Hirsutism vs Virilization: What’s the Difference?

In both hirsutism and virilization, there is excess growth of coarse hair on different body areas like the face, underarms, arms, legs, etc. However, virilization is a more severe form of hormonal dysregulation as patients with this condition also develop a male-like physical appearance, such as a deepened voice and small breasts. This is uncommon in hirsutism.

This article aims to discuss the detailed distinction between these two, their causes, manifestations as well as treatments so that you can have a better understanding of these conditions for appropriate intervention.

Table of Contents:

• Part 1: Hirsutism
• Part 2: Virilization
• Part 3: Hirsutism vs Virilization
• Part 4: How Do I Stop My Hirsutism from Growing?
• Part 5: FAQs

Part 1: Hirsutism

Hirsutism is a word that comes from the Latin word “hirsutus,” which means “Hairy.” It is defined as

“The development of thicker, male-like body hair in females affects 5% to 15% of women [1].”

The growth of this terminal hair is common in areas like the chin, upper lip, chest, and back.

In general, these areas have fine hair, but in hirsutism, they become thicker and darker.

It is caused by the presence of endocrine disorders in which androgen is overproduced within the body due to conditions like

• PCOS: Polycystic ovarian syndrome leads to excess androgens and, thus, coarse body hair growth.
• Adrenal hyperplasia: Here, adrenal tissues overgrow and cause an over-release of androgens. So, in addition to hirsutism, patients have short height and develop early puberty.
• Ovulatory dysfunction: It is a disturbance of the functions of the ovaries, and this stimulates hair growth in androgen-sensitive areas and disrupts menstrual cycles.
• Obesity: Obesity causes hirsutism primarily through increased insulin resistance and elevated androgen production from adipose tissue.
• Use of steroids and Minoxidil: The use of anabolic steroids raises androgen levels and promotes hirsutism. Also, minoxidil can cause hypertrichosis by stimulating hair follicles.
• Cushing’s syndrome [2]: Cushing’s syndrome causes hirsutism primarily through elevated cortisol levels. This excess cortisol can lead to increased testosterone levels, a hormone involved in hair growth.

What are the symptoms of hirsutism?

Hirsutism itself is a clinical feature of various other disorders of the body. Here are the symptoms associated with hirsutism,

• Excess hair growth on the body
• Development of thick facial hair
• Increased weight
• Menstrual irregularities

Part 2: Virilization

Virilization is often confused with hirsutism due to its similar appearance and causes. The term virilization means

“development of male-like characteristics in females”.

It may be noticed at the time of birth or may develop later in life.

What causes virilization?

Similar to hirsutism, the condition mainly occurs due to the overproduction of androgen hormone in the body. This overproduction may be associated with

• Tumors of the ovaries or adrenal glands: Ovarian tumors, like Leydig cell tumors, secrete testosterone directly, resulting in hyperandrogenism. Moreover, adrenal tumors can also produce androgens or cause Cushing syndrome, leading to increased cortisol and secondary androgen production that results in virilization
• Excessive utilization of anabolic steroids: Excess use of anabolic steroids causes virilization by significantly increasing androgen levels, particularly testosterone, leading to masculine traits
• Non-classic congenital adrenal hyperplasia: Nonclassic adrenal hyperplasia (NCAH) is a genetic condition where the adrenal glands produce too much male hormone (androgens) due to an enzyme deficiency. This leads to virilization

How to diagnose virilization?

Following are the symptoms and signs of virilization in females [3]:

• Excessive growth of hair that mainly involves the face
• Deepened voice
• Male-pattern baldness
• Reduced size of breasts
• Enlarged clitoris
• Increased sexual drive
• Irregular periods
• Shrinkage of uterus
• Acne on the face, hairline, underarms, and groin area

Part 3: Hirsutism vs Virilization

Manifestations

Because hirsutism itself is not actually a medical condition but instead can be a symptom of other conditions, it presents differently according to the associated disorder. The most common symptoms you will notice are irregular periods, weight gain, and terminal hair growth.

However, if you see other man-like characteristics like a deepened voice and baldness in a female then it is virilization. The breast size would also be smaller than normal like that of a male.

Severity

In virilization and hirsutism, the main causative factor for producing male-like characters is hyperandrogenemia because of the overproduction of androgens. But to a great extent, it depends on the severity of the problem.

Also, note that this intense version of hirsutism is called virilization when a woman has enough male hormones in her system to cause her physical appearance to resemble a man.

Age of Onset

The age of occurrence of virilization and hirsutism may also vary.

• Hirsutism mostly occurs at the time of puberty due to an imbalance of hormones in the body
• On the other hand, virilization may occur at puberty or at the time of birth specifically in newborn girls who are exposed to high androgen levels during pregnancy.
• In newborns, medical professionals may find signs of male hormone exposure in the body [4].

Self-Induced

Hirsutism can occur later in life due to intake of medications like steroids but it can never be induced intentionally. In contrast, virilization can be induced on purpose among certain groups.

For example, transmasculine individuals often take hormones under medical supervision to align their physical appearance with their gender identity.

Muscle Mass

The difference in the muscle mass of an individual affected with either of the two conditions is attributed to the exposure to androgen hormones.

• In hirsutism, there may not be a significant increase in muscle mass
• The effect of androgen hormones in virilization is more pronounced thus resulting in increased muscle mass

Treatment

The management of hirsutism and virilization will also depend on the underlying etiology. Hirsutism is primarily focused on cosmetic issues. It can be managed easily through

• Weight loss measures
• Long-lasting hair removal solutions
• Anti-androgens.

However, this is insufficient to treat virilization because other physical changes are associated. Thus, it requires,

• Intense therapies
• Intensive hormonal control care

Part 4: How Do I Stop My Hirsutism from Growing?

Lifestyle Changes

Lifestyle changes can help lower the levels of androgens in the body and lead to a reduction in hair growth caused by hirsutism. Reducing weight can help normalize the levels of androgens [5] and stop hirsutism. For this, one must

• Stop eating processed or sugary food
• Exercise regularly
• Manage stress through meditation and therapy
• Eat a balanced diet

Prescription Creams

Prescription creams such as eflornithine (Vaniqa) can slow the rate of hair growth. VANIQA is a cream that you apply to the areas where hair grows too fast. But this does not remove hair, and rather you have to first shave off all your unwanted hair and afterwards apply the cream. Results take 4–8 weeks to appear and you have to keep using it in order not to lose the results.

Medications

Some medications can stop hirsutism from growing. These include:

Oral contraceptives:

These help by

• Lowering the level of androgens in the body
• Reducing hirsutism
• Regulating the menstrual cycle

Androgen-suppressing drugs:

Drugs such as spironolactone can help reduce the growth of coarse hair.

Insulin-lowering medicines:

Thiazolidinediones and metformin are the Insulin-lowering drugs that,

• Diminish insulin
• Lower the levels of androgens in the body

These are to be used under professional guidance as otherwise might make the hormonal balance worse.

Long-Lasting Hair Removal Methods

Lastly, you can go with long-lasting hair removal options like IPL because it is considered an effective option to combat hirsutism [6] and keeps your body hair-free for a long time.

What’s even better is that you can go for at-home IPL hair removal with Ulike Air 10. It is an IPL device that:

• Shows noticeable results of up to 96% within just 2 weeks of use
• It is an FDA-cleared device so you can safely use it to control hirsutism
• The device has multiple intensity levels to help you adjust the power level according to your skin sensitivity and use it on all areas of the body
• Its sapphire-ice cooling technology makes treatment sessions smooth and comfortable for an enhanced consumer experience

Part 5: FAQs

1. What Causes Hirsutism to Worsen?

Below are some facts about the causes of the worsening of hirsutism,

• The condition can worsen if you do not take care of your diet
• Obesity and the use of refined food like white bread or pasta can further intensify it
• The worsening may also be associated with anxiety or the use of medications like glucocorticoids that increase hormonal sensitivity

2. Is Virilization Seen in PCOS?

Hirsutism is much more frequently related to PCOS than virilization. It has been noted that, at times, it is possible to observe virilization in girls with PCOS. However, these signs are mostly very mild. It usually happens when there are ovarian cysts as a result of PCOS, which enlarges ovaries and triggers increased secretion of androgen.

3. How Long Does it Take to Reverse Hirsutism?

In most cases,

• It takes 4 to 6 months for the condition to be alleviated.

In some circumstances,

• the therapy may last for up to 9 months

So, the duration varies depending on

• The severity of the condition
• The kind of therapy to be given to the patient

References

[1]. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003 May;101(5 Pt 1):995-1007.

https://pubmed.ncbi.nlm.nih.gov/12738163/

[2]. Hafsi W, Kaur J. Hirsutism. [Updated 2023 May 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan

https://www.ncbi.nlm.nih.gov/books/NBK470417/

[3]. What to Know About Virilization, Healthline.

https://www.healthline.com/health/virilization

[4]. Santi M, Graf S, Zeino M, Cools M, Van De Vijver K, Trippel M, Aliu N, Flück CE. Approach to the Virilizing Girl at Puberty. J Clin Endocrinol Metab. 2021 Apr 23;106(5):1530-1539.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8063244/

[5]. Dokras A, Sarwer DB, Allison KC, Milman L, Kris-Etherton PM, Kunselman AR, Stetter CM, Williams NI, Gnatuk CL, Estes SJ, Fleming J, Coutifaris C, Legro RS. Weight Loss and Lowering Androgens Predict Improvements in Health-Related Quality of Life in Women With PCOS. J Clin Endocrinol Metab. 2016 Aug;101(8):2966-74.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4971336/

[6]. Khodaeyani E, Amirnia M, Babaye-Nazhad S, Alikhah H, Brufeh B. Efficacy of intense pulsed light in hirsutism. Pak J Biol Sci. 2010 Jul 1;13(13):635-41

https://pubmed.ncbi.nlm.nih.gov/21717866/