For most women, hirsutism does get worse with age, particularly after menopause. The hormonal shifts that come with aging create conditions that favor unwanted hair growth, even in women who never experienced it before. Understanding why this happens can help you figure out what’s driving the change and what you can realistically do about it.
Why Aging Promotes Unwanted Hair Growth
The core issue is a shifting balance between estrogen and androgens (the hormones that drive coarser, darker hair growth). After menopause, estrogen levels drop rapidly, but androgen production declines much more gradually. The ovaries remain hormonally active for years after menopause, continuing to secrete meaningful amounts of androgens while producing relatively little estrogen. This imbalance is the main reason many postmenopausal women notice new coarse hairs, especially on the face.
A second factor amplifies the problem. A protein called SHBG acts like a sponge in your bloodstream, soaking up testosterone and keeping it inactive. Only about 1 to 2 percent of testosterone circulates freely and can actually affect your body. During and after menopause, SHBG levels drop significantly, which means more of your existing testosterone becomes “free” and available to stimulate hair follicles. You can have completely normal total testosterone levels yet experience hirsutism simply because less of it is being bound up and neutralized.
The result is predictable: menopause is commonly accompanied by the appearance of scattered terminal hairs on the face, particularly in the beard area, alongside thinning of scalp and body hair. This pattern is considered a normal part of the menopausal process, though the degree varies widely from person to person.
How PCOS Changes the Picture
If you have polycystic ovary syndrome, the trajectory is more complicated. Some women with PCOS actually see mild improvement in certain symptoms after menopause as overall hormone production winds down. But the improvement is often incomplete. Postmenopausal women with PCOS continue to have higher levels of both ovarian and adrenal androgens compared to women without the condition, which means hirsutism tends to persist rather than resolve.
Weight gain makes this worse. Extra body fat, particularly around the midsection, promotes insulin resistance, which in turn lowers SHBG levels and increases the amount of free testosterone in your system. Since weight tends to increase with age and becomes harder to manage after menopause, this creates a cycle that can intensify hirsutism for women with PCOS even as they get older.
The Role of the Adrenal Glands
Your ovaries aren’t the only source of androgens. The adrenal glands, which sit on top of your kidneys, also produce androgens throughout your life. In some women, the adrenal contribution becomes more significant after menopause, when ovarian estrogen production has largely stopped but adrenal androgen output continues. This is one reason hirsutism can appear or worsen well into your 60s and 70s, not just around the menopausal transition.
In rare cases, a sudden or dramatic worsening of hirsutism in an older woman, especially if accompanied by other changes like a deeper voice or significant hair thinning on the scalp, can signal an androgen-producing tumor in the ovaries or adrenal glands. A gradual increase in facial hair over months or years is far more likely to be the normal hormonal drift of aging, but rapid changes warrant investigation.
Medications That Can Make It Worse
Older adults tend to take more medications, and several commonly prescribed drugs can trigger or worsen excess hair growth. These include corticosteroids (often prescribed for inflammation or autoimmune conditions), certain anti-seizure medications like phenytoin, blood pressure drugs containing minoxidil, and immunosuppressants like cyclosporine. If you’ve noticed new hair growth that coincides with starting a medication, it’s worth checking whether the drug could be contributing.
Treatment Challenges for Older Women
Managing hirsutism becomes trickier with age for one straightforward reason: hair loses its pigment. Laser hair removal, the most effective long-term option for younger women, relies on melanin in the hair shaft to absorb light energy and destroy the follicle. Gray, white, and very light blonde hairs have little to no melanin, which means the laser essentially can’t detect them. If your unwanted facial hair has already gone gray, laser treatment won’t work.
That leaves several alternatives, none of which are permanent on their own. Electrolysis is the one method that works regardless of hair color, since it targets follicles with an electric current rather than light. It’s effective but slow, requiring multiple sessions. Tweezing works well for scattered hairs but isn’t practical for larger areas. Waxing handles bigger patches but needs to be repeated as hair regrows. Prescription creams that slow facial hair growth can help reduce the frequency of these other methods.
For women whose hirsutism is driven by a clear hormonal imbalance, addressing the underlying cause, whether that’s managing insulin resistance through weight loss, adjusting medications, or in some cases using hormone-based treatments, can slow the progression. But it rarely reverses hair growth that’s already established. Once a fine hair has been converted into a coarse terminal hair by androgen exposure, it tends to stay that way even if hormone levels later normalize. This is why earlier intervention generally produces better results than waiting.
What “Normal” Looks Like at Different Ages
The clinical tool used to measure hirsutism, called the Ferriman-Gallwey score, rates hair growth across several body areas. A score of 8 or higher is considered diagnostic. Interestingly, population data from one study showed that average scores among women being evaluated for hirsutism were highest in the under-20 and 20 to 29 age groups (around 24), then declined slightly in the 30 to 39 group (about 21) and the 40-plus group (about 20). This might seem to contradict the idea that hirsutism worsens with age, but the pattern reflects the fact that younger women seeking evaluation often have more severe hormonal conditions like PCOS driving their symptoms.
For women without an underlying condition, the more typical experience is a slow, steady increase in facial hair after age 40, with a noticeable uptick around menopause. About half of all women experience visible hair thinning on the scalp by age 50, and many notice coarser hair appearing on the chin and upper lip around the same time. These changes are driven by the same hormonal shifts and represent two sides of the same coin: androgens stimulate facial hair while contributing to scalp hair loss.