Hirsutism
Last reviewed
Hirsutism is excess coarse, dark, terminal hair growth in women in a typically male pattern — chin, upper lip, sideburns, chest, abdomen, lower back. The most common cause in Indian women is PCOS; less common causes include thyroid disorders, congenital adrenal hyperplasia and rare androgen-secreting tumours. Treatment combines underlying hormonal management with laser hair reduction; lifelong maintenance is often needed.
Hirsutism is one of the most common dermatology concerns for women in their twenties and thirties in Indian clinics, and one of the most under-discussed. Patients often arrive after years of waxing, threading and bleaching, frustrated by hair that returns coarser each cycle.
Most hirsutism in our patient population is PCOS-driven, which means treating the hair without treating the underlying condition gives you ongoing maintenance forever. The most effective approach is coordinated — dermatology plus gynaecology, with bloodwork before either prescribes anything.
How hirsutism shows up
- Coarse, dark hair on chin, upper lip and sideburns
- Chest, abdomen (especially mid-line), lower back hair growth
- Inner thigh and buttock hair growth
- Hair that returns thicker after waxing or threading (an illusion — hair density doesn't actually increase, but consistency feels different)
- Often accompanied by acne along the jawline, scalp hair thinning, irregular cycles (the PCOS pattern)
- Sometimes acanthosis nigricans (dark velvety patches at neck/armpits) signalling insulin resistance
- Onset usually in late teens or twenties; sudden onset after 30 warrants endocrine workup
Common causes
- Polycystic ovary syndrome (PCOS) — by far the most common cause in Indian women
- Idiopathic hirsutism — coarse hair without other PCOS features in some women
- Congenital adrenal hyperplasia (non-classical CAH) — under-recognised, common in some populations
- Thyroid dysfunction
- Cushing's syndrome (rare)
- Androgen-secreting tumours (rare; usually rapid-onset)
- Some medications — anabolic steroids, danazol, certain anticonvulsants
When to see a dermatologist
See a dermatologist if facial or body hair growth has clearly increased, if it's accompanied by irregular periods, acne or weight gain, or if maintenance hair removal is becoming a daily burden. Bloodwork helps before any treatment — hormonal panels and screening for PCOS, thyroid and adrenal causes are usually ordered at the first consult.
How hirsutism is treated at SkinWise
Treatment runs on two parallel tracks. The dermatology side: laser hair reduction (medical-grade diode or Nd:YAG, chosen for skin tone) is the most effective long-term solution for visible hair, with 6–8 initial sessions plus ongoing maintenance because PCOS keeps producing new growth cycles. The endocrine side: anti-androgens (spironolactone, sometimes combined oral contraceptives) reduce new hair growth and often improve acne too — we coordinate with your gynaecologist for the hormonal piece.
Services that treat hirsutism
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Frequently asked questions
Will laser hair reduction work if I have PCOS?
Yes — laser reduces existing hair effectively. The caveat: PCOS keeps producing new hair-growth cycles, so most PCOS patients need maintenance sessions yearly indefinitely. Patients without PCOS often complete a single course and need very little maintenance.
Does laser cause hair to grow back thicker?
No. That's a common misconception from waxing. Laser destroys hair follicles in the active growth phase; properly done, hair that regrows in untreated follicles isn't thicker than baseline. If you're seeing more hair after laser, it's usually from previously dormant follicles cycling into the growth phase — not laser-induced thickening.
Should I start anti-androgens before laser?
Often yes for PCOS patients. Anti-androgens reduce new hair growth, so laser sessions are working against a quieter system. We don't routinely prescribe them ourselves — gynaecology or endocrinology leads, we coordinate.
Is there a permanent cure?
Not for the underlying PCOS, but laser can produce permanent reduction (70–90%) in existing hair. With ongoing maintenance and hormonal management, daily hair removal usually becomes unnecessary within a year of starting treatment.
Ready to start with a consult?
A focused 15-minute first consultation is where we slow down, map your concern and build the smallest plan that will actually move the needle. No oversell, no fixed menu.