Hair Today, Horomones Tomorrow

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“Hair” raising topic ahead.

As estrogen decreases, its ratio to testosterone changes—and suddenly, hair changes enter the picture.

There are two main things that can happen to hair in perimenopause and menopause. First: thinning or loss of hair on your head (we will talk about this in a future blog). Second: extra hair growth on your face.

Bold and beautiful: A striking illustration captures the confident expression of a bald woman with vibrant red lips and a bright orange collar. Image created by AI.

Oh, what a cruel and deeply ironic twist of fate.

Before perimenopause and menopause, the body usually produces enough estrogen to help control the amount of free, active androgens—or what we commonly think of as the “male hormones”—circulating in the blood.

Basically, female hormones keep male hormones such as testosterone in check.

Hmmmm. Interesting. Females keeping males in check. (I know- I’m stretching things a bit.)

Testosterone production does not increase in perimenopause. But as estrogen decreases, it’s no longer there to keep free testosterone in check. As a result, there’s relatively more testosterone circulating through the body (at least for a while until testosterone also decreases).

And where does the free testosterone go?

Chemical structure of testosterone, illustrating its complex molecular arrangement.

Straight to the tissues with the most androgen receptors—specifically the chin, cheeks, and upper lip.

To make matters worse, it’s often coarse hair.

Wow. The irony just keeps building.

About 15% of women experience facial hair growth during perimenopause.

There are, of course, other conditions that can cause facial hair growth too, including polycystic ovarian syndrome (and yes, we should definitely talk about this another time).

In addition to the coarse hairs, there’s also the lovely phenomenon of “peach fuzz”—those small, fine hairs all over the face that you’re used to seeing on pubescent boys’ upper lips. And then there are the long, rogue, willowy single hairs that somehow appear in the most offensive places imaginable. I get one between my thumb and index finger, and I yank it out with the intensity of someone settling a personal vendetta. Honestly, when I get it, it feels very satisfying.

So… what can you do for all this unwanted hair?

Well, the global hair removal industry is currently valued at over 4 billion dollars. That’s billion with a B.

You’ve got shaving, depilatory creams, waxing, threading, epilation, laser hair removal, intense pulsed light (IPL) devices, and electrolysis. Somebody is making a whole lot of money off women’s backs—or rather, their faces.

A close-up illustration depicting a woman applying wax to her chin, focusing on self-care and grooming. Image created by AI.

And while these methods can help, they’re not without downsides. Potential side effects include inflammation, ingrown hairs, skin discoloration, and even burns, just to name a few.

There are also a few medications that can be prescribed:

• Birth control pills (especially those with drospirenone): These can suppress ovarian androgen production.

• Spironolactone: A medication that also helps block or suppress the effects of androgens.

• Finasteride: A medication that inhibits the conversion of testosterone into its more active form.

• Eflornithine: A prescription cream that may help slow the growth of facial hair.

• Metformin: A common diabetes medication that can be helpful in women with polycystic ovarian syndrome who have excess hair growth (more on that in the future).

• Estrogen: This may help delay the progression of facial hair but is not a permanent fix.

And now, a little personal story.

I am like many other South Asian women: I have an abundance of facial and body hair.

For as long as I can remember, I was told I had excess hair because I didn’t towel off well enough after a shower. I was told I needed to scrub harder and spend be more diligent- and if I didn’t, the hair would just grow and grow resulting in me turning into a Yeti.

Yes. Really.

When I started junior high, there was a group of boys at the lunch table who used to ask about my mustache. (For most of my childhood, I couldn’t even say the word mustache without wanting to crawl out of my skin.) I would walk out of the lunchroom blinking back tears, only to completely fall apart in the bathroom a few minutes later (while avoiding looking at myself in the mirror).

A young woman sits with her face in her hands, embodying a moment of sadness and distress. Image created by AI.

Those boys were bullies. But they had no idea that their teasing only deepened the shame I already carried about what I believed was my own making. I thought I had been lazy and did not practice proper personal hygiene. I thought I was to blame for the harassment in the lunchroom.

Now imagine me at 23 years old, sitting in a medical school lecture hall, hearing the word hirsutism (excess hair growth in male pattern areas) for the very first time.

And then imagine my surprise when I learned about hormones—and their role in hirsutism. Those tears started falling again.

You may wonder how it took me 23 years to figure this out.

All I can tell you is this: when you’re told something over and over again, you believe it, even when the science around you says otherwise. You don’t notice the science when you are stuck in a cycle of self-hatred.

It never occurred to me to question the idea that I had somehow caused the hair on my face. And for years, I loathed myself and my body for what I thought was a self-inflicted curse.

The reason I’m including this here is because this myth is still told to so many South Asian kids. And if that was you, I want you to know: I see you.

I carried that shame for years.

Truthfully, part of me still carries it, because shame has a way of settling into the body and making itself at home- even when you know the truth. Your mind may realize one thing but your body may take longer to get on board.

But I am trying—intentionally—to tell myself a different story now: this is my body, this is my biology, this is my hormones.

And it is not my fault.

So yes, perimenopause may come for your scalp and your chin at the exact same time, because apparently hormones have a dark sense of humor. But beneath the jokes, there’s something real here: so many women are blindsided by changes no one warned them about, and so many of us have carried shame about our bodies for far too long.

Three women share a warm embrace, symbolizing friendship and support amidst a backdrop of blooming flowers. Image created by AI.

Facial hair is common. Hormonal changes are real. And the myths we were taught—especially the ones rooted in culture, embarrassment, or silence—deserve to be challenged.

If this is happening to you, you are not dirty, you are not doing something wrong, and you did not cause it by failing to towel off correctly after a shower.

You are just a woman with hormones (and maybe not enough of other hormones).

And honestly? That’s already enough to deal with.

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