Balancing the Most Common Side Effect of Testosterone Replacement – Facial Hair

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Dr. Maupin and Brett discuss options for dealing with unwanted facial hair.

Susan is a fairly new patient for me came in for her follow up patient visit after 3.5 months of estradiol and testosterone pellet treatment.  She should be ready for her next dose.  Before she came to see me for follow up I reviewed her lab, and all of her hormone levels were normal.  I was happy that she would feel better at our follow up appointment.

After I greeted her I knew she was not happy as I expected.  I reviewed her lab and symptoms with her and went over each symptom that had been resolved with the first dose of estradiol and testosterone.  I thought it was a great outcome.  But she still frowned.  When I asked why she was unhappy she pointed at her upper lip and stifled a scream and said, “look at the hair on my upper lip!”  I was surprised so we talked about all the benefits she had gleaned from her first insertion: her sex drive was back, her husband was happy again, she had lost fat around her middle, her energy was coming back, no hot flashes or dry vagina and she could sleep through the night again!  But that pesky facial hair that I couldn’t even see from across the table was torturing her.  I had given her an inexpensive medication to prevent facial hair like I do with all my patients but she didn’t take it because she doesn’t like pills.

Fortunately after I discussed the ease of removing hair from a woman’s face, since I have been doing this my whole life, she realized how miniscule this problem was compared to all of the symptoms that had retreated due to the pellets.

This is not an infrequent problem in my practice or any one that treats women with testosterone.  It is the doctor’s responsibility to provide preventive treatment for facial hair to female patients, and to make sure the testosterone dose is moderate.  I believe facial hair is an insignificant problem that can be prevented or treated locally with waxing, laser, dermaplaning, or epilating.  I never recommend shaving with a razor because it leaves stubble.

There are psychological and social fears about having facial hair for women that supersedes the actual weight of maintenance of hair removal.  I’m Italian so I have had facial and lower arm hair my whole life.  When I had my ovaries removed that facial hair and arm hair just went away.  I have to say it was the only thing that improved after my oophorectomy.  I gained a lot of weight, had no energy, couldn’t; think, lost strength and muscle mass and I couldn’t think. When I finally found the godsend that was Testosterone and estradiol pellet therapy, I was ecstatic and no amount of hair on my face or body mattered, because I was so miserable!

Most of us over 50 have seen the movie, “My Big Fat Greek Wedding” and the scene with all the girls who had bleach on their upper lip to bleach their natural facial hair.

I find that those women who have had natural facial hair early in their lives are not disturbed by the return of it when they get their testosterone back.  Those who have not dealt with this problem, facial hair is a sign of masculinity, or lack of femininity.  Most of my patients who initially find facial hair to be a problem, end up understanding that facial hair is a miniscule problem compared to the many symptoms that have been erased by replacing their female hormones-estradiol and testosterone.

Please don’t let a minor problem that is easy to fix, prevent you from replacing your lost hormones and improving your health as you get older!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.

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