It is one of the great injustices of the world that today men with thick, long body hair are considered virile, while women with the same condition must expend a great deal of time and effort removing this unwanted body hair, often resorting to methods like waxing and plucking that are both painful and expensive.

For a percentage of women, this body hair is even harder to ignore because it sprouts up in unusual places - such as across the face, chest, back and abdomen - revealing the presence of hirsutism. Hirsutism can sometimes be the red flag signalling underlying conditions like Polycystic Ovarian Syndrome or cancers (tumours) of the ovary and adrenal glands says Dr. Nalinda Rodrigo, consultant obstetrician and gynaecologist. However, the good news is that once such alternate causes are dismissed, hirsutism is more reason for embarrassment than concern, and can be treated with a combination of medical and cosmetic therapies.

Hairy scary?

We all have hair on our bodies. It protects skin from dirt and germs, provides a buffer for sensitive parts and helps your body regulate its temperature. Androgenic hair, which is most commonly referred to as body hair, first starts growing on the body during and post-puberty. Less visible, but also covering the body, are fine strands of vellus hair. Both are separate from hair that grows on our heads.

Cosmetic treatment for hirsutism: Sticky wax applied to the skin is allowed to harden a little and is then pulled off, against the direction of hair growth. Pic courtesy ehow.com

The amount and distribution of hair across your body is largely determined by your genetic makeup. But if you're a woman who has developed excessive amounts of coarse and pigmented hair on body areas where men typically grow hair, than it's likely you have hirsutism.

A woman with the mildest form of hirsutism may notice significant growth of hair that is mature (the same colour as scalp hair) on the upper lip, chin, sideburn area, around the nipples or lower abdomen. That having been said, a woman's judgement of what is normal and what is hirsute is heavily determined by factors such as culture and race. The impact of cultural norms is seen most obviously in men with hirsutism - a majority will never feel the need to seek any sort of treatment.

Other symptoms of hirutism include a deepening voice, acne, balding, enlargement of the clitoris and increased muscle mass.

What causes hirsutism?

Conditions that can cause high androgen levels include:

Polycystic ovary syndrome (PCOS): Caused by an imbalance of sex hormones, this common condition can result in irregular periods, obesity, infertility and sometimes, multiple cysts on your ovaries. Insulin resistance is also commonly associated with PCOS, and so diabetes is among the conditions that can be linked with hirsutism. Polycystic ovary syndrome is the most common identifiable cause of hirsutism.

Cushing's syndrome: Cushing's syndrome is a condition that occurs when your body is exposed to high levels of the hormone cortisol, a steroid hormone involved in your body's response to stress. It can develop when your adrenal glands - small hormone-secreting glands located just above your kidneys - make too much cortisol, or it can occur from taking cortisol-like medications over a long period. Increased cortisol levels disrupt the balance of sex hormones in your body, which can result in hirsutism.

Tumours: Rarely, the cause of hirsutism may be an androgen-secreting tumour in the ovaries or adrenal glands.

Medications: Some medications such as phenytoin danazole testosterone and glucocorticoids can cause hirsutism.

Diagnosis

A thorough medical history, with special attention to your menstrual cycles, is crucial in diagnosing the causes of hirsutism. A normal cyclic pattern of menstrual periods might indicate that the hirsutism is inherited. If your menstrual cycles are irregular and have always been irregular, the cause could be polycystic ovary syndrome. You will also need to be evaluated for a potentially more serious condition, such as a tumour of the ovary or adrenal glands. Your doctor might also order tests to eliminate the possibility of diabetes.

Women approaching menopause or in the early years of menopause may develop coarse chin or other unwanted facial hair, as a result of the changing hormonal balance in their bodies. This is not generally considered hirsutism.

Treatment

Treatment for hirsutism often involves a combination of self-care methods, hair-removal therapies and using medication. Oral contraceptives are a common treatment for hirsutism in women who don't want to become pregnant. These contain the hormones estrogen and progestin, and treat hirsutism by inhibiting androgen production by your ovaries. Anti-androgens drugs, which block androgens from attaching to their receptors in your body, may also be prescribed. It may take several months of treatment before you begin seeing results. If you have weight problems, controlling obesity and getting some exercise can have positive results. In the meantime, cosmetic treatments might be your best option.

Self-care methods to remove unwanted body hair include:

• Plucking: Using a pair of tweezers and a mirror will help you keep your facial hair in check; however going one hair at a time might strain your patience.
• Shaving: Shaving is quick and inexpensive, but it needs to be repeated on a regular basis since it removes the hair only down to the surface of your skin. Though shaving does not make your hair thicker, the new growth will be stubbly.
• Waxing: Sticky wax applied to the skin is allowed to harden a little and is then pulled off, against the direction of hair growth. If you're willing to put up with the pain, waxing removes hair from a large area quickly. It can sometimes cause skin irritation and redness. Hot wax can also burn your skin.
• Chemical depilatories: Generally available as a cream that you spread on your skin, chemical depilatories work by breaking down the protein structure of the hair shaft. Some people are allergic to the chemicals used in depilatories.
• Bleaching: Instead of removing unwanted body hair, some women prefer to bleach their hair. Bleaching removes the hair pigment, so the hair is less visible against the surface of your skin. Bleaching may cause skin irritation.