Issue 12: Upper lip, too?
On hairless beauty standards, PCOS in Indian womxn and the mental health connection
Foreign Bodies is a mental well-being newsletter for immigrants and refugees with a mission to de-stigmatize vulnerability through storytelling. Our issues are free for the public until 2020, when our grant money runs out and we will become fully funded by readers like you. We need your support to do this.
It all started in third grade.
During recess on one warm April day, some boy I was crushing on pointed out dark, thick hairs sprouting from the follicles polka-dotting my pale legs as I swung from the swings. His eyes moved from limb to limb, accompanied by comments about my arms, my eyebrow (singular) and, finally, the damn upper lip.
Others in our group joined in with a cackle or two, and the white girls in class kindly pointed out how light and nearly invisible their own body hairs were, how unlucky I must feel to not be blonde.
You have no idea, I remember thinking.
I went home crying to mama that day, and thus began my foray into the tortuous world of hair removal.
I wish it was just the razor bumps and cuts from shaving I had to endure. The simplicity of a blade gliding and slicing was not an option for me, I was often reminded. Use a razor, and the hair will grow back ten times thicker. Use a razor, and your skin will be as prickly as a man’s beard. Who will want to touch you?
That year, I began the weekly threading appointments, quietly nodding “Yes” to every beautician’s “Upper lip, too?” For the longer limbs and more private areas, I turned to dripping hot wax. The physical pain of ripping away my hairs was only secondary to how it felt being overexposed and vulnerable, nearly naked on a table in the back room of a corner salon at an age I was only beginning to find a relationship with my own body.
The smelly Nair and Sally Hansen creams that promised painless ease never did work on my stubborn threads. The burning hair lightening bleach from Jolen made me feel less-than, and I could feel my skin getting more irritable. The painful, never-ending zap-zap-zap of evil lasers seemed to hyper-discriminate against my dark hair and fair skin (and emptying bank account) no matter how many buckets of numbing cream I purchased.
The practice of removing female body hair can be traced all the way back to cave-people, who used flint blades, shells and other sharp objects to get rid of hair to prevent frostbite or parasite infestation.
Ancient Egyptians used copper razors and homemade pastes. Unlike the Egyptians, who promoted hairlessness in all people, Romans reserved the trait as a uniquely feminine ideal, and men were free to wear their natural body and facial hair however they liked.
Across Europe, a womxn’s hairlessness eventually became a symbol of status. (We’ve all seen the eyebrow-less Elizabethan portraits, right?)
But according to the Women’s Museum of California, “the modern era of hair removal may have been encouraged by Charles Darwin’s 1871 book, Descent of Man, through the popularization of his theories of natural selection.”
Darwinist interpretation might suggest “homo sapiens have less body hair than his/her antecedents because less hairy mates were more sexually attractive.” Thus, “body hair became a question of competitive selection.”
Within 30 years of the book’s publishing, upper- and middle class white American womxn began associating smooth skin with a desirable femininity. In 1915, Gillette advertisements encouraged womxn to remove any “unsightly” and “objectionable hair,” especially if that hair grew in places like—gasp—the underarms! By 1964, as hemlines rose, 98% of white American womxn were regularly shaving.
“In a remarkably short time, body hair became disgusting to middle-class American women, its removal a way to separate oneself from cruder people, lower class and immigrant,” Rebecca M. Herzig wrote in her book, Plucked: A History of Hair Removal.
In the ‘60s, doctors even began prescribing hormonal drugs with dangerous side effects to combat stubborn excess facial and body hair (or hirsutism) in womxn, drugs now primarily reserved for individuals transitioning from male to female.
“It’s not a coincidence that the pressure for women to modify their body hair has risen in tandem with their liberties,” Nadine Ajaka wrote for The Atlantic in 2017. According to Herzig, Ajaka wrote, “the effect of this hairlessness norm is to ‘produce feelings of inadequacy and vulnerability, the sense that women’s bodies are problematic the way they naturally are.’”
Hair removal might just be one of the biggest self-care lies we’ve adopted as womxn, she argued. “It keeps us in an impossible loop, one in which we are constantly in pursuit of velvety limbs and the moral virtue of cleanliness.”
For those of us with darker skin, with thicker hair or wider hips, the feminine western beauty ideal is already pretty much unattainable. Add stubborn excess facial or body hair and, well, you get the point.
While western conventions of beauty have undoubtedly influenced the global standard (hi, colonization), let’s consider the ways certain cultures make living with excess hair all the more complicated or shameful for womxn—cultures where her objective worth is still deeply rooted in feminine prowess and fertility.
I’m going to introduce you to a dear friend of mine now. Puja Shah and I have known each other for about a decade (maybe longer?) and have been close since college. She’s one of those people you meet once and want to meet again, always oozing genuine love for the people in her life and for the work she does.
At 16, Puja received a diagnosis to explain the excess hair and irregular periods she was experiencing: polycystic ovary syndrome. PCOS is one of the most common hormonal disorders among womxn, affecting 1 in 10 of those within childbearing age.
According to the Mayo Clinic, the exact cause of the condition is unknown, but several factors play a role: too much insulin, genetics, high levels of androgen.
If you have PCOS, you may experience severe acne, male-pattern baldness and enlarged ovaries that fail to function regularly. It can put you at higher risk of infertility, Type 2 diabetes, miscarriage, metabolic syndrome, sleep apnea and a slew of mental illnesses, including depression, anxiety and eating disorders.
Anyone with ovaries and uteruses, no matter their ethnic background, is at risk during reproductive age. But the way PCOS manifests physically (its phenotypic expression) can indeed vary across ethnicities and geographies.
For example, research shows a strikingly high prevalence of PCOS-related hirsutism among womxn of South Asian, Middle Eastern or Mediterranean origin.¹
Puja is a born-and-bred Georgian and her family comes from Gujarat, India. While she’s learned to master the balancing act of her Indian roots and western upbringing, she admits it wasn’t easy to appease the harsh beauty standards of both cultures, especially with PCOS.
When her endocrinologist suggested birth control at 16—a customary treatment option for PCOS management—Puja’s mom was adamantly against the idea. Stigma against contraceptive use is fairly common in Asian American communities, even if the patient isn’t sexually active. It’s the mere possibility of sex, the mere taboo of discussing sexual health at all.
So her doctor recommended the next best course of action: a change in diet and exercise coupled with Metformin, a medication used to lower blood sugar and improve insulin sensitivity. I’ve used it myself when I was pre-diabetic and dealing with my own metabolic syndrome.
As the years went by, Puja’s periods became so irregular that she often had to learn to induce them. She’d skip out on trips and pool parties and anything that required her to leave the house because she never knew when the induced period would arrive, or just how intense it might be.
“I was honestly just really, really devastated,” Puja says. “I didn’t really know why this was happening or what exactly was going on. There wasn’t much research or support out there at the time.”
It didn’t help that the subject was rarely addressed in family settings. To this day, Puja’s dad has no idea.
The irregular periods are certainly still cumbersome. But 12 years later, it’s the hirsutism that gets to Puja most.
“It’s definitely influenced my confidence and self-esteem,” she says. “Hair is always on my mind.”
When she takes photos with friends, she asks to see the final shot before anyone uploads it. Then she scans the image to see if there are any visible hairs sprouting from her chin or upper lip.
Sometimes Puja will skip out on big events or hangouts with friends because she just doesn’t want to go through the pain of waxing her upper lip for a couple of hours of fun.
Recently, she met up with a male friend after getting her eyebrows threaded, leaving her brows and forehead lit up in a reddish hue. When her friend commented on the redness, Puja let him know that, you know, threading hurts!
“Couldn’t be that bad,” he replied. So she drove him to get his own eyebrows threaded for the first time.
He left the beautician’s chair in tears.
But it’s not just the pain of hair removal (and lack of understanding) that bothers Puja. For her and for many with metabolic syndromes (myself included) any type of hair removal tends to give way to even thicker, more stubborn replacements. And the more you shave or wax or laser, the more the skin gets exacerbated and discolored.
That’s influenced the type of clothes Puja feels comfortable wearing, too. Sleeveless tops and dresses expose the discoloration under her shaved underarms. A bikini feels out of the question.
If you know Puja, you know she’s the biggest, warmest cuddlebug around and she loves to hug, kiss, hold her friends’ hands. It’s hardly surprising that her primary love language is touch.
Still, she says, she hates being touched.
“It’s weird, I know. And I definitely think that’s stemmed from insecurity,” she says. “I don’t want people to touch me and feel the hair on my body.”
It makes her self-conscious about being intimate with someone, too. “What if they wonder why I’m discolored? Or think I’m not clean?”
The hair and discoloration have also affected her relationship with her mom, who constantly reminds her to get rid of the fuzz before a trip to the temple, to a wedding, to any family gathering. The repetitive reminders have added a lot of anger and resentment toward a culture that rarely speaks aloud about womxn’s health but unquestionably promotes hairless, fair and velvety skin as the sole face of beauty.
Even when Puja’s mom says she’s “just joking around,” it gets to her.
“Because of the comments, I don’t lay on her or let her touch my face,” she says.
But Puja recognizes how different her mom’s upbringing had been, how the culture shock of leaving a country for an alien world may have complicated the way she shows her love. She may not always have the right words, but Puja’s mom is constantly on the lookout for new herbal supplements and vitamins that might ease her daughter’s symptoms, and that means a helluva lot to Puja.
Fostering a close friend group has also been critical through all this, she says. At least half of her friends have PCOS or some kind of metabolic syndrome, and they’re actually willing to talk about it.
“We’ll help each other out, you know,” she says. “We’ll share what works and what doesn’t.” Sure, PCOS symptoms and treatment effectiveness vary by individual, but it’s just good to openly talk about a subject that’s still so hush-hush at home, she says.
Puja’s also found support in Facebook and Instagram groups for others diagnosed with PCOS. She attended a conference for PCOS awareness and met people who were dealing with the same sh*t. Being part of these cohorts helped her feel a little more understood. And it’s been key to her gaining confidence over the years.
“If you had asked me to talk about this five years ago, I would have said no,” Puja says. But now, “I've kind of grown and accepted that, you know, it is what it is. All I can do is maintain what I can. I'm not gonna let it stop me from doing whatever I want.”
Looking ahead, Puja (a total science nerd) is optimistic about the research emerging around PCOS symptom management, considering the condition has had a long history of limited funding.
But if you’re reading this and dealing with metabolic syndrome or hirsutism and all the psychological distress associated with the conditions, some advice from Puja:
Connect with others who can relate, whether that’s through a support group, online, or friends willing to chat.
While Puja wasn’t diagnosed with a mental illness, she recommends everyone get screened for common mental disorders. If your social anxiety, self-esteem or body dysmorphia is affecting your daily life or keeping you from enjoying yourself, please consider counseling.
Know you’re not alone. Just in the U.S., between 5% to 10% of women of childbearing age (~5 million) have PCOS. And yet, less than 50% are properly diagnosed, leaving millions of womxn living with PCOS undiagnosed.
Don’t take your anger out on loved ones (or your endocrinologist!) Frustrated with her new normal, Puja ended up avoiding her endocrinologist for a while and resenting her when she was just trying to help.
The mental health and well-being connection
To what degree PCOS influences your individual mental health and well-being depends on so. many. factors. Do you already have a history of mental illness in your own life or in your family? Which PCOS symptoms are most personally troublesome for you? Is it the excessive facial hair, the weight gain, the irregular periods, the infertility? Some interesting research:
In general: Infertility = higher scores of depression. Obesity = higher anxiety scores. But PCOS patients with oligomenorrhea-hirsutism (infrequent menstrual periods + excess hair) are “overall more affected in terms of physical functioning, physical role function, pain, social functioning, emotional role function, and emotional well-being.”²
For Iranian and Sri Lankan womxn, hirsutism tends to be the most psychologically distressing PCOS symptom. “Not only is hirsutism itself a major concern for womxn diagnosed with PCOS, but the time and energy spent at concealing it aggravates the distress further.”³
A study on American, German and Australian womxn with PCOS found that obesity was the most distressing PCOS symptom, whereas body hair was the least of their concerns.⁴
Because this issue is dedicated to #hairhairhair let’s focus on why hirsutism—whether it’s a symptom of PCOS, another medical condition or simply due to genetics—might be especially burdensome to psychological well-being.
“Despite the fact that the syndrome, from my perspective as a physician, may give rise to other serious conditions such as high blood pressure, cardio-vascular diseases, high lipid levels in the bloodstream, diabetes, difficulties conceiving and overweight, women with polycystic ovary syndrome rate the excess hair as the second most difficult thing to live with. Second to difficulties conceiving.”
— Dr. Maria Palmetun Ekbäck, a physician and researcher with Sweden’s Örebro University
Those with unwanted hair due to hirsutism often feel self-conscious, and plan their lives according to how well they can hide their bodies, Ekbäck says. Because of this, they might avoid close physical contact, or make themselves seem unapproachable.
The more unwanted excess hair growth a patient experiences, she adds, the more potential for social anxiety and depression. And statistically, womxn living with PCOS who tend to experience anxiety or depression seldom seek psychiatric help for their hirsutism symptoms because they’re embarrassed.
"As doctors, looking at the whole picture, we most likely often view the hair growth as trivial,” she said. “But if these women are to find the strength to cope, follow dietary and exercise advice, and go under medication, there must be a sense of empowerment in the way that they are approached and treated by healthcare staff. We need to provide adequate information and lift the stigma brought about by this condition.”
Research shows South Asian womxn with PCOS disproportionately experience more severe hirsutism and infertility⁵. Research also shows multiple countries in South Asia, including Pakistan and India, are among the worst for women⁶ based on violence and lack of health services. Research also shows South Asians, who are more likely to exhibit depressive symptoms and are at higher risk of suicide⁷ compared to the general U.S. population, are among the least likely demographic to seek psychiatric help, and that includes migrants.⁸
Find a doctor or specialist
Introductory guide to finding the right doctor (Endorcineweb.org)
Amino search engine: Free and personalized! Search function based on how much experience clinicians have treating patients like you—with the same condition or procedure you need, your age, and your sex.
NeedyMeds: Low-cost, sliding sale nonprofit clinics. The PCOS Awareness Association offers U.S. patients a free prescription drug card.
Ongoing clinical trials (global)
PCOS and Depression: Understanding the Connection and Finding Relief (Therapy options via Healthline)
UCSF PCOS Clinic: Patients see a team of specialists in reproductive endocrinology, dermatology, nutrition, psychology and genetics. (Only Oakland and San Francisco, but reach out and ask for recommendations near you?)
Get support: Online groups
Cysters.org (website dedicated to reproductive justice for marginalized womxn)
myPCOSteam (free social network)
The Cysterhood (paid web program)
Instagram: @pcosaa | @twobrokegirlswithpcos
Facebook: PCOS Support Group | Soul Cysters
Apps: PCOS Diva | everyPCOSbody | PCOS Tracker
Get educated and stay informed
Q&A with Cedars-Sinai’s Dr. Jessica Chan (PCOS specialist)
PCOS and the associated mental health conditions (Care For Your Mind)
Expertscape (Uses the National Institute of Health’s PubMed database to identify individuals and institutions currently conducting research, publishing papers, and conducting clinical trials around PCOS and thousands of other medical conditions).
PCOS Challenge Magazine (e-zine)
Get involved: Events and advocacy
PCOS Awareness Month and Challenge (September awareness/fundraising fun)
PSOS Con (Annual PCOS conference)
For clinicians
Clinical manifestations of polycystic ovary syndrome in adults (UpToDate)
A comprehensive mental health care program for women with polycystic ovary syndrome: protocol for a mixed methods study (Reproductive Health)
From PCOSAA: The Crisis Text Line serves anyone, in any type of crisis, providing access to free, 24/7 support and information. Text PCOS to 741741 from anywhere in the United States or UK, 24/7. We will text about whatever is a crisis to you - addiction, anxiety, assault, bullying, depression, eating disorders, self-harm, and suicide.
The Casualties of Women's War on Body Hair (Nadine Ajaka, The Atlantic). “I’m sure there was a time when I was not hairy, but I can’t remember it,” writes Ajaka. “I recall inspecting the black hairs on my legs with serious fascination; my mother would use sticky sugar to rip them out from their stubborn roots. ‘Beauty requires strength,’ she would say.” Read here.
The Syndrome That Made Me Question My Femininity (Mariana Viera, ZORA). “She just needs to scrub harder when she showers,” Mariana’s aunt lovingly said when she was just 10. As she reached teen-dom, Mariana’s mom let her replace meals with Slim Fast shakes to combat the weight gain. In the bathroom mirror, she began noticing the discoloration along her neck, “the most stubborn dirt I had ever encountered.” Read here.
6 Women On Living With Polycystic Ovary Syndrome (Jacqueline Kilikita, Refinery29). Priya, 33, admits she’s slathered herself in skin lightening cream and even slept with the harmful hydroquinone on her face overnight. Twenty-six-year-old Rachel is primarily concerned about infertility. But what’s frustrating is the pity from others. “I shouldn’t be made to feel that I’m broken.” Read here.
Brown Girls and Hair by Neamah Hussein. “Body hair and the ordeal of dealing with it is a big part of my life... and I find that hilarious.” This “cathartic tragicomedy on body hair” will leave you laugh-crying for days. Watch here.
Issue 13, out on New Year’s Eve, will mark one year since we launched! We want to hear from you. What have you loved or disliked about Foreign Bodies? Do you have a favorite issue? Is there something you want us to do differently in 2020?
And remember, our grant money runs out at the end of December. That means in 2020, we will be fully funded by readers like you. We really need your support to continue this work.
If you haven’t yet, please consider upgrading your account from free to paid:
You can also send in one-time donations. If your gift exceeds any of the above annual rates, we’ll automatically add you to our paying subscribers list for 365 days so you never miss a beat. Just shoot us an email and let us know you’ve sent us a gift.
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Share this post. Share any of our posts. Spread the word so we can reach more readers. Help us in our mission to de-stigmatize vulnerability through storytelling, however you can.
- Fiza
P.S. A very special thanks to Puja for being a stellar friend and for sharing her story. And don’t forget: The giveaway for Bassey Ikpi’s powerful memoir, I’m Telling the Truth But I’m Lying, ends TONIGHT!
Sources
Lo JC, et al. (2006). Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. DOI: 10.1210/jc.2005-2430.
Acmaz G, et al. (2013). Level of anxiety, depression, self-esteem, social anxiety, and quality of life among the women with polycystic ovary syndrome. DOI: 10.1155/2013/851815.
Khomami M, et al. (2015). Of PCOS Symptoms, Hirsutism Has the Most Significant Impact on the Quality of Life of Iranian Women. DOI: 10.1371/journal.pone.0123608.
Thomson RL, et al. (2010). Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. DOI: 10.1016/j.fertnstert.2009.11.001.
Mehta J, et al. (2013). Phenotypic expression of polycystic ovary syndrome in South Asian women. DOI: 10.1097/OGX.0b013e318280a30f
Sohrabji, Sunita. (2013). Suicide Amongst Indian Americans: We’re Stressed, Depressed, But Who’s Listening?
Elias, Priya-Alika. (2015). The Silence About Mental Health in South Asian Culture Is Dangerous.
Foreign Bodies is an email newsletter dedicated to the unique experiences of immigrants and refugees as they relate to coping with mental illness and wellness. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter @4nbodies or Facebook. Special shout-out to Carter Fellow and friend Rory Linnane for the adorable animated logo!
If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.
