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Electrolysis, the only permanent hair removal method |
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Dear Dr. Redmond: It is not unusual for electrologists to get questions from clients who are afraid their preteen daughters are going to have the same excess hair problem as themselves. There are conflicting opinions on whether or not we should treat these youngsters with electrolysis. Can you tell me more about the causes of body hair on girls, and what should be done about it at an early age? This question has been discussed in this column before, but it commonly recurs, and is well worth a revisit. I too, am regularly asked this question by mothers. Often, the mother has been troubled by unwanted hair and is afraid her daughter will develop the same condition. Genetics is a factor, of course, in the amount of facial and body hair on a woman. The very dark hair on Mediterranean people is more noticeable than a similar amount of blond hair on a Scandinavian. Aside from East Asians, who have much less facial and body hair than other ethnic groups, unwanted hair is common in all peoples around the world. There are also individual genetic differences. Just as a daughter is likely to resemble her mother in other ways, she may have a similar amount and distribution of hair as she reaches adulthood. Hormones are an important factor of hair growth. Testosterone is the hormone that stimulates hair follicles on the face and body and causes hair to increase. To look at the role of this hormone, we need to consider the stages of a girl’s physical development. During fetal life the ovaries are actively involved in the formation of a female’s reproductive system. In addition to estrogen, the ovaries probably make some testosterone at this time. Within a few weeks following birth, the ovaries become quiescent and remain that way until puberty. Though most often the first visible change of puberty is the appearance of breast buds, on occasion it is pubic hair that appears first. Both can appear normally at age eight or older, but the average age is between 10 and 11 years. I should explain that in a medical sense puberty refers to the entire process, not just to the beginning of menstruation. Periods generally don’t start until about two-and-a-half years after the breast buds and pubic hair. Puberty lasts several years, during which time there are increasing effects of estrogen and (to some degree) testosterone on a girl’s body. Once puberty has started, pubic and underarm hair will appear in all girls. Hair in other places than the pubic region usually starts about the time menses begins and may increase after that. Most start to get leg hair at this time and some may have slight increases on the forearms. Underarm hair is normal, as is the presence of a few hairs around the nipples. The medical term hirsutism refers to noticeable hair in other areas. When the face is affected, hirsutism usually appears first on the chin, then the upper lip, and later, sometimes, the sideburns and cheeks. On the body, hair growth starts in the midline and may spread sideways. There can also be an extension of pubic hair – up toward the navel, and down along the upper thighs. The lower back can also be affected. The development of hirsutism is gradual over several years. It may become noticeable by the mid-teens and increase through the early twenties. After that, progression slows. Before there are any signs of puberty, some little girls do have visible hair on their forearms and sometimes on their back. I suspect this is a result of the higher testosterone levels before and just after birth: genetic sensitivity of the hair follicles may be a factor, too. During childhood, noticeable increases in hair are rare because testosterone is then extremely low. Occasionally, extra hair seen on a young girl will fall out before she reaches puberty. But generally speaking, girls who have more hair before puberty tend to have more than an average amount after puberty. Mostly it is the mother who worries; with very few exceptions, most little girls are unaware of their extra hair and not in the least self-conscious of it. I do think it is best for mothers not to draw their daughters’ attention to it unnecessarily. Casually bringing the subject up during a “routine” visit to the child’s doctor is probably the best idea. When pubic hair develops before age eight without breast development, the condition is termed pubarche, or premature adrenarche. Although this condition is usually benign, a pediatric endocrinologist should evaluate it because infrequently it is the sign of a hormonal disorder. When both pubic hair and breast development occur early, the condition is termed precocious puberty, and prompt evaluation is necessary. In a prepubertal girl, most of the medications used for hirsutism in adults are not appropriate or necessary. Since testosterone levels are low in childhood, the extra hair on arms or on the back grows very slowly if at all, and so removal will last for a long time. Bleaching the hairs, shaving them or removing them with depilatories may be feasible with parental supervision (allowing for the relatively delicate skin of children). Waxing the hair is a possibility, but it may be too painful for a child. Again, if the extra hair is not a concern to the prepubertal child, it may be best to do nothing. A girl without signs of puberty, no pubic hair and only slight extra arm and back hair need not create anxiety. It is prudent to watch what happens to such children during the teens, however, so that if the amount seems to be increasing to the point at which it causes embarrassment, treatment can be started early. Medical treatment can be safe and effective in the teens but is not the only possible approach. Electrolysis is reasonable so long as the girl understands the reason for it, and is accepting of it. |
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