Excessive growth of thick, dark and strong hairs on upper lip, chin, sideburn areas, neck, around the nipple region, between the breasts, abdomen, back, shoulders, inner and outer thighs and arms is a common symptom in women with polycystic ovary syndrome.

1. Excessive Hair Growth and Polycystic Ovary Syndrome
Dr. Burak HACIHANEFİOĞLU
WOMEN'S HEALTH AND RESEARCH & POLYCYSTIC
OVARY CENTER
Büyükdere Cad. Melek Ap. No:17 Kat:3
Şişli / İstanbul
Tel: 00 90 (212) 296 78 95 -00 90 (212) 296 78
96
Gsm : 00 90 530 561 89 96
www.polycysticovary.net
Excessive growth of thick, dark and strong hairs on upper lip, chin, sideburn
areas, neck, around the nipple region, between the breasts, abdomen, back,
shoulders, inner and outer thighs and arms is a common symptom in women
with polycystic ovary syndrome.
An increase in production and efficacy of male hormones (testosterone, etc.)
and a decrease in production of a substance called sex hormone binding
globulin (SHBG)which neutralizes the male hormones by binding them in
circulation causes light and thin hairs turn into dark and thick hairs.

2. The picture below demonstrates excessive hair growth on the neck area in a
woman with polycystic ovary syndrome.
Insulin is a hormone produced in pancreas. Pancreas produces much more
insulin than normal in women with insulin resistance. Hyperinsulinemia
(increased insulin levels) causes excessive hair growth in women with
polycystic ovary syndrome by two ways, including increased production of
male hormones (testosterone, etc.) in ovaries and decreased production of
binding substance (SHBG) in liver.

3. The picture below demonstrates excessive hair growth on chin in a woman
with polycystic ovary syndrome.
Body fat (adipose tissue) percentage is negatively correlated with sex
hormone binding globulin (SHBG) levels. For this reason, overweight and
obese women have low levels of SHBG. Low SHBG levels cause excessive hair
growth in overweight or obese women with polycystic ovary syndrome
because there is an increase in amount and efficacy of male hormones
(testosterone, etc.) in these women. But, low levels ofSHBG do not cause
excessive hair growth in overweight and obese women who do not have
polycystic ovary syndrome because the levels and efficacy of male hormones
(testosterone, etc.) are normal in these women.

4. The picture below demonstrates excessive hair growth on the lower abdomen
in a woman with polycystic ovary syndrome.
Thyroid gland produces thyroid hormones. Hypothyroidism (decreased
thyroid hormone levels) causes reduced energy use (low body temperature,
etc.). Reduced energy use leads to fat storage in the body. Increased body fat
(adipose tissue) percentage decreases production of binding
substance (SHBG) of male hormones. For this reason, increased body fat
storage causes excessive hair growth by increasing the efficacy of male
hormones in women with polycystic ovary syndrome. Hypothyroidism can
lead to excessive hair growth even in normal weight women with polycystic
ovary syndrome if she has an increased body fat.

5. The picture below demonstrates excessive hair growth on the forearm in a
woman with polycystic ovary syndrome.

6. The picture below demonstrates excessive hair growth on the sideburn area
and neck in a woman with polycystic ovary syndrome.
Treatment; The primary principle of the treatment of excessive hair growth
is to decrease the production and efficacy of male hormones (testosterone,
etc.) and to increase the production of sex hormone binding globulin
(SHBG) which neutralizes the male hormones.
The treatment of insulin resistance by decreasing hyperinsulinemia is one of
the treatment options which causes decreased production of male hormones
(testosterone, etc.) in ovaries and increased production of binding
substance (SHBG) in liver.
Male hormones (testosterone, etc.) cause hair growth by binding receptors
located on hair follicles in the skin. For this reason, medications that block
the binding of male hormones to these receptors is another alternative for

7. the treatment of excessive hair growth.
An enzyme called 5-alpha reductase located on hair follicles in the skin
converts male hormones (testosterone, etc.) to active forms
(dihydrotestosterone, etc.) after male hormones bound to their
receptors. Active forms (dihydrotestosterone, etc.) are much stronger forms
of male hormones which cause hair growth. For this reason, medications that
block the conversion of male hormones to active forms is another alternative
for the treatment of excessive hair growth.
The black arrows in figure-1 (below) point out the treatment alternatives of
excessive hair growth. The treatment option for a person changes to the
origin, distribution and severity of hair growth. Subgroups of polycystic ovary
syndrome (A, B, C), obesity and insulin and sugar metabolism are also
important factors determining the treatment options.
FIGURE-1