families have "werewolf syndrome," a genetic predisposition to an extreme form of hypertrichosis, in which almost the entire body is covered with hair.

Hormone imbalance

1. The most common cause of hirsutism is hormone imbalance. Some women with hirsutism have elevated levels of androgens or testosterone, male hormones, in the blood. Overproduction of these hormones can take place in the adrenal cortex (rare) and ovaries. A relatively common cause is PolyCystic Ovarian Syndrome (PCOS), where menstruation is also irregular. Less often, a hormone-producing tumor is the culprit. Patients with hormonal hirsutism also sometimes have other symptoms of masculinization, such as a lower voice, enlargement of the muscles and clitoris, and little breast tissue. Much more often the hair follicles are simply hypersensitive to a normal amount of male hormones. For example, a normal testosterone level can still cause increased hair growth.

2. The most common cause of hirsutism is hormone imbalance. Some women with hirsutism have elevated levels of androgens or testosterone, male hormones, in the blood. Overproduction of these hormones can take place in the adrenal cortex (rare) and ovaries. A relatively common cause is PolyCystic Ovary Syndrome (PCOS), where menstruation is also irregular. Less often, a hormone-producing tumor is the culprit. Patients with hormonal hirsutism also sometimes have other symptoms of masculinization, such as a lower voice, enlargement of the muscles and clitoris, and little breast tissue. Much more often the hair follicles are simply hypersensitive to a normal amount of male hormones. For example, a normal testosterone level can still cause increased hair growth.

Medicines as cause

1. There are some medications that can cause excessive hair. The most important are the hormone preparations that menopausal women use for menopausal symptoms. Anabolic steroids, the muscle-strengthening 'gym pills', can also cause hirsutism. In patients who use Cyclosporine (an immune suppressor) after an organ transplant, excessive hair is a (lifelong) side effect.

Smooth is the norm

1. In our society, body hair is seen as undesirable. Glossies show smooth legs, bare armpits and no downy hair on the upper lip. Today it is also very common among young women to shave the vulva smooth. Hair removal is of all times and all cultures. Already in ancient Egypt, body hair was removed with the help of a depilatory cream and tweezers. Oriental women work wonders with threads to depilate their faces. Many people find smooth skin not only beautiful and pleasant, but also more hygienic. This excess hair is therefore a major problem for women with hirsutism. They are ashamed of their hairy legs and face. They spend a lot of money and time shaving and waxing or bleaching their dark leg hair. For some, excess hair dominates their entire life. They even get psychological problems and do not dare to leave the house.

Hormone treatment

1. Hirsutism does not go away by itself. During pregnancy, under the influence of the higher amount of female hormones, some improvement may occur. If you find the excess hair cosmetically very disturbing, you should first have a doctor or family doctor investigate the cause. An excessively high level of male hormones can be tackled medicinally. The birth control pills Diane-35 or Minerva often give good results. Diane-35 contains cyproterone acetate, a hormone similar to the female sex hormone progesterone. It is also anti-androgenic, that is, it counteracts the action of male sex hormones. An (additional) treatment with cyproterone acetate (brand name Androcur) is a second solution. With a hormone treatment, hair growth diminishes after six months to a whole year and / or the existing hairs become thinner. In principle you can continue the hormone treatments for a very long time. Obviously, you shouldn't use these hormones if you're trying to get pregnant or breastfeeding.

Remove excess hair

1. If there is no hormonal cause, you can remove the excess hair. There are two different ways: depilation methods and epilation methods. In depilation, the hair is removed at some point in the hair shaft. Then you can shave the hair or pull it loose with resin. Depilation with (chemical) hair removal creams also falls under depilation. With epilation, the hair including the hair follicle is removed or destroyed. The hair follicle is then permanently destroyed and no hair will ever grow back. Dark hair is best removed with laser. The light from the laser only penetrates the pigment cells in the hair roots and is then converted into heat. The follicle is then 'boiled', as it were, and dies. The so-called 'flash lamps' work in a similar way. Multiple treatments are required with lasering, because the hair root is only sensitive to the laser in the growth phase. Because gray or light blond hair contains hardly any pigment, they cannot be heated with a laser. Electric epilation is the best solution for light hair removal. A skin therapist or specialist beautician inserts a thin needle into the skin pore of the hair and applies power for a few seconds. Then the follicle dies. A big advantage of this technique is that each hair can be treated separately. That is also the disadvantage, because it is a very time-consuming and sometimes painful process. The social consequences of hirsutism can be so drastic that there is a medical necessity for hair removal. Laser hair removal and electric facial epilation for women are in most cases (fully or partially) reimbursed. Sometimes it depends on an additional insurance package. You must then apply for the treatment with a medical statement from a general practitioner or dermatologist.