Your Guide to Unwanted Facial Hair

UFH Unwanted Facial Hair

Learn about UFH: What are the causes? Dealing with UFH: Hair Removal Methods www.canadianskin.ca Prescriptioncanadianskin.ca Therapy1

Contents

Learning about Unwanted Facial Hair ...... 4 What is Unwanted Facial Hair? ...... 5 Do You have Unwanted Facial Hair? ...... 6 Who does Unwanted Facial Hair affect? ...... 7 What are the causes of Unwanted Facial Hair? ...... 8 How is Unwanted Facial Hair diagnosed? ...... 9 The psychological burden of Unwanted Facial Hair ...... 10 What are the approaches to dealing with Unwanted Facial Hair? ...... 11 I. Hair Removal Methods ...... 12 II. Prescription Therapy ...... 14 Taking control of Unwanted Facial Hair ...... 16 What questions should I ask my doctor? ...... 17 Helpful Resources ...... 17 FAQs ...... 18 Glossary ...... 20 Notes ...... 21

canadianskin.ca 3 Learning about unwanted facial hair

nwanted Facial Hair (UFH). UIt can range from a simple nuisance to a severe problem in a person’s life. Those who live with UFH know it’s about more than the hair itself. It’s about the time it takes to remove it; about its effect on intimacy, socializing, and the work environment; and about how uncomfortable and embarrassing it can be. Keep in mind that working together The good news, however, is the more with your healthcare professional will you know about the causes of UFH go a long way in helping you manage and how to manage and treat it, the your UFH symptoms successfully. easier it will be to deal with. This You can become an active partner in booklet provides the information your treatment by learning as much you need to know about UFH and as you can about UFH and how you will point you in the right direction in can manage it through educational handling your UFH. resources, such as this guide. ... the more you know “ about UFH, the easier “ it will be to deal with. 4 canadianskin.ca What is unwanted facial hair? The amount of body hair you have There are, however, various strategies is largely determined by your genetic to help you effectively manage your makeup and varies widely among UFH. Once a medical diagnosis of women. Usually a woman will only UFH is made, you and your physician grow fine hair (peach fuzz) on her lips, can explore the treatment options chin, chest, abdomen, or back. However, available to you. It is, however, important when women grow coarse, dark hairs that your physician first rule out any in these areas, typical of male hair underlying medical conditions. growth, this is a sign of a common yet frustrating condition called hirsutism (HER-soot-iz-um).

While hirsutism can present itself in many areas of the body, this information guide focuses specifically on equipping women with the knowledge to tackle hirsutism on the face or neck also known as Unwanted Facial Hair (UFH).

UFH is a medical condition that causes too much hair to grow on a woman’s face and neck. It typically begins to develop during puberty, however, an inherited tendency, hormonal imbalance, or various medications, can cause it to appear at any age. Sometimes, the cause remains unknown (idiopathic hirsutism). Regardless of the cause, excess hair, especially on the face, can be a source of great distress for most women, leading to anxiety, depression and reduced quality of life. canadianskin.ca 5 Do you have unwanted facial hair? The major sign of Unwanted Facial as your upper lip, cheeks, chin, neck, Hair (UFH) is thick, dark hair mid-chest, inner thighs, abdomen, or appearing on a woman’s face. This low back? hair is typically coarse and pigmented • Do you notice unwanted hair and is different from the hair that growth associated with irregular some women have on their upper lip, menstrual periods? chin, breasts or stomach, or the fine ‘baby’ hair all over their body. • Are you experiencing hot flashes? • Do you notice an increase in the While stray hairs on your face and amount of acne on your face or neck may be not a cause for concern, body? your doctor can help you understand • Do you suspect there are physical when UFH is a result of an underlying issues affecting your fertility or medical condition. limiting your ability to conceive? It is important to pay attention to • Do you notice any unwanted the development of other signs and hair growth that appears to be symptoms in addition to UFH. Here worsened from a medication? are a few simple questions that may help you determine whether you are If you answered ‘yes’ to any of the experiencing symptoms that require above questions, make sure to see you to seek medical advice. your healthcare professional to discuss your symptoms so Answer ‘yes’ or ‘no’ that you can be to the following properly diagnosed, questions: rule out any other • Do you notice underlying medical rapidly growing, conditions, and unwanted hair help you to decide on places such the best treatment approach for you. 6 canadianskin.ca Who does unwanted facial hair affect?

nwanted Facial Hair (UFH) can These include: affect women of all ages, skin Utypes or hair colour and can • Family history be a source of considerable emotional Several conditions that cause distress and social embarrassment. UFH run in families. These conditions, including congenital UFH can have a detrimental impact adrenal hyperplasia and polycystic on a woman’s physical confidence and ovary syndrome, are discussed quality of life, as it contradicts common further in this booklet. cultural and social perceptions of what is physically attractive or acceptable. • Ethnicity Women of Mediterranean, Middle Several factors may influence your Eastern and South Asian ancestry likelihood of developing UFH. are more likely to develop UFH with no identifiable cause than are women of other ethnicities.

canadianskin.ca 7 What are the causes of unwanted facial hair? Unwanted Facial Hair (UFH) growth in women can be caused by a number of issues. Most commonly, these issues are related to either a hormonal imbalance or the impact of various medications. Sometimes, however, the cause remains unknown (idiopathic hirsutism).

Hormonal Imbalance Congenital adrenal hyperplasia All women normally produce low This inherited condition is characterized levels of male hormones (androgens). by abnormal production of steroid Unwanted Facial Hair (UFH) growth hormones, including cortisol and in women may occur when the body androgen, by your adrenal glands. makes too much male hormone. Conditions that can cause high Menopause androgen levels include: As hormone levels, and even weight, change during and after menopause, Polycystic Ovary Syndrome (POS) some women may find they develop POS is one of the most common UFH. identifiable causes of hirsutism. This condition is caused by an Other rare conditions imbalance of sex hormone levels in Rarely, tumors in the ovaries or adrenal a woman’s body that may result in gland, formed when abnormal cells irregular periods, acne, obesity, infertility grow out of control and clump together, and sometimes multiple cysts on the may cause UFH. ovaries. Medication Cushing’s Syndrome Some medications can cause UFH. This is a condition that occurs when These medicines include hormones, your body is exposed to high levels anabolic steroids and some of the hormone cortisol, a steroid immunosuppressive drugs. hormone involved in your body’s response to stress. It can develop when Idiopathic your adrenal glands – small hormone- Sometimes, there is just no identifiable secreting glands located just above your cause. Excessive facial hair growth in kidneys – make too much cortisol, or women with normal androgen levels, it can occur from taking cortisol-like regular menstrual periods and no other medications over a long period of time. underlying conditions is called idiopathic Increased cortisol levels disrupt the hirsutism. This occurs more frequently balance of sex hormones in your body, in certain ethnic populations, such which can result in UFH. as women of Mediterranean, Middle Eastern and South Asian ancestry. 8 canadianskin.ca How is unwanted facial hair diagnosed?

A number of healthcare professionals may help determine whether may be involved in the diagnosis, your UFH is caused by elevated treatment and management of androgen levels. Unwanted Facial Hair (UFH), including: • General practitioners/family doctors Further testing. • Dermatologists 3. The extent of further testing • Gynecologists you’ll undergo depends on the • Endocrinologists severity of your UFH and any other associated symptoms. If In order for your doctor to make a androgen levels in your blood diagnosis of UFH you will first need to are elevated, you may undergo discuss your medical history. Your doctor imaging tests. These may may ask you about your menstrual include: cycles, the time of onset of your • Ultrasound. This imaging symptoms, whether you’re taking any test uses high-frequency medications and whether you have a sound waves to produce family history of certain conditions. pictures of your body’s Your doctor is likely to: internal structures. An ultrasound of the ovaries or Perform a physical exam. adrenal glands may be 1. Your doctor will examine your performed to check for face. He or she may also tumors or cysts. conduct a physical examination to check for other signs of • Computerized tomography androgen excess and for (CT) scan. A CT scan is a conditions that can result in a type of X-ray test that hormonal imbalance. provides cross-sectional images of your internal Order blood tests. organs. A CT scan of your 2. Tests that measure the amount body may be used to of certain hormones in your evaluate the adrenal glands. blood, including testosterone, canadianskin.ca 9 The psychological burden of unwanted facial hair

Your dermatologist and family physician will appreciate if you are open and honest about how you feel, not only physically, but emotionally, socially and psychologically. He or she will be able to confirm what you have is a common condition and that you are not alone. t should come as no surprise to the Most importantly, they will be able I many women affected by excessive to help you to understand that your facial hair growth that the unwanted feelings are in fact valid. hair is only one part of the challenge. Dealing with Unwanted Facial Hair Studies report the anxiety and (UFH) can involve much more than depression associated with excessive simply the efforts to remove the hair. facial hair can affect quality of life in much the same way as a diagnosis of UFH can be emotionally distressing for gynecological or breast cancer. Taking some women. In fact, in a recent survey, steps to treat UFH has been shown to the vast majority of UFH sufferers help restore confidence and contribute surveyed (91%) agreed that UFH can to the overall well-being of those who have a negative effect on someone’s are affected by it. quality of life. Speak up: take charge of your overall Many women with UFH feel extremely health by addressing the issues, like UFH, self-conscious about having UFH and that affect your day-to-day happiness. are even uncomfortable discussing it You are your best health advocate. with others including their own family doctor or other healthcare professional.

10 canadianskin.ca What are the approaches to dealing with unwanted facial hair?

A number of treatment options are available to help you manage your Unwanted Facial Hair (UFH). The kind of treatment or combination of treatments you decide upon depends on you, the severity of your UFH, and the commitment you are willing to make to effectively manage it. By raising this subject with your physician you will be able to benefit from an open discussion on the best course of action for you.

Remember that before starting any treatment regime it is important to Treatment first rule out any underlying medical There are numerous ways to remove condition. If you are experiencing a or treat UFH. Available options can vary rapid increase or sudden onset of facial in effectiveness, degree of discomfort, hair growth, and signs of increased male and cost. Treatment for UFH most often characteristics, make sure to first see involves a combination of hair removal your physician. methods and medications. Therefore, a solid understanding of the various Prevention pros and cons of each treatment is a While Unwanted Facial Hair (UFH) worthwhile exercise as part of your generally isn’t preventable and tends to decision-making process. This guide will be a long-term issue, a logical starting provide you with an overview of the point is to determine if there are ways various treatments available by grouping to control it. If you are overweight, them into the following categories: losing weight will be key to reducing the amount of hormones in your body that 1. Hair Removal Methods are associated with increased facial hair 2. Prescription Therapy growth. canadianskin.ca 11 Hair Removal Methods Hair removal methods to deal with Unwanted Facial Hair (UFH) include depilatories, which remove hair above the surface of the skin and epilatories, last forever, it is the most common which remove the entire hair method women use to get rid of including the part below the skin. UFH. Examples include: • Waxing. Waxing involves applying warm wax on your skin where the Depilatories unwanted hair grows. Once the wax • Shaving. Shaving is quick hardens, it’s pulled back from your and inexpensive, but it skin against the direction of hair needs to be repeated regularly since growth, removing hair. Waxing may it removes the hair only down to the sting temporarily and sometimes surface of your skin. causes skin irritation and redness. Results usually last a few weeks. • Chemical depilatories. Generally available as gels, lotions or creams • Threading. Is an ancient method of that you spread on your face, hair removal originating in the Eastern chemical depilatories work by world. Practitioners use a pure, thin, breaking down the protein structure twisted cotton thread which they roll of the hair shaft. Some people are over areas of unwanted hair, plucking allergic to the chemicals used in the hair at the follicle level. Unlike depilatories. tweezing, where single hairs are pulled out one at a time, threading can • Bleaching. Instead of removing remove an entire row of hair, resulting UFH, some women use bleaching in a straighter line. As a larger area of agents. Bleaching removes the hair hair is removed at once, however, it color, making the hair less visible can be relatively painful. against some skin tones but potentially more noticeable on darker • Sugaring. Is used in much the same skin. Bleaching may cause skin way as traditional waxing for irritation, so test the bleach on a small removing UFH although the area first. ingredients used are few in number and all natural typically consisting Epilatories of sugar, lemon and water. Proponents of sugaring say that it can • Plucking. Also referred to as tweezing, be done more frequently than plucking is a good method to remove waxing with the same benefits and a few stray hairs, but is not useful for that it causes less skin irritation removing a large area of hair. While among other benefits. plucking may hurt a little and doesn’t 12 canadianskin.ca • Home electrolysis. These tools work that requires many repeat treatments. by applying an electric current It is best used for small areas. through a pair of tweezers. They are Laser Therapy good for small areas, and are quick but can be painful. Results may last Laser therapy is a procedure in which for many weeks or months. These a beam of highly concentrated light kits can be costly and may produce (laser) is passed over your skin to skin discoloration. disable the hair follicles and prevent hair from growing. With laser there is Other facial hair removal treatments permanent hair reduction and in some can offer numerous advantages and, cases permanent removal. Lasers work although they tend to be expensive, best for those with fair skin and dark their popularity has made them more hair. Individual sessions can last from a widely available with many estheticians few minutes to a few hours, depending and spas. on the size of the area being treated. Hair on the upper lip and particularly The risk is that the level of expertise on the chin may need many treatments and competence of the practitioner is as they are in very hormone sensitive sometimes questionable. Not all laser parts of the skin. However, a treatment treatments need to be performed by for the upper lip takes only about a a doctor but it is advisable that the minute. After treatment, some people treatment be administered in a facility experience long periods without hair when there is a doctor present on re-growth, while others may need site to supervise the therapy and to occasional touch ups to remain hair- ensure that any adverse side effects are free. In between treatments the hair properly dealt with. The most common is trimmed or shaved as the melanin facial hair removal therapies include: target, which is the hair root, has Electrolysis to be present for the laser light to This type of therapy involves inserting be absorbed. Laser therapy can be a tiny needle into each hair follicle and uncomfortable, it may cause redness emitting a pulse of electric current to and swelling and can, in rare cases, cause damage and eventually destroy the burns or color changes in your skin. follicle. Electrolysis results in permanent This can be minimized by not treating hair removal, but the procedure can be the skin if it is tanned. While the cost painful. Some numbing creams may be of laser treatment can be high it may in spread on your skin to many instances be more cost effective reduce this discomfort. due to the longer-term benefits. The Side effects include most important thing is that the correct lightening or darkening laser is used in the right situation and of the treated skin and, at the appropriate power setting. rarely, scarring. As one Make sure to do your research and hair is treated at a time select a facility with a great reputation it is a very slow process and experienced staff. canadianskin.ca 13 Prescription Therapy

Two classes of prescription therapies, used to treat hormonal issues, are also used to help manage Unwanted Facial Hair (UFH). The first are hormone blockers, which are drugs that inhibit androgens (male hormones) from working on hair growth. The second are growth inhibitors, which are drugs that block enzymes in the hair itself to inhibit growth. menstrual periods, Hormone Blockers electrolyte disturbances and diarrhea. Because these drugs can Oral contraceptives. • Birth cause birth defects, it’s important control pills, or other hormonal to use good contraception while contraceptives, containing the taking them. Do not take this drug hormones estrogen and progestin, if you think you are or may become treat UFH by inhibiting androgen pregnant. production by your ovaries. Oral contraceptives are a common • Anti-diabetic. Metformin, a drug treatment for UFH in women who normally used in the treatment of don’t want to become pregnant. diabetes, has in recent years shown Possible side effects include to be beneficial in women with dizziness, nausea, headache, and polycystic ovarian syndrome, a key stomach upset. cause of UFH. • Anti-androgens. These types of drugs block androgens from Growth Inhibitors attaching to their receptors in your • Eflornithine hydrochloride. A body. The most commonly used topical cream which is applied to anti-androgen for treating UFH is the skin, called eflornithine spironolactone. Anti-androgens hydrochloride, is the first topical usually take at least three to six prescription medication that has months to work. They can decrease been approved by Health Canada the amount of new hair growth, specifically for slowing the growth but they are less likely to change of UFH in women. It is indicated the amount of hair you already for use along with other hair have. Possible side effects include removal techniques. drowsiness, nausea, irregular Eflornithine hydrochloride

14 canadianskin.ca is not a depilatory and What to expect from medication. does not If you begin taking medication for permanently UFH, it will take some time remove hair or before you will notice a “cure” UFH. difference in facial hair What it does is growth. Follow your reduce or doctor’s instructions, slow down the ask questions, and hair growth to share your feelings improve the about the results condition. It you are seeing. is applied twice a day to the If you and your area to be treated doctor aren’t able to and, when combined find a medication that with other hair removal works well for you, he or techniques, such as the ones she may recommend that you described above, enhances the see a doctor who specializes in skin overall effectiveness of other disorders such as a dermatologist, if treatment types. you haven’t already seen one.

canadianskin.ca 15 control Taking of unwanted facial hair

Hopefully, this booklet has answered menstrual cycle and in your sex life. most of your questions about Unwanted Facial Hair (UFH) and • Make a list of all medications, has helped provide you with enough vitamins, creams or supplements information to understand your you’re taking or have used in the past. symptoms and feel comfortable talking Include the specific name and dose of to your healthcare professional. these medications and how long you’ve been taking them. While you’re likely to start by seeing your family doctor or a general • Take a family member or friend practitioner, you may be referred to along, if possible. Sometimes it can be someone who specializes in endocrine difficult to take in all the information disorders (endocrinologist) or skin provided to you during an issues (dermatologist). Here are some appointment. Someone who pointers to help you prepare for your accompanies you may remember appointment. something you missed or forgot. • Be aware of pre-appointment • Write down questions to ask your restrictions, specifically if there’s doctor. anything you need to do to prepare. If you’ve scheduled an appointment • Write down your symptoms, including with your doctor to talk about excessive any that may seem unrelated. facial hair growth, you may already have tried and been disappointed with at- For example, if you’ve been feeling home treatments. Because your doctor depressed or fatigued lately, tell your will want to see your hair growth doctor. Also tell your doctor about pattern, it’s best to avoid trying new any other changes in your at-home treatments in the days leading appearance, such as weight gain or up to your appointment. It’s natural to loss, changes in your breast size or feel distressed by the effect the UFH muscle mass, new acne, or patches of has on your appearance, but in most dark, velvety skin. cases, your doctor will be able to help • Write down key personal information, you find a treatment plan that is right including any changes in your for you. 16 canadianskin.ca What questions should I ask my doctor?

Preparing a list of questions will help • I have these other health conditions. you make the most of your time with How can I best manage them your doctor. For Unwanted Facial Hair together? (UFH), some basic questions to ask • Are there any restrictions I need to your doctor include: follow? • What is likely causing my symptoms • Should I see a specialist? or condition? • Are there brochures or other printed • What are other possible causes? material that I can take home with • Is it normal that my UFH is impacting me? What websites do you my self-confidence and overall recommend? happiness? Don’t hesitate to ask your doctor any • What kinds of diagnostic tests do I other questions you have about your need? condition. • What are my treatment options? • If the first treatment I try isn’t Helpful Resources effective, what will we try next? Here are a few other resources that • How much will treatment improve you may find helpful in your search my physical signs and symptoms? for information or additional skin care • Will I need to be treated long term? related resources: • What are the possible side effects • Canadian Skin Patient Alliance (CSPA): of the medications you’re www.canadianskin.ca recommending? • Society of Obstetricians and • Will the medications you’re Gynaecologists of Canada: recommending affect my ability to www.sogc.org have children? • Canadian Dermatology Association: • How will you monitor my response www.dermatology.ca to treatment over time? • Skinergy: UFH Patient Community • Are there alternatives to the primary www.skinergy.ca/ufh approach you’re suggesting? canadianskin.ca 17 FAQs: Answers to your most frequently asked questions.

1. Is Unwanted Facial medical condition, warranting a visit Hair (UFH) a common to your healthcare professional. Q condition? 3. Why am I developing UFH is a fairly common UFH now as an adult? A condition affecting Q between 5 per cent and 15 per cent UFH growth in adult of women. At least 5 per cent of women can result from women of reproductive age suffer A abnormally high levels from this ailment. Experts often of male hormones (androgens) or consider these figures to be an from an increased sensitivity of your underestimation. hair follicles to these androgens. In addition to a possible hormonal 2. How serious is this imbalance, various medications can condition? cause UFH to appear. Sometimes, Q the cause remains unknown. In general, UFH is a harmless condition. A Yet, it can be a source of considerable emotional distress and social embarrassment impacting a woman’s body image and quality of life. While it can vary in terms of severity from one individual to another, in some cases the appearance of UFH may be a sign of a more serious underlying

18 canadianskin.ca 4. I am so embarrassed are willing to dedicate to effectively by my facial hair, what manage it. Q can I do? 6. What While there happens if I are no Q discontinue A permanent my treatment? solutions for UFH and generally it isn’t Depending preventable, there on your type are many treatment A of treatment, options that can if you discontinue the considerably improve treatment, the UFH the condition. Read may eventually return more about “What are the to pretreatment levels. Every Approaches to Dealing with UFH”(pg. person, however, is unique, so your 11) in this booklet as well as speak to experience will be personal to you. your healthcare professional about your options.

7. How do I know if my 5. What is the best treatment is working? Q treatment available? Q There is no The best indication of one best treatment efficacy is A treatment A how you feel about the available for results. Every person will respond managing your UFH. to treatments differently. If you The treatment or have questions about the results combination of you are seeing, speak with your treatments you physician. Remember to do decide upon really your part, and carefully depends on you, follow the treatment the severity of your plan provided by UFH and the time your healthcare commitment and professional. resources you

canadianskin.ca 19 Glossary

Hair Follicles A skin organ that produces hair. Attached to the follicle is a sebaceous gland. This is a tiny sebum-producing gland found everywhere except on the palms, lips and soles of the feet. The thicker the density of the hair, the more the number of sebaceous glands that are found.

Facial Hirsutism A condition characterized by the changes during menopause that cause presence of excess terminal (coarse) a reduction in estrogen in the body. hairs on the face of females in a Facial hair growth may be particularly pattern typically seen in adult males. evident in women who are not taking an oral form of hormone replacement. Idiopathic A common cause of UHF, it is present Polycystic Ovarian Syndrome (PCOS) in up to 15 per cent of women who A common cause of UFH, it is a have UFH and who have no evidence syndrome of symptoms and signs of of elevated androgen levels. The ovarian dysfunction with the cardinal androgen excess will be found only features of hyperandrogenism and locally around the hair follicle. polycystic ovarian morphology. PCOS affects between 3 per cent and 15 per cent of women irrespective of their Menopause ethnic background. 70 per cent and A common cause of UFH. Some 80 per cent of women with PCOS women may experience a worsening have hirsutism. of their UFH after menopause because of the hormonal

20 canadianskin.ca Notes

canadianskin.ca 21 Notes

22 canadianskin.ca canadianskin.ca 23 We wish to acknowledge Dr. Charles Lynde for his collaboration in assuring the medical accuracy of the information provided.

Your Guide to Unwanted Facial Hair (UFH) has been made available as a patient education resource to enhance knowledge and information on UFH, thanks to an educational grant from Triton Pharma Inc.

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