Are laser hair removal and spironolactone your only options for those pesky, rogue dark hairs?

When I was first diagnosed with polycystic ovary syndrome (PCOS), the gynecologist made the diagnosis based solely on my lack of a period and the visible dark hairs on my upper lip.

For years, I waged war against those pesky dark hairs, found on my upper lip, chin, and lower belly. My mom has some unwanted hair as well, so I assumed it was part genetic, and part PCOS. And I assumed there was little I could do about this unwanted hair growth.

Then I started experimenting with a paleo diet, while still on hormonal birth control, and the dark hairs slowly started disappearing. This disappearance was the first thing that prompted a years-long attempt to get off of birth control pills.

I finally realized that I had control over my PCOS symptoms by altering what I ate.

But before we talk about what has helped, let's talk a bit more about what's going on with this unwanted facial hair growth and extra hair growth on various parts of the body.

WHAT IS HIRSUTISM?

Hirsutism is the technical term for a more masculine pattern of hair growth on the face and body, and PCOS is the most common cause of hirsutism. Hirsutism in women with PCOS (and other women) is driven by high androgen levels (aka excess male hormones), specifically free testosterone. Most of the testosterone in a well-functioning female body will be bound up by sex hormone-binding globulin (SHBG) and albumin. When testosterone is bound up, it can’t contribute to more masculine characteristics. 

In the presence of excess insulin, the ovaries excrete higher levels of testosterone while SHBG levels decrease, resulting in more unbound testosterone, known as free testosterone. Insulin resistance, a common underlying cause of PCOS, leads to high levels of insulin and these hormonal imbalances.

High free testosterone can then act on androgen receptors in the body, causing excessive hair growth where you don’t want it. These hairs are referred to as “terminal hairs” and are coarse and pigmented, in contrast to vellus hairs, often referred to as peach fuzz, which are softer, shorter, and not pigmented.

​Many women with PCOS will also experience hair loss from places they do want it (primarily your head!), which is also a result of high male hormone levels. 

Okay, back to my story.

attempting to quit hormonal birth control

During my first attempt to stop using hormonal birth control, I relied on following a Paleo diet, taking inositol, and receiving acupuncture. Given how much the Paleo diet had improved my symptoms of PCOS (primarily acne and those pesky dark hairs), I was certain that it would also take care of the irregular periods I had experienced before using hormonal birth control.

Well... I had one 30-something day cycle, and then I was on day 60-something of my second cycle, with dark hairs sprouting seemingly everywhere, when I threw in the towel and resumed using NuvaRing. While diet can be highly effective at addressing PCOS, for me, the Paleo diet was not enough.

In my second attempt at quitting hormonal birth control, I will admit that my biggest fear was the return of those dark hairs.

With a better supplement plan in place, and much better stress management skills and sleep hygiene, in my second attempt to quit NuvaRing, some dark hairs returned, but not nearly to the extent that they sprouted in my previous attempt. While they weren't quite as embarrassing as they had previously been, I still didn't love the vigilance I had to maintain to keep my chin free of dark hairs.

is Spironolactone the answer?

When I saw my gynecologist after quitting the hormones (yes, I just quit them on my own), I discussed this lingering concern. She immediately suggested that I try Spironolactone, which blocks the effects of testosterone, without actually addressing the root cause of why it is being produced. 

There was no discussion of the underlying causes of the high testosterone that was causing the hair growth.

In her defense, my testosterone levels were just within the normal range on the day of my blood tests that year. I strongly suspect if I retested levels in the late luteal phase, however, that I would have elevated testosterone. (You’ll see why below.)

I tried Spironolactone for a few days. The drug is also used to manage high blood pressure. As someone whose blood pressure is usually right about 90 over 60, I don’t really need a medication that further lowers blood pressure. And indeed, when I tried weightlifting on Spironolactone, I got horribly lightheaded. 

I had no intentions of quitting weightlifting, so I quit the Spironolactone instead and just kept on tweezing the pesky, rogue hairs. I also tried laser hair removal, which helped a bit, but my ever-wobbling androgen hormones seemed to continuously create new hairs, so laser hair removal felt a bit like whack-a-mole, and I abandoned that costly strategy.

Better blood sugar control… and fewer dark hairs?

Curiously, over my last three cycles, I’ve noticed that I don’t need to be quite as vigilant with the tweezers to keep the chin hair at bay. There are fewer of them, and they seem to be slower to reappear. I also have only minimal body hair growth.

You can check out my previous two posts to learn a bit more, but the short version is that I’ve cut back on my carbohydrate consumption during the week or so before my period, when I’ve discovered that I am quite insulin resistant. My blood sugar soars, and so too do my insulin levels. As mentioned above, high insulin levels increase the production of testosterone and… cause those pesky dark hairs to sprout where I don’t want them. While my blood tests showed normal testosterone levels, I strongly suspect that this snapshot didn’t accurately capture the hormonal changes that occur across my entire menstrual cycle.

Better understanding my blood sugar patterns has helped me realize that I don’t need Spironolactone and its pesky side effects.

And I don’t need costly laser hair removal.

I just need to maintain steady blood sugar levels. 

And those steady blood sugar levels, and thus steady insulin levels, will have a whole host of other benefits that Spironolactone and laser hair removal can’t provide.

Elevated insulin levels are associated with shorter lifespans, high blood pressure, atherosclerosis, and type 2 diabetes, and indeed, women with PCOS also have an elevated risk of all of these health conditions. 

When we treat PCOS by masking the symptoms of the disease, through drugs like Spironolactone, we're leaving women vulnerable to a whole host of other health consequences. We can and should do better.

​Treatment Options for excessive facial and body hair growth

Okay, let's talk about effective ways to address excessive facial and body hair growth:

1. Just live with it. Some people are totally cool with the hairs, and if this is you, keep on doing you!

2. Use simple hair removal methods like tweezing, shaving, threading, waxing, or hair removal creams - I think these are relatively self-explanatory ways to remove those hairs, and if you're reading this, I bet you're already doing at least one of these things!

3. Add in spearmint tea. Research shows that spearmint tea can lower testosterone levels. I've had clients notice a substantial reduction in excessive hair growth just from adding spearmint tea each day. Personally, I put a tea bag in 16 oz of water before bed, let it steep in the fridge overnight, and then drink it first thing in the morning. Morning hydration + testosterone control = a great way to start your day!

4. Use diet to address your insulin resistance. Following a ketogenic diet or a low glycemic index/load diet has been shown to improve insulin resistance in women with PCOS. The meals provided in my Women's Health Meal Plan Membership follow a low-glycemic load diet. I also love working one-on-one with clients to help personalize their diet plans.

5. Use carb-cycling if just following a low glycemic index diet alone doesn't fully resolve your hirsutism. See the lists of carbs below and learn about menstrual cycle tracking here.

6. Use lifestyle changes to improve insulin resistance. Exercise and stress management can be highly effective at improving insulin sensitivity.

7. Get laser hair removal. In theory, laser hair removal is permanent hair removal that works by damaging the hair follicle, but in reality, changes to your hormones may cause new hairs to form. This was my experience. Laser hair removal is also most effective on dark hair and coarse hair on people with fair skin. It is less effective for those with light hair or darker skin tones. 

If you have another method, I'd love to hear about it! Please add it in the comments below!

MY FAVORITE LUTEAL PHASE CARB SOURCES:

All non-starchy vegetables including asparagus, bell pepper, broccoli, Brussel sprouts, cabbage, cauliflower, carrots, cucumbers, eggplant, fennel, green beans, kohlrabi, lettuce, kale, mushrooms, onion, radishes, spinach, summer squash, Swiss chard, tomatoes, zucchini

MY FAVORITE CARB SOURCES FOR THE REST OF MY CYCLE:

All of the vegetables listed above as well as acorn squash, beets, butternut squash, pumpkin, rutabaga, boiled sweet potatoes, and turnips.

Fruits including apples, avocados, blackberries, blueberries, fresh figs, grapefruit, kiwi, mandarins, nectarines, oranges, plums, raspberries, strawberries, and tangerines.

Grains including black wild rice (sometimes labeled forbidden rice) and quinoa.

Legumes including black beans, cannellini beans, chickpeas, fava beans, great northern beans, green peas, hummus, lentils, mung beans, red beans, and soybeans. 

Not sure how to know where you are in your cycle? Check out my post on using basal body temperature to track your cycle.