Women affected by PCOS commonly report bothersome excess hair growth, acne or balding (scalp hair loss or thinning). Hirsutism refers to the excess growth of coarse, often long and dark hair, in a male-like pattern over the face, chest, abdomen, back, arms and legs. Balding, also called androgenic alopecia refers to the loss or thinning of scalp hair.

Hirsutism, acne or androgenic alopecia can be the result of increased production of male hormone, called androgens, in women with PCOS. The ovaries, and frequently the adrenals of women with PCOS overproduce androgens. The excess male hormones circulate in the blood and act on hair follicles in the skin to stimulate the growth of long, coarse and commonly dark hairs. They also cause hairs in the scalp to stop growing, resulting in balding. Excess androgens also result in the overproduction of sebum, the skin oil, which results in clogged pores and acne.

In addition to being considered a significant cosmetic problem for many women, hirsutism, acne and androgenic alopecia may indicate an underlying problem of significant concern - elevated androgen levels. There is evidence to suggest that long-standing elevations in androgens in women with PCOS can lead to problems with cholesterol and other lipid levels, which are risk factors for heart disease.

It is important to note that not all women with hirsutism, acne or alopecia have PCOS. Also, not all women with hirsutism will be found to have elevated androgen levels. Conversely, not all women with PCOS will have hirsutism.

An important factor in the development or lack of development of hirsutism is race and ethnicity. It has been shown that women of eastern European decent are at increased risk of demonstrating hirsutism, whereas Asian women will have little or no hair growth, despite similar levels of androgens.