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Q:  Why do some women notice an increase in facial and body hair around the time or menopause?

A: Unwanted hair growth usually begins in the late teens or early twenties. However it often gradually increases after that. (Men's beard and body hair also increases over the years.) This increase is not usually due to increased testosterone. Actually, testosterone levels actually fall with age after the early twenties. Most women in perimenopause or menopause have levels around 20 ng/dL which are too low for most labs to accurately measure.
Women with polycystic ovary syndrome may have a different situation. The PCOS sometimes evolves into a condition called hyperthecosis in which there are too many testosterone-producing cells in the ovary. They can continue to have high levels after menopause. This is uncommon however.

However, the most important factor leading to hair increases during women's forties and fifties is not the level of testosterone but the duration of exposure. The same is true for female alopecia. The effects of testosterone on hair follicles are very gradual. Also, sensitivity of the follicles varies between individuals, partly due to genetic factors. Women who have hair follicles which are particularly sensitive to testosterone tend to have more facial and body hair and less scalp hair as the years go by.

Needless to say, no one welcomes such changes. Fortunately, unwanted hair and scalp hair loss are treatable. The details are given in my website articles on increased hair and female hair loss.

Estrogen does not have much direct effect on unwanted hair. However, when estrogen levels start to fall, usually in the mid to late forties, alopecia may result. This is also discussed in the website article on alopecia.

Hope this is helpful.

Geoffrey Redmond, MD

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