What are the treatment options for hirsutism (excessive facial hair) and their advantages?

From the Guidelines

For unwanted facial hair, I recommend considering a combination of medical interventions, such as oral contraceptives and antiandrogen drugs (spironolactone; flutamide; finasteride), as the most effective treatment approach. This is based on the guidelines released by the American College of Obstetricians and Gynecologists, as reported in the American Family Physician journal 1. The combination of an antiandrogen and an ovarian suppression agent appears to be effective in women with Polycystic Ovary Syndrome (PCOS), although the best oral contraceptive pill or antiandrogen agent is not known.

Some key points to consider when treating facial hair include:

• Mechanical removal of hair (e.g., plucking, shaving, waxing) can provide temporary relief, but may not be a long-term solution
• Electrolysis and laser vaporization can be effective, but may require multiple treatments and can be impractical for removing large numbers of hairs
• Topical eflornithine hydrochloride cream is the only FDA-labeled treatment for hirsutism, but its benefits and risks in women with PCOS are unknown
• Insulin-sensitizing agents may also be used to treat hirsutism, particularly in women with PCOS

It's essential to note that the primary treatment for hirsutism in PCOS has not been established, and treatment is often palliative rather than curative. Therefore, a combination of medical interventions, along with mechanical removal of hair, may be the most effective approach. As reported in the American Family Physician journal, concomitant medical management directed at reducing androgen levels usually is necessary 1.

When choosing a treatment, consider factors such as skin type, hair color, budget, and pain tolerance. It's also crucial to address underlying hormonal imbalances, particularly in women with PCOS, to achieve optimal results. Spironolactone (50-200mg daily) may be prescribed to reduce androgen effects, but it's essential to consult with a healthcare professional to determine the best course of treatment.

From the FDA Drug Label

VANIQA (eflornithine hydrochloride) Cream, 13.9% is indicated for the reduction of unwanted facial hair in women. Approximately 32% of patients showed marked improvement or greater (protocol definition of clinical success) after 24 weeks of treatment with VANIQA (eflornithine hydrochloride) Cream, 13.9%, compared to 8% with the vehicle. VANIQA statistically significantly reduced how bothered patients felt by their facial hair and by the time spent removing, treating or concealing facial hair.

The pros of using eflornithine (VANIQA) for facial hair treatment include:

• Reduction of unwanted facial hair in women, with approximately 32% of patients showing marked improvement or greater after 24 weeks of treatment 2
• Statistically significant improvement in patient-observable differences, such as reduced bother from facial hair and time spent removing, treating, or concealing facial hair, as early as 8 weeks after initiating treatment 2
• Indicated for use on the face and adjacent involved areas under the chin of affected individuals 2

From the Research

Facial Hair Treatment Options

• Various treatment options are available for unwanted facial hair, including plucking, waxing, depilatories, bleaching, shaving, electrolysis, laser, intense pulsed light (IPL), and eflornithine 13.9% cream 3
• Eflornithine 13.9% cream is a topical treatment that reduces the rate of hair growth and is effective for unwanted facial hair on the mustache and chin area 3
• Combination therapy with laser and topical eflornithine may be used to give the patient the best chance for successful hair removal 3, 4

Hirsutism Treatment

• Hirsutism is a common disorder affecting between 5 and 15% of the population, characterized by excessive growth of terminal hair in a typical male pattern in females 5, 4
• Treatment of hirsutism involves a two-pronged approach: treating the underlying cause and reduction of visible hair 4
• Pharmacological therapies, such as combined oral contraceptives, finasteride, spironolactone, and topical eflornithine, may be used to treat hirsutism 5, 6
• Hair removal methods, such as shaving, waxing, and plucking, may be effective but have temporary effects 5, 7

Effectiveness of Treatment Options

• There is low quality evidence that spironolactone 100 mg daily is effective in reducing Ferriman-Gallwey scores, a measure of hirsutism severity 6
• Flutamide 250 mg twice daily appears to be effective in reducing Ferriman-Gallwey scores, but the evidence is low to very low quality 6
• Finasteride 5 mg daily shows inconsistent results in different comparisons, and no firm conclusions can be made about its effectiveness 6
• Metformin is ineffective for hirsutism, and GnRH analogues have significant side effects and inconsistent results in reducing hirsutism 6

Combination Therapy

• Combination therapy with laser and topical eflornithine may be used to give the patient the best chance for successful hair removal 3, 4
• Combination therapy with pharmacological agents and hair removal methods may be effective in treating hirsutism 5, 6
• Further research is needed to determine the effectiveness of combination therapy and to identify the most effective treatment options for hirsutism 6