It is one of the crueller tricks female hormones play: the same androgen shift that thins the hair on your head grows it on your chin. Hirsutism — coarse, dark hair on the face, chest or stomach — affects up to one woman in ten, spikes around PCOS and menopause, and is treated by many clinics as a cosmetic complaint to be plucked rather than a hormonal signal to be read. It is a hormonal signal, and it responds to hormonal treatment.
Hair GP treats hirsutism the way we treat hair loss: doctor-led, cause-first. We treat the hormones driving the growth with prescription medication and holistic care, and where removal of established hair is wanted — electrolysis being the definitive option — we refer you to trusted local electrolysis specialists we work with, with your hormonal treatment running alongside so the hair they remove stays gone.
- – Facial and body hair in women is androgen-driven — PCOS is the commonest cause, and the hormonal shift of perimenopause and menopause is the classic reason chin hair arrives in your 40s and 50s
- – Medication treats the cause: anti-androgens such as spironolactone reduce new growth — the same mechanism that protects thinning scalp hair
- – Removal treats the result: electrolysis is the only permanent method — we refer to trusted local electrolysis teams rather than offering it in-house
- – The two work best together: medication without removal leaves established hair; removal without medication chases regrowth forever
- – Rapid-onset or severe hirsutism needs proper medical assessment — occasionally it signals something that must not be missed
Why women grow facial hair
Every woman produces androgens — the question is how much, and how sensitive her follicles are to them. Facial follicles respond to androgens in the opposite direction to scalp follicles: androgen exposure miniaturises hair on the crown while it coarsens and darkens the fine vellus hairs of the chin, lip and jaw. So anything that raises androgens, or raises your sensitivity to them, grows facial hair. PCOS is the leading cause in younger women. From the mid-forties the mechanism is subtler: at menopause oestrogen falls faster than testosterone, so the androgen share of the mix rises — which is why chin hairs arrive on the same timeline as crown thinning, and why so many of the women in this clinic have both. Some medicines contribute, and a small group of causes — rapid onset over months, marked virilisation — need prompt, thorough medical assessment, which is one more argument for a doctor reading the picture first.
How hirsutism is treated — cause and result
| Approach | What it does | Where it fits |
|---|---|---|
| Spironolactone | Blocks androgens at the follicle — reduces new coarse growth over 6+ months | First-line medical treatment; doubly useful when scalp thinning coexists |
| Combined hormonal contraception | Lowers ovarian androgen output; co-cyprindiol adds an anti-androgen | Younger women, especially with PCOS, where contraception is also wanted |
| Metformin & lifestyle care | Improves the insulin resistance that drives PCOS androgens | Root-cause work in PCOS — part of our holistic plan |
| Eflornithine cream | Slows the growth rate of facial hair at the skin | A bridge while systemic treatment takes effect |
| Electrolysis | Destroys follicles individually — the only permanent removal | Via our trusted local electrolysis partners, with a referral letter |
| Laser / IPL | Long-term reduction, best with dark hair on lighter skin | Independent providers; they can advise honestly on whether your hair will respond |
Plain statement of scope: Hair GP provides the medical side — diagnosis, blood testing, prescriptions and holistic care. We do not perform electrolysis or laser in-house; we refer to local specialists we trust, and coordinate so the medical and removal work reinforce each other.
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The cruellest pairing: thinning crown, growing chin
If you are losing scalp hair and gaining facial hair, that is not two problems — it is one androgen story told twice, and it should be treated once. The blood work is shared: testosterone, SHBG and the free androgen index, read properly at our blood testing service, with thyroid and iron checked alongside because they complicate both pictures. The treatment is often shared too — spironolactone in particular defends the scalp and quietens the chin with one prescription. This is the practical advantage of a clinic that treats female hormonal hair from both directions: our PCOS clinic and menopause clinic handle exactly this combination every week.
What treatment actually looks like
It starts with the standard fifty-minute consultation: history, examination, and if needed the blood panel your presentation actually requires. Results come back interpreted — not as a PDF — and the plan is written: which medication, what dose, what the holistic work addresses, and honest timelines. The honesty matters here more than anywhere: hair grows in slow cycles, so anti-androgen treatment shows its effect on new growth over six to nine months, not six weeks — existing coarse hairs are already built and are the removal side’s job. If removal is wanted we write the referral to a local electrolysis team we trust, sequenced with the medication so cleared areas stay clear. Review and re-testing keep the plan tuned; where HRT questions ride alongside — they often do at menopause — they are handled in the same room.
What Patients Say
Facial hair is under-discussed and quietly corrosive to confidence, and most women wait years before raising it with anyone. It is treatable, the earlier the better, and raising it takes one phone call that costs nothing: Dr Amy’s free fifteen-minute call.
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Dr Amy Vowler · GMC-registered GP · GMC 7451097
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Androgens — male-pattern hormones every woman produces. Facial hair appears when androgen levels rise or follicles become more sensitive to them: PCOS/PMOS is the commonest cause in younger women, the oestrogen fall of perimenopause and menopause shifts the balance in midlife, and some medicines contribute. Occasionally rapid-onset hirsutism signals an underlying condition that needs prompt investigation, which is why new, fast-developing hair growth deserves a doctor’s assessment rather than a razor and reassurance.
Because oestrogen falls faster than testosterone. Your total androgen level barely changes at menopause, but the oestrogen that used to balance it drops away, so the androgen share of your hormonal mix rises — and facial follicles respond by producing coarser, darker hair. It is the same shift that thins scalp hair at the crown, which is why the two so often arrive together. Both respond to treatment, and where HRT is in the picture its androgen balance is worth reviewing at the same time.
Yes — it is the most used anti-androgen for hirsutism, blocking androgen receptors at the follicle so new growth becomes finer and slower. Two honest caveats: it works on hair that hasn’t grown yet, so the visible effect builds over six to nine months as follicles cycle, and it does not remove the coarse hairs already established — that is what electrolysis is for. Its double action is the appeal for many of our patients: the same prescription that quietens facial growth also protects thinning scalp hair. It requires a prescription and monitoring, which is exactly what the consultation pathway provides.
Yes — electrolysis is the only hair-removal method recognised as permanent, because it destroys each follicle individually with a fine probe rather than suppressing it. The trade-offs are time and patience: follicles are treated one by one over a course of sessions, and hairs must be cycling to be caught. Laser, by contrast, achieves long-term reduction and works best with dark hair against lighter skin. Pairing either with medical treatment of the underlying androgen driver is what stops new follicles replacing the ones removed.
No — and we would rather be straightforward about that. Hair GP provides the medical side of hirsutism care: diagnosis, blood testing, prescription treatment such as spironolactone, and holistic management of drivers like PCOS. For removal of established hair we refer you to trusted local electrolysis specialists we work with, with a referral letter and your treatment plan coordinated so the medical and removal sides reinforce each other. In our experience that combination — cause treated medically, result removed by a dedicated specialist — beats either alone.
A combination, sequenced properly. The hormonal driver responds to anti-androgen medication — spironolactone, or co-cyprindiol where combined contraception suits — while metformin and lifestyle care address the insulin resistance underneath PCOS androgen production. Established coarse hair is then removed by electrolysis or laser, which stays cleared because the medication has quietened new growth. Blood testing first matters: confirming the androgen picture (testosterone, SHBG, free androgen index) makes sure the treatment matches your biology, and our PCOS clinic manages scalp thinning and facial hair as the single hormonal picture they are.
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