Many women with PCOS in Malaysia start noticing coarse, dark hair growing in places usually thought of as “male” zones: the chin, upper lip, around the nipples, the lower belly from the navel down, or the inner thighs. This is called hirsutism. It is not a hygiene problem and it does not mean you are “unclean”. It is a sign that androgens (the typically masculine hormones that all women actually carry in small amounts) are running high, or that your hair follicles are unusually sensitive to them. Hirsutism is one of the three signs of hyperandrogenism that help doctors diagnose PCOS, which is why it matters and is not merely a cosmetic issue.
How hirsutism differs from ordinary body hair
Every woman has fine vellus hair on the face and body, usually thin, short and almost invisible. Hirsutism means that fine hair has turned into terminal hair, the coarse, dark and longer kind, in areas that respond to androgens. The difference is in location and texture, not just quantity.
Common signs Malaysian women with PCOS report:
- A few stiff hairs on the chin or jaw that need plucking almost daily.
- A line of dark hair running from the navel down the lower abdomen.
- Hair around the nipples or on the upper chest.
- Thicker hair on the upper lip, sometimes looking like a faint moustache.
It is important to distinguish this from hypertrichosis, which is generalised heavy hair across the whole body that does not follow an androgen pattern and is usually linked to medication or genetics rather than PCOS hormones. Hirsutism follows a specific pattern; hypertrichosis does not.
How doctors assess hirsutism
Doctors use a visual score called the modified Ferriman-Gallwey (mFG). Nine body areas (upper lip, chin, chest, upper abdomen, lower abdomen, upper arms, thighs, upper back, lower back) are each graded 0 to 4 for terminal hair density, then summed.
What many people do not realise: the cut-off score varies by ethnicity. For white European women, a score of 8 or above counts as hirsutism. For Asian women, including many Malaysians of Chinese descent and some other groups, the threshold is lower, roughly 4 to 6, because baseline body hair is on average finer. This means a score of 5 considered “normal” in a European woman may already be meaningful in an Asian woman. Do not be surprised if a doctor in Malaysia takes your hirsutism seriously even when your score looks low on an international chart.
This assessment is usually paired with androgen blood tests (free and total testosterone, sometimes DHEAS) to confirm a hormonal cause. Hirsutism that appears suddenly and rapidly, or comes with a deepening voice and an enlarged clitoris, needs prompt evaluation because that is a different pattern from ordinary PCOS.
Why PCOS causes facial hair
In PCOS, the ovaries and sometimes the adrenal glands make more androgens than they should. Insulin resistance, which is very common in PCOS, worsens this because high insulin pushes the ovaries to produce more testosterone and lowers the protein (SHBG) that should “bind” testosterone and keep it inactive. The result is more free testosterone circulating and reaching the hair follicles, converting fine hair into coarse hair.
This is why approaches that tackle insulin and weight often improve hirsutism indirectly, even if slowly. To understand the bigger picture of how these hormones connect, read what PCOS is and the list of other PCOS symptoms that often appear together, such as acne and scalp hair thinning.
Treatment options: from clinic to cosmetic
Hirsutism can be treated, but every method requires patience because the hair cycle is very slow. Follicles take months to turn over, so even when treatment “works” at the hormonal level, your eyes only see change after roughly 3 to 6 months. This is not a sign of failure; it is simply how hair biology works.
Options doctors commonly discuss:
- Combined hormonal pills (COC) are often first-line for PCOS hirsutism because they lower ovarian androgens and raise SHBG. The clearest effect appears after about six cycles.
- Antiandrogen medication such as spironolactone blocks the effect of androgens on follicles. It works but must not be used while trying to conceive or during pregnancy because of risk to the fetus, so it is always combined with safe contraception and monitored by a doctor.
- Eflornithine cream slows facial hair growth when applied twice daily, but it only works while in use and does not remove existing hair.
- Cosmetic methods such as laser and IPL reduce hair more permanently after several sessions, while plucking, shaving, waxing or threading are safe immediate fixes. Shaving does not make hair grow back thicker; that is a myth.
Costs vary widely. At a KKM Klinik Kesihatan, a single visit for citizens is only around RM1 and includes basic investigations plus referral to a specialist O&G or endocrine clinic if needed. Laser and cosmetic treatments at private clinics are far more expensive and prices differ by location, so ask for a quote first. If you have just been diagnosed and feel unsure where to begin, the newly diagnosed PCOS guide lays out sensible first steps.
Spearmint tea: what the research actually says
Spearmint tea is the only herbal remedy for PCOS hirsutism with controlled-trial evidence, so it deserves an honest discussion. An early study by Akdogan in 2007 found that drinking spearmint tea twice daily for five days lowered free testosterone in women with hirsutism. A randomised controlled trial by Grant in 2010 over 30 days confirmed that spearmint tea twice daily lowered free and total testosterone compared with a placebo tea.
But there is one honest detail: in Grant’s study, women reported that their hair felt reduced, yet the objective hirsutism score (mFG) had not changed significantly. The reason comes back to that slow hair cycle: 30 days is too short for follicles to turn over. So the evidence is moderate, not strong. Spearmint tea is reasonable to try as support, especially since it is cheap, halal and easy to find, but it is not a medicine and not a replacement for treatment if your hirsutism is moderate or severe.
If you want to explore other supplement support targeting androgens and insulin, see our supplements page, and remember to check halal status and NPRA registration, and to tell your doctor what you are taking so there are no interactions with other medication.
When to see a doctor
See a doctor if coarse hair appears alongside irregular periods, stubborn acne, or weight gain, because that is a PCOS pattern worth confirming. Seek prompt evaluation if hirsutism comes on suddenly and rapidly over a few months, with a deepening voice, an enlarged clitoris, or increased muscle bulk, because that may point to a rarer cause rather than ordinary PCOS. Hirsutism also often comes alongside the weight and fertility struggles many Malaysian women feel most heavily, so you deserve comprehensive care, not just “go ahead and pluck it” advice.