Excess Body Hair

This is defined as excess growth of terminal hair in women in male distribution sites (i.e. chin, cheeks, upper lip, lower abdomen and thighs). It presents as a cosmetic problem. Ethnic origin must be taken into account: Mediterraneans and Indians grow more than Nordics. Japanese, Chinese and American Indians grow the least. In the UK, according to surveys, up to 15% of women believe they have excess body hair, although only a minority present to the GP.

Published: 2nd August 2022 | Updated: 15th August 2022

Differential diagnosis

Common Diagnoses

  • Constitutional (Physiological)
  • Polycystic Ovary Syndrome (PCOS): 50% of Cases
  • Anorexia Nervosa
  • Menopause
  • Iatrogenic (e.g. Phenytoin, Minoxidil, Danazol, Glucocorticoids)

Occasional Diagnoses

  • Congenital Adrenal Hyperplasia (1 in 5000)
  • Anabolic Steroid Abuse
  • Ovarian Tumours: Arrhenoblastoma, Hilus Cell Tumour, Luteoma
  • Adrenal Tumours: Carcinoma and Adenoma
  • Congenital (1 in 5000 Live Births) and Juvenile Hypothyroidism

Rare Diagnoses

  • Acromegaly (Incidence 3 Per Million)
  • Porphyria Cutanea Tarda
  • Cushing’s Syndrome (Incidence 1–2 Per Million)
  • Hypertrichosis Lanuginosa
  • Cornelia De Lange Syndrome (Amsterdam Dwarfism)

Ready reckoner

Key distinguishing features of the most common diagnoses

Excess Vellous HairNoNoYesNoPossible
Facial HirsutismPossiblePossibleNoYesPossible
Otherwise WellYesYesNoPossiblePossible
Weight LossNoNoYesNoNo

Possible investigations

Likely: None.

Possible: Serum testosterone, SHBG, pelvic ultrasound, FBC, U&E, TFT.

Small Print: FSH/LH, other tests of endocrine function and specialised imaging techniques (for adrenal/pituitary disorders), urinary porphyrins.

  • Serum testosterone and SHBG: Probably the most useful investigation. Mild elevation (up to three times the normal value) and normal or low SHBG suggests PCOS; testosterone levels above this indicate a possible tumour.
  • FBC, U&E: Possible iron deficiency anaemia and electrolyte disturbance in anorexia; U&E may be deranged in adrenal disorders.
  • FSH/LH and TFT: The former may help to confirm menopause and may point towards PCOS (elevated LH, normal FSH); the latter reveals hypothyroidism.
  • Other tests of endocrine function and imaging techniques: To investigate possible adrenal and pituitary disorders (usually undertaken in secondary care).
  • Pelvic ultrasound: Multiple ovarian cysts characteristic of PCOS; may also reveal ovarian tumour.
  • Urinary porphyrins: For porphyria.

Top Tips

  • Mild, long-standing hirsutism does not require investigation.
  • Enquire about self-medication, especially in athletes – anabolic steroids may occasionally be the cause.
  • Take the problem seriously and be prepared for questions about cosmetic treatments such as bleaching, depilatory creams and electrolysis.

Red Flags

  • Sudden and severe hirsutism is the most important marker for serious underlying pathology.
  • Other clues suggesting a possible hormone-secreting tumour include amenorrhoea, onset of baldness at the same time as hirsutism and a patient who seems generally unwell.
  • Consider psychological factors: Hirsutism can cause – or be the presenting complaint in – significant depression.
  • Recent onset of significant headache and visual field defect raise the possibility of a pituitary adenoma.
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Website disclaimer

Pulse Reference is based on the best-selling book Symptom Sorter.

The experts behind Pulse Reference are Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse’s editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.

This website is for clinical guidance only and cannot give definitive diagnostic information. Practitioners should work within the limits of their individual professional practice, seek guidance when necessary and refer appropriately.