Managing facial hair with hormone-aware care
What causes excessive facial hair in women, which hormonal conditions are most common in Nigeria, and what treatment options are available.
Excessive facial hair in women is almost always driven by elevated androgens, and in Nigeria, the most common cause is PCOS, affecting an estimated 10–15% of women of reproductive age. Treating the hair without treating the underlying hormonal cause means the hair comes back.
Facial hair in women: when it's a medical issue
Some degree of facial hair is normal. Hirsutism, excessive, coarse, dark hair in a male-pattern distribution (upper lip, chin, jaw, chest), is different. It affects about 5–10% of women globally and is almost always driven by elevated androgens (male hormones).
Common hormonal causes in Nigeria:
| Condition | Other signs | Prevalence |
|---|---|---|
| PCOS | Irregular periods, acne, weight gain, fertility issues | Most common cause |
| Congenital adrenal hyperplasia (CAH) | Can present at any age | Less common |
| Cushing's syndrome | Weight gain, stretch marks, high BP | Rare |
| Androgen-secreting tumour | Rapid onset, severe virilisation | Rare |
| Idiopathic hirsutism | No hormonal abnormality found | Common |
Diagnostic steps before medication
A hormonal panel is the starting point, not a prescription. The tests to request:
- Hormonal panel: Testosterone (total and free), DHEAS, LH, FSH, prolactin, thyroid function
- Pelvic ultrasound: To check for polycystic ovaries
- Fasting glucose and insulin: PCOS is associated with insulin resistance in 50–70% of cases
Do not start anti-androgen medications without a confirmed diagnosis. The treatment for PCOS-related hirsutism is different from the treatment for idiopathic hirsutism.
Medication options
Combined oral contraceptives (COCs): First-line for PCOS-related hirsutism. Reduce ovarian androgen production. Takes 6–12 months to show visible effect on hair. This is the most common reason women stop too early.
Spironolactone: Anti-androgen; blocks androgen receptors at the hair follicle. Often combined with COCs. Not suitable during pregnancy. Requires reliable contraception.
Metformin: For PCOS with insulin resistance. Reduces androgen levels indirectly by improving insulin sensitivity. Available in Nigeria as Metformin 500mg. Often the first drug prescribed when insulin resistance is confirmed.
Eflornithine cream (Vaniqa): Topical; slows hair growth. Does not remove existing hair. Less commonly available in Nigeria.
Managing long-term hormonal treatment
PCOS is a chronic condition. Anti-androgen and hormonal treatments require months of consistent use. A care plan or chronic care plan ensures your medication supply doesn't lapse mid-treatment. Famasi's women's health medications hub covers available options with delivery across Nigeria.
Six to twelve months is the realistic timeline for visible improvement. The treatment only works if it's taken consistently for that entire period.
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