Bravery of the bearded lady: Getting to the root of a taboo female condition
10:49 GMT, 2 December 2012
Last week,TV’s This Morning featured a ‘Movember’ moustache-grower with a difference. Siobhain Fletcher sported the kind of facial hair many men struggle to achieve. I was shocked, not by the fact she had a goatee, but that she was brave enough to admit it.
The 36-year-old housewife from Leek, Staffordshire, agreed to appear on television to raise money and awareness for prostate cancer charities.
But her case also highlights a taboo subject, and one that I know causes a great deal of distress to millions of women: female hirsutism.
Bearded and brave: Siobhan Fletcher shows off her goatee beard on ITV's This Morning
Siobhain first started growing hair on
her face in her late teens, and had tried in vain to tackle the problem,
including shaving and clipping. So depressed, she became a recluse and
even took to pretending to be a man to avoid cruel comments.
Although she undoubtedly felt isolated, she is far from alone. Indeed, Liz Taylor and Marilyn Monroe – two of the world’s most celebrated beauties – were said to shave their faces.
The cause, in Siobhain’s case, was a common one – polycystic ovarian syndrome (PCOS), in which small fluid-filled sacs, or cysts, develop in the ovaries, causing an excess of testosterone. One result, alongside fertility problems, is growth of hair in ‘male’ places.
Siobhain’s facial hair is dramatic, but from my experience of patients with a less significant quantity, they find the condition an equally terrible psychological burden. However, there are treatment options.
Taking it on the chin: Magazine Esquire from 1965 featured an article about the 'masculinisation' of the American woman
Q We all know about the bearded lady at the circus, but surely it’s pretty rare for women to have facial hair
A Not at all, but most will go to great lengths to get rid of it, or cover it up. It is estimated that up to 15 per cent of women suffer with hirsutism of different degrees. It is more common in Asian and Mediterranean women, and in women with darker head hair. Hirsutism causes hair in the beard area, the breasts and the abdomen of women.
Q What is PCOS, and does it just cause facial hair
A It is a condition characterised by cysts developing on the ovaries: this in itself is not a problem, and is termed polycycstic ovaries. Many women will have this with no effects. But some have cysts, and a hormone imbalance, and that is PCOS. The typical symptoms are irregular periods, facial hair, acne and difficulty conceiving.
Q What causes PCOS and is it getting more common Are environmental toxins to blame
A We are not certain what causes it. Genetics play a part. Women with the condition seem to use the blood sugar-balancing hormone insulin in their body in a different way. It is also very much associated with obesity, and the rise in women’s waistlines could certainly be responsible for the condition becoming more common. I have heard suggestions that oestrogen in the water supply, due to women on the contraceptive Pill excreting excess amounts, is to blame but there is no evidence of this.
Q What other reasons can women have facial hair, or hair in ‘male’ places, such as on the tummy
A PCOS accounts for two-thirds of the cases we see. There are other much less common causes such as problems with the adrenal or pituitary glands, and malformations of the ovaries. Hirsutism can also be caused by medicines, such as anti-epileptic medicine and even the Pill.
Q Is it always a disorder that causes it
sometimes we don’t know the cause – as there is nothing else
discernible wrong – and, yes, some women are just hairier than others.
Hirsutism can be measured by doctors with what is known as the
Ferriman-Gallway score, which takes into account hair quantity in nine
areas of the body. But society has a lot to answer for.
Western culture, we expect women to be completely hairless, to the
point where some choose to be completely denuded. It breeds a certain
paranoia at what should be considered a variation of normal.
Common cause: As with Siobhan Fletcher many who suffer from female hirsutism do so as a result of polycystic ovarian syndrome (PCOS)
Q Are there treatments that can get rid of hirsutism
A If hirsutism is a part of PCOS, then treatment for this would be advised. This would be weight loss and medication to control the hormones.
The diabetic drug metformin is used for PCOS, as is the contraceptive pill Dianette, which blocks testosterone. But it is not without its risks: it has a higher level of oestrogen than normal contraceptive pills and so the risk of deep-vein thrombosis (DVT) is slightly higher.
Q My friend has been prescribed a cream by her doctor that she says is reducing the hair. What is this
AThis will be Vaniqua cream, which GPs can prescribe. It is not intended as a replacement for the usual ways of removing hair, but it reduces the frequency of needing to do this. About a third of women with hirsutism find it effective.
Q What about laser treatment
A There is scientific evidence that treatment with lasers significantly reduces the number of hairs in women with hirsutism, but the long-term results are not known.
It is most effective for fair-skinned people with dark hair, and multiple treatments are needed – and it can cost up to 1,000 for a course.
Whatever you do, don’t be seduced by cut-price offers, and make sure you go to a reputable cosmetic clinic with medically trained staff, as these lasers can cause horrific burns when used incorrectly.
Also, laser is not suitable for those with dark skin and is known to increase pigmentation in the short term. The side effects for everyone can include redness, swelling and blistering but these last only a few days.
Electrolysis or thermolysis with diathermy – which involve tiny needles being inserted into follicles – are effective on all skin and hair colours, but do require multiple treatments. And some patients say both options are excruciatingly painful.
The long-term results really depend on the skill of the operator.
Q If nothing else works, is shaving or other depilatory options a bad idea
A Shaving, threading, waxing, depilatory creams and bleaching can all be effective in the short term and do not worsen hair growth, despite common misconceptions.
And don’t despair. Speak to your GP. It is a problem we are used to dealing with and we understand the psychological effects.
Hirsutism should always be investigated for the hormonal causes and then your doctor can direct your treatment to the problem.
Referral to a dermatology department on the NHS is recommended in many areas, and will help with the range of treatments.