Assuming that heavy hair growth is not just your own genetic make-up, hirsutism can be caused by several different factors and the best treatment to reverse the excess hair growth depends upon which of those factors are working in your specific case.

  • altered androgen metabolism (conversion from weak to potent androgens) - this is the most common cause of hirsutism and it appears to be the result of an increased conversion in the skin of testosterone to DHT.
  • increased androgen production - either the ovary (testosterone) or the adrenal gland (dehydroepiandrosterone sulfate - DHEA-S) can be responsible for excess androgens. The adrenal gland is less common but there are several recognized genetic instances in which the adrenal gland over produces androgens.
  • decreased androgen binding in the circulation - only free androgen is biologically active. Estrogens increase liver manufacture of SHBG. Androgens decrease it. Thus lack of estrogens can effectively increase available blood androgens. Also any ingestion of androgens by mouth will further decrease SHBG and make those ingested androgens even more available to stimulate hair growth.
  • exogenous androgens - medications such as Estratest®, danazol, anabolic steroids in some of the body building supplements and even some birth control pills containing norgestrel (e.g., Lo-Ovral®, Ovrette®) can cause increased hair growth. Even when testosterone cream is used on the vulva for certain vulvar skin conditions, there can be absorption into the blood stream which stimulates hair growth.