In 1865, as a 1-year-old, Annie Jones Elliot was put in P.T. Barnum's sideshow as the new "Infant Esau." ("Esau" in Hebrew means "hairy.")

By age 5, The Bearded Girl had sideburns and a mustache, and was launched on her lifelong career as The Bearded Woman.

Annie was unusually hairy. But 7 percent of women contend with some degree of hirsutism, or abnormal hair growth.

Three-quarters of cases are associated with polycystic ovary syndrome, triggered by excessive levels of androgen hormones like testosterone.

Some medications for seizures, blood pressure and low blood sugar also can cause hirsutism.

In addition, hypertrichosis, or excess hair, can result from thyroid dysfunction, anorexia and porphyria (a blood disorder).

The Endocrine Society Clinical Practice Guidelines for managing these conditions have been updated:

1. Get an accurate diagnosis. Have blood tests to check levels of male sex hormones. You want to know if unwanted hair growth is because of PCOS, adrenal hyperplasia, thyroid dysfunction, Cushing syndrome, or androgen-secreting tumors.

2.Select safe treatments.

• The first-line treatment for women with hirsutism is oral contraceptives.

• Topical agents, such as eflornithine may be used.

• Photoepilation (intense pulsed light therapy) works on brown/auburn/black hair. However, women of color may need to use a long wavelength, long pulse duration light source to avoid complications. Women of Mediterranean and Middle Eastern descent are at risk of pigment changes, blistering or scarring.

Evidence for the effectiveness of electrolysis and laser therapy is limited, but these may work for white or blond hair.