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Extra Hairy in All the Wrong Places? Get Expert Insight on Hirsutism.

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Extra Hairy in All the Wrong Places?

Town & Country Compounding Can Help.

Many women have something in common. Something you can’t help and don’t want— experiencing hair growth in undesirable places where males naturally grow hair.

Undesirable Hair Growth Patterns in Women

Hair growth patterns change with aging and there’s a multitude of reasons why you may have a problem. Some of these can be taken care of with laser or electrolysis, but the pain and expense may add up over time. Getting procedures done takes time, and finding appointments or the willingness to go to repeat appointments may be more of an issue, especially during COVID times. 

What are some alternative options? Explore possible factors and options for addressing undesirable hair growth.

What Factors Contribute to Unwanted Hair Growth?

Unwanted excessive hair on the face in females (hirsutism) occurs from excess production of androgens (like testosterone) by the ovaries or adrenal glands. The true definition of hirsutism is excessive terminal hair that appears in places on a female where males would have hair.

Hirsutism is typically associated with a metabolic syndrome like polycystic ovarian syndrome (PCOS), but the cause can also be unknown or even be medication-induced.

There are also multiple factors that may affect unwanted hair growth; for example, imbalances in hormones such as testosterone, DHEA, thyroid, or cortisol. With a mild form of hirsutism, a female may see growth of hair above the lip, on the chin, and even sideburn areas.

Source: NCBI

Other Factors to Consider:


Progesterone is considered an anti-androgen because of the fact that it competes with androgens for the androgen receptor. Some have suggested that it has an effect on 5-alpha reductase (5-αR) — an enzyme whose main function is converting testosterone to dihydrotestosterone (DHT), a highly active form of testosterone — but the literature does not support this concept. However, if progesterone occupies the androgen receptor, then testosterone or DHT is unable to bind and have an effect.

Azelaic Acid

A prominent theory is that azelaic acid is responsible for decreased DHT production, and in fact, it has been shown to inhibit the activity of 5-αR. By suppressing this cycle, hair growth will slow or even stop.


Spironolactone is an androgen blocker and competes with DHT for binding to the androgen receptor. Studies have also shown spironolactone to have an inhibitory effect on 5-AR. Typically spironolactone is used orally, but it is also used topically to elicit a local effect while minimizing systemic side effects. The downside with a topical preparation is the odor, which is unpleasant and may require the addition of a fragrance.


Metformin is a drug that is used in women’s health for polycystic ovarian syndrome (PCOS) and problems with excessive facial hair (hirsutism). It’s also used for addressing diabetes. Metformin reduces circulating insulin, which decreases the concentration of free levels of androgens. It is most commonly prescribed as an oral dosage form (tablets or solution). However, unwanted side effects are often seen with taking metformin orally. Nausea, vomiting, gas, bloating, diarrhea, and loss of appetite can occur in one out of three patients who take it. These side effects cause many patients to discontinue therapy.

Topical Metformin

It is well known that metformin reduces circulating androgens, which can decrease the occurrence of excess hair in women, it’s possible that applying metformin topically may inhibit and reduce terminal hair growth. Topical metformin in a permeation enhancing base may help eliminate those side effects. It must be made by a compounding pharmacy. Topical metformin allows the drug to be absorbed into the body without having to take it orally.

Finasteride Compounded Cream and Combinations

Finasteride is a competitive inhibitor of 5α-reductase. It is recommended to be taken as second-line option for hirsutism. Based on some guidelines, oral contraceptive pills used as first-line option for hirsutism may be combined with finasteride after six months if response is considered suboptimal. One particular study compared finasteride 0.25% cream to placebo. After six months of therapy, mean hair counts decreased significantly in the finasteride exposed sites compared to no significant change observed in the placebo-applied sites.

Example Formulas to Discuss with your Prescriber
  • Metformin HCl 5%/Progesterone 1%/Azelaic Acid 1%/ Spironolactone 5% Topical Cream
  • Metformin HCl 5%/Progesterone 1%/Azelaic Acid 1% Topical Cream
  • Finasteride 0.25% Facial Cream
  • Other options are available depending on your needs.

Our experts can talk to your doctor and suggest formulations.
Getting hormone levels tested may be important to help narrow down your cause.

At-Home Hormone Test Kits

Knowing your hormone levels may be helpful in finding the best course of action with compounded prescriptions. We sell saliva test kits you can complete at home and can recommend what hormones to test if you’re not sure. With our tests, you get a free 15-minute consultation with a pharmacist who specializes in hormones.

Town & Country Compounding Pharmacy is located at
Town & Country Compounding Pharmacy is located at 535 East Crescent Ave Ramsey, NJ 07446

Town & Country Compounding provides the most advanced formulations based on the most recent research and peer-reviewed guidelines.

We work with patients and their medical providers to customize solutions that are right for their individual needs when commercially-made medications are not showing results.

Medication is not one-size-fits-all. 

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