By Leila Martyn, Founder of MyOva

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If you have PMOS (PCOS) and you've started noticing dark, coarse hair on your chin, jaw or upper lip, you're not imagining it, and you are nowhere near alone. PMOS, short for polyendocrine metabolic ovarian syndrome, is the updated name for polycystic ovary syndrome, and excess facial hair is one of its most visible signs.

It isn't dangerous on its own. But it shows up on your face in a way that irregular cycles and insulin resistance don't, and the shame and frustration are real, especially if someone has told you it's "just cosmetic". It isn't. Your body is trying to tell you something, and it deserves a proper explanation.

This guide covers what is happening hormonally, how it's diagnosed, what the evidence says about each treatment option, and how to manage the hair you have while longer term approaches take effect. Root cause, not symptom suppression. No hype, no shame.

In this guide:

• What is hirsutism, and is it different from normal hair growth?
• Why does PMOS (PCOS) cause excess facial hair?
• Which androgens are involved?
• What does hirsutism look like, and how is it scored?
• What else can cause hirsutism besides PMOS?
• How is PMOS-related hirsutism diagnosed?
• What are the treatment options?
• How long does it take for hirsutism to improve?
• Can you stop it getting worse?
• Does facial hair affect how you feel?
• Frequently asked questions

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What Is Hirsutism, and Is It Different From Normal Hair Growth?

Hirsutism is the medical term for thick, dark hair growing where women usually have only fine hair, typically the chin, upper lip, jaw, chest, abdomen and back. It's not the soft, pale peach fuzz everyone has. That's vellus hair. Hirsutism is terminal hair: darker, thicker and more visible, and the follicles that make it respond to androgen hormones.

Around 5 to 10% of women worldwide have hirsutism, and PMOS accounts for roughly 70 to 80% of cases [1]. How often it shows up within PMOS varies between ethnic groups [2], so a smaller amount of hair doesn't mean it isn't PMOS, and plenty of hair doesn't mean you did anything wrong. You are not in a small, unlucky minority.

If you're mainly after a practical, day to day routine for removing it, our guide to dermaplaning with PCOS and our rundown of hair removal methods that actually work cover that side. This guide is about the why, the diagnosis and the treatment.

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Why Does PMOS (PCOS) Cause Excess Facial Hair?

In women without PMOS, androgens are present but in relatively small amounts. In many women with PMOS, the ovaries and adrenal glands make more of them than they should, a state called hyperandrogenism.

Those androgens bind to receptors in hair follicles. In androgen sensitive areas like the chin, jaw, upper lip, chest and abdomen, the follicle responds by producing terminal hair in place of vellus hair. The cruel irony is that the same androgen excess can thin the hair on your scalp at the same time. Two opposite effects, one hormonal driver. (We cover that in our guide to hair loss with PMOS.)

Insulin plays a part too. In many women with PMOS, high insulin nudges the ovaries to make more androgens, which is why PMOS is described as a metabolic condition as much as a reproductive one [3]. If that's a new idea, our guide to PMOS and insulin resistance walks through it.

This matters because it changes the plan. Shaving, waxing and threading deal with the result. Addressing the hormonal drivers deals with the cause. You usually need both.

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Which Androgens Are Involved in PMOS (PCOS) Hirsutism?

Three androgens are most often involved:

• Testosterone, made mainly in the ovaries and adrenal glands and the best known androgen.
• DHEA-S (dehydroepiandrosterone sulphate), made largely by the adrenal glands and raised in a subset of women with PMOS.
• Androstenedione, a precursor that is converted to testosterone in other tissues.

Not every woman with PMOS has the same profile. Some have clearly raised total testosterone. Others have a normal looking total but a raised free testosterone, the unbound, active portion. That happens when SHBG (sex hormone binding globulin), the protein that carries testosterone around the blood, is low, which is common in PMOS. Guidelines recommend looking at free testosterone, or a calculated free androgen index, as well as total testosterone for this reason [1, 4].

So a "normal" testosterone result doesn't always close the case. If you've been told your bloods are fine but you still have hirsutism, ask whether free testosterone or SHBG were checked. Our guide to which blood tests to ask for with PMOS spells out exactly what to request.

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What Does Hirsutism Look Like, and How Is It Scored?

Hirsutism typically shows up as dark, coarse hair on:

• The upper lip, chin, jaw and sideburn area
• The chest, including around the nipples
• The upper and lower abdomen, often as a line from the navel downwards
• The upper and lower back
• The upper arms and thighs

Doctors score these areas using the modified Ferriman-Gallwey (mFG) scale, which rates hair growth in nine body areas from 0 to 4. A total of about 8 or more is the usual cut off in White and Black women, with lower cut offs in East Asian women [5]. The 2023 international guideline suggests a threshold of 4 to 6 depending on ethnicity [4].

Here's what I wish someone had told me: that guideline also tells clinicians to take unwanted hair seriously whatever your score [4]. There is no number below which your experience doesn't count.

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What Else Can Cause Hirsutism Besides PMOS?

PMOS is the leading cause, but it isn't the only one [1]. Others include:

• Idiopathic hirsutism, where androgen levels are normal but the follicles are more sensitive to them.
• Non-classic congenital adrenal hyperplasia (NCAH), a genetic condition affecting cortisol production that can look identical to PMOS and needs to be ruled out.
• Cushing's syndrome, caused by excess cortisol.
• Androgen secreting tumours, which are rare but important to exclude.
• Certain medicines, including valproate, danazol, some corticosteroids, ciclosporin, and anabolic steroids or testosterone.

Hair that appears quickly, especially alongside a deepening voice, increased muscle bulk or an enlarged clitoris, is not a "wait and see" situation. See your GP promptly. This is why a proper workup matters: assuming PMOS without ruling out other causes can mean missing something that needs different treatment.

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How Is PMOS-Related Hirsutism Diagnosed?

A good assessment usually includes:

• Your history: when the hair started, how fast it has progressed, your cycle pattern, medicines and family history.
• A physical examination: hair distribution, plus skin changes like acne or acanthosis nigricans (darkened skin at the neck or armpits, a sign of insulin resistance).
• Blood tests: total and free testosterone (or a free androgen index), SHBG, DHEA-S, 17-hydroxyprogesterone to rule out NCAH, thyroid function and prolactin, with glucose and insulin checks to look at the metabolic side.
• An ultrasound or AMH test, where appropriate, to look at the ovaries.

PMOS itself is diagnosed when at least two of three features are present: irregular or absent ovulation, clinical or biochemical hyperandrogenism (hirsutism counts), and polycystic ovarian morphology on ultrasound, or in adults a raised AMH under the 2023 guideline [4, 6].

One thing worth knowing: you do not need polycystic ovaries on a scan to be diagnosed, and your bloods don't need to be dramatically abnormal. Your diagnosis is a starting point, not a verdict.

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What Are the Treatment Options for PMOS (PCOS) Hirsutism?

Working on the drivers: insulin and lifestyle

Insulin is one of the biggest levers you have [3]. Here is what the research on it actually says:

• Weight and insulin. In a small, older study of obese women with PMOS, those who lost more than 5% of their body weight saw lower free testosterone, higher SHBG and lower fasting insulin, and ovulation improved. Some also had less hirsutism. Women who lost less than 5% saw little change [7]. This doesn't mean weight loss is the answer for everyone, and PMOS is not a weight problem. It does show that when insulin comes down, androgens can follow.
• Resistance training. In a 16 week supervised programme, women with PMOS built lean muscle and had lower testosterone afterwards, although women without PMOS saw the same drop, and insulin resistance didn't clearly change [8]. Strength training is worth doing for muscle, which is a major site of glucose uptake, but don't expect it to work as a hair treatment on its own.
• Myo-inositol. This is the subject of ongoing research into insulin sensitivity and ovarian function. The 2024 systematic review done for the 2023 guideline update found possible benefits for some metabolic measures, but described the overall evidence as limited and inconclusive, and found metformin may improve hirsutism more than inositol does [9]. Myo-inositol has no authorised health claim, and it will not remove facial hair.

Where does MyOva Hair, Skin & Nails fit? It pairs 2000mg of myo-inositol with zinc, selenium, biotin, vitamin A, vitamin C and vitamin B6, plus ingredients like hyaluronic acid and grape seed extract. Biotin, zinc and selenium contribute to the maintenance of normal hair. Zinc and selenium contribute to the maintenance of normal nails. Biotin, zinc and vitamin A contribute to the maintenance of normal skin, and vitamin C contributes to normal collagen formation for the normal function of skin. Vitamin B6 contributes to the regulation of hormonal activity.

To be clear about what that is: nutritional support for hair, skin and nails, not a treatment for hirsutism. It won't stop or remove facial hair. It's not a magic fix. But it gives your body what it's often missing.

Zinc deserves a quick honest note, because it gets a lot of airtime in hirsutism circles. Lab work shows zinc is involved in the enzyme that converts testosterone to its more potent form in skin, but that hasn't been confirmed in good quality trials of women taking zinc supplements, so we won't claim it lowers androgens or hair growth.

Medical treatments

These are prescription treatments, so they are a conversation with your GP, gynaecologist or endocrinologist, not a DIY decision.

• The combined oral contraceptive pill is the first line medical treatment for hirsutism in the 2023 guideline [4]. It lowers ovarian androgen production and raises SHBG, so less testosterone is free and active [1]. It doesn't address an underlying metabolic driver, and it isn't suitable for everyone.
• Spironolactone blocks androgen receptors at the follicle. The guideline suggests considering an anti-androgen when other therapies haven't worked or aren't suitable, and giving it at least six months [4]. A Cochrane review found some evidence that it reduces hirsutism, although the trials were small and mostly used 100 mg a day [10]. It isn't safe in pregnancy, so reliable contraception is needed [1].
• Metformin improves insulin sensitivity and is mainly used for the metabolic side of PMOS. In the inositol review, metformin may have improved hirsutism more than inositol did [9].
• Eflornithine cream is a topical treatment that slows facial hair regrowth while you keep using it. The guideline says it can be considered alongside laser or electrolysis [4].

Hair removal: managing the hair you have

Medical approaches take months to show, so hair removal is a legitimate part of the plan, not a failure to "deal with the cause".

• Laser and IPL give long lasting hair reduction, but they work best on dark hair against lighter skin, need multiple sessions, and are not usually available on the NHS [11].
• Electrolysis aims to destroy the hair root permanently, works on all hair colours and skin types, and takes repeated sessions [11].
• Shaving, waxing, threading and dermaplaning remove hair at or near the surface. Shaving does not make hair grow back thicker or darker, a myth that a small, old controlled study put to the test [11, 12]. Regrowth after shaving can feel coarser because the tip is blunt, not because the follicle changed.

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How Long Does It Take for Hirsutism to Improve?

Hair doesn't grow in a hurry. Each follicle moves through a growth phase, a resting phase and a shedding phase, so a change in hormones takes months to show up on your face. That is why the guideline suggests allowing at least six months to judge whether an anti-androgen is working [4].

In the meantime, track it so you can see progress you can't feel day to day. A photo in the same light once a month works better than staring in the mirror every morning. And use hair removal if it helps you feel like yourself. Patience here isn't passive. It's informed.

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Can You Stop PMOS (PCOS) Hirsutism From Getting Worse?

There's no guarantee here, and anyone who offers one is selling something. But there is plenty you can do to reduce the hormonal load:

• Get assessed early. The sooner the cause is identified, the sooner you can start treating it.
• Keep blood sugar steady. Not through restriction, but by building meals around protein, fibre and healthy fats.
• Build muscle. Resistance training is worth it for the muscle itself and for insulin handling, even if it isn't a hair treatment [8].
• Protect your sleep and manage stress. Stress and poor sleep push cortisol and insulin in the wrong direction. We don't have trial proof that managing them changes hair growth, but they're worth doing anyway. Our guide to nervous system regulation and hormone health is a good place to start.
• Look at your gut. Early research links an altered gut microbiome, including more Bacteroides vulgatus, with PMOS. In mice, transplanting that microbiome caused PMOS-like features, but we don't yet know whether it's causal in women or how it relates to hair [13]. Our guide to liver and gut health covers the practical side.
• Review your medicines. If you take something linked to hirsutism, ask your prescriber about it. Never stop a prescribed medicine without advice.

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Does Facial Hair Affect How You Feel? (Yes, and It's Valid)

This guide would be incomplete without saying it plainly. Excess facial hair carries a disproportionate emotional weight for many women with PMOS. It's visible, and it intersects with identity, femininity and confidence in ways that are hard to put into words and easy to feel alone with.

You're not being dramatic. In a population based study of 796 Iranian women with PCOS, hirsutism had the strongest effect on health related quality of life of any symptom [14]. It's one study in one population, but it matches what so many women describe.

What helps isn't being told to accept it or not to care. It's a clear explanation of what's driving it, a credible plan, and the knowledge that improvement is possible. If low mood or anxiety is creeping in, tell your GP. It's part of PMOS care, not a side issue.

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Frequently Asked Questions About PMOS (PCOS) and Facial Hair

Does everyone with PMOS get facial hair? No. How often hirsutism occurs varies, partly by ethnicity [2], and the amount of hair varies with how sensitive your follicles are. Not having hirsutism doesn't rule out PMOS.

Will losing weight reduce facial hair with PMOS? It can, for some women. In a small study of obese women with PMOS, those who lost more than 5% of their body weight had lower free testosterone and some had less hirsutism, while those who lost less saw little change [7]. It isn't a requirement for everyone, and the number on the scale is one data point, not the whole picture.

Will hair removal and hormonal treatment both be needed? Often, yes. They work on different parts of the problem: treatment aims at the hormonal drivers, and hair removal deals with the hair already there. Electrolysis aims for permanent removal of the hairs it treats [11].

Is shaving safe for PMOS facial hair? Yes. Shaving does not make hair grow back thicker, darker or faster [11, 12]. Shave if it helps you feel comfortable while longer term approaches take effect.

What blood tests should I ask for? Total and free testosterone (or a free androgen index), SHBG, DHEA-S, 17-hydroxyprogesterone, thyroid function, prolactin and glucose and insulin checks. Our full guide to PMOS blood tests explains how to ask for them.

When should I see a GP about facial hair? Any time it bothers you. Make it urgent if the hair appears quickly, or comes with a deepening voice, increased muscle bulk or an enlarged clitoris.

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The Bottom Line

PMOS facial hair is hormonal, it is common, and it is not your fault. The most effective plans combine assessment, work on the drivers like insulin, sensible medical options if you want them, and hair removal for the hair you have, with enough patience for the hair cycle to catch up. The research on this is actually pretty clear: there's no single fix, but there is a plan.

If you're working on the metabolic side of PMOS, MyOva Myoplus combines 4000mg of myo-inositol with B6, folate and chromium, and you can browse our full range of PMOS (PCOS) supplements too. Supplements are one part of a wider plan, never a replacement for medical care.

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Related Reading

• Dermaplaning With PMOS (PCOS): Is It Safe at Home?
• PCOS Hair Removal: What Actually Works and What Doesn't
• Hair Loss and PMOS (PCOS): What's Actually Happening and What Helps
• PMOS (PCOS) and Insulin Resistance: Understanding the Link
• What Blood Tests Should I Ask For With PMOS (PCOS)? The Complete Guide
• What is PCOS?

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This article is for educational purposes only and does not constitute medical advice. MyOva products are food supplements, not medicines, and are not intended to diagnose, treat, cure or prevent any disease. Always consult your GP or pharmacist before starting a new supplement, particularly if you are pregnant, breastfeeding, on medication, or managing a diagnosed condition.

References

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2. Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106(1):6-15.
3. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774-800.
4. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2023;120(4):767-793. doi:10.1016/j.fertnstert.2023.07.025
5. Escobar-Morreale HF, Carmina E, Dewailly D, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012;18(2):146-170.
6. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-47.
7. Kiddy DS, Hamilton-Fairley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol. 1992;36(1):105-111.
8. Kogure GS, Miranda-Furtado CL, Silva RC, et al. Resistance exercise impacts lean muscle mass in women with polycystic ovary syndrome. Med Sci Sports Exerc. 2016;48(4):589-598.
9. Fitz VW, Graca S, Mahalingaiah S, et al. Inositol for polycystic ovary syndrome: a systematic review and meta-analysis to inform the 2023 update of the international evidence-based PCOS guidelines. J Clin Endocrinol Metab. 2024;109(6):1630-1655. doi:10.1210/clinem/dgad762
10. Brown J, Farquhar C, Lee O, Toomath R, Jepson RG. Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne. Cochrane Database Syst Rev. 2009;(2):CD000194.
11. British Association of Dermatologists. Hirsutism: patient information leaflet. 2021. Available at: skinhealthinfo.org.uk
12. Lynfield Y, MacWilliams P. Shaving and hair growth. J Invest Dermatol. 1970;55(3):170-172.
13. Qi X, Yun C, Sun L, et al. Gut microbiota-bile acid-interleukin-22 axis orchestrates polycystic ovary syndrome. Nat Med. 2019;25(8):1225-1233.
14. Bahri Khomami M, Ramezani Tehrani F, Hashemi S, Farahmand M, Azizi F. Of PCOS symptoms, hirsutism has the most significant impact on the quality of life of Iranian women. PLoS One. 2015;10(4):e0123608.

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References