Thick facial hair should not be part of a woman’s appearance. They are the result of growth influenced by male hormones – androgens. About 12% of girls at puberty suffer from increased hair growth, which is called hirsutism. In the initial assessment of hair growth, one must know if it is really hirsutism, what are the causes, how the complaint is diagnosed and what would be the most adequate treatment. Hirsutism is a condition in which hair grows under the influence of androgens. With it, the normal mossy hair is replaced by hairs that are thicker, coarser, more pigmented. The areas that are commonly affected are those where hair is normally seen in men, namely the beard, upper lip, chest, rear and waist. Sometimes hirsutism is accompanied by oily skin and acne. An important consideration is the ability to differentiate between hirsutism and hypertichosis. Hypertrichosis is an increase in bushy, normal body hair. The bones are thin, delicate and do not have the characteristic spread of male hair. The main hormones that affect the hair follicle are androgens (free testosterone, dihydroepiandrosterone sulfate – DHEA-S and precursors such as 17-hydroxy progesterone – 17-OH Progesterone). Under physiological conditions, they are produced by the adrenal glands and the ovaries in the female body. Conversely, estrogens and progesterone suppress the rate of hair growth. This means that testosterone is the main cause of hair growth because of an increased, genetically determined sensitivity of the hair follicle to the hormone or because of its increased production. The causes of hirsutism are numerous, the most common being the idiopathic, tumor process, congenital adrenal hyperplasia, and polycystic ovarian disease. In the case of idiopathic, it concerns an increased sensitivity of the hair follicle to androgens. It is common in certain regions, and menstruation is ovulatory. In contrast to idiopathic hirsutism together with anovulatory cycles, oily skin, acne, increased body mass point to polycystic ovarian disease. In this disease, free testosterone levels are increased, so is the LH/FSH ratio (above 3.5 when normal is about 0.7) and the ultrasound finding is multiple ovarian follicles. Elevated testosterone levels and a recent increase in male pattern hair growth are the two hallmarks of a tumor that produces androgens. On the other hand, congenital adrenal hyperplasia results from an enzyme defect that leads to overproduction of male hormones. In Bulgaria, there is screening against this disease, which is carried out 3-5 days after birth. NEWS_MORE_BOX Treatment depends on the cause as usual. In the presence of a hormone-producing tumor, its surgical removal is mandatory. For congenital adrenal hyperplasia, treatment with a corticosteroid such as dexamethasone is the most appropriate treatment.The use of estrogens and progesterones as inhibitors of hair growth is reasonable, for example, in polycystic ovarian syndrome. They suppress the secretion of LH, which, in turn, leads to a decrease in free testosterone. Another successful method of treating hirsutism is anti-androgen drugs such as cyproterone. Cyproterone blocks the conversion of testosterone to the more active compound dihydrotestosterone. After 3 months of using the preparation, the hairs are significantly reduced. The unfortunate thing is that when cyproterone is discontinued, relapses are often observed. In addition, side effects such as depression, nausea, migraine are not excluded. Cosmetic procedures such as electroepilation, laser and photoepilation are also an important part of the treatment. The combination between medication and aesthetic treatment is the most complete. Abundant hair growth is an important symptom, especially for pubescent girls. In addition to being a symptom of an underlying process, hirsutism creates feelings of inferiority and strains social relationships. Therefore, consultation with a professional and adequate treatment are essential.