Body Hair Changes RCGP Metabolic Problems & Endocrinology Curriculum

Body‑hair changes are an important clinical clue to metabolic and endocrine disorders.

• Included in the RCGP curriculum under Metabolic problems and endocrinology.

• Presentations range from:

  • Excess hair growth – hirsutism (male-pattern) or hypertrichosis (generalised).

  • Hair loss or thinning – alopecia (patchy or diffuse).

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Why Relevant for GPs

• May indicate underlying hormonal imbalance (e.g., androgen excess, thyroid dysfunction, adrenal or pituitary disorders).

• Can be physiological (puberty, pregnancy, menopause) or pathological (PCOS, Cushing’s, androgen-secreting tumours).

• Often associated with psychological distress → impacts quality of life.

• Early recognition → appropriate investigation, management, and referral.

Physiology of Hair Growth

Hair Growth Cycle

• Anagen (growth phase): Active hair production; lasts years on scalp.

• Catagen (involution phase): Follicle regression; lasts weeks.

• Telogen (resting phase): Shedding phase; lasts months.

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Role of Androgens

• Convert vellus hair → terminal hair (thicker, pigmented).

• ↑ Sebum production and anagen duration on body hair.

• Shorten anagen on scalp → may contribute to androgenic alopecia.

• Follicle sensitivity varies by individual and ethnicity.

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Hirsutism Assessment

• Ferriman–Gallwey score: Rates 9 androgen‑sensitive areas (e.g., upper lip, chin, chest).

• Score ≥8 = hirsutism in UK women (NICE CKS).

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Other Hormonal Influences

• Thyroid hormones: Regulate follicle metabolism and hair cycle.

• Cortisol, GH, prolactin: Direct impact...