The hidden suffering of bromhidrosis: when body odour becomes a medical crisis

Hayat chose her restaurant tables carefully—always far from other diners, always near a door or window. On planes, she paid extra to sit alone. At the cinema, she timed her visits to avoid crowds. For more than a decade, she lived with bromhidrosis, a chronic body odour condition that had nothing to do with hygiene and everything to do with her body working against her.

The condition began during menopause. In 2007, at 48, she had an ovary removed, which disrupted her oestrogen production. What followed was relentless: constant overheating, burning sensations even in New York's freezing winters, and a smell that emanated from her armpits, under her breasts, her groin. On the subway, she would be in a sleeveless top and sandals, hair dripping wet, while other commuters wore heavy coats and boots. People stared. Some covered their noses as she passed. Others moved away. A few verbally abused her. She was harassed off trains more than once. "It was awful, a total nightmare," she says now.

Bromhidrosis is not simply bad hygiene. It is a bacterial imbalance or metabolic issue that causes the body to produce offensive odour regardless of how often someone showers or which deodorant they use. Chris Callewaert, a senior research fellow at Ghent University and one of the few scientists specialising in body odour, explains that the apocrine glands—concentrated around the armpits, breasts and groin—secrete lipids, steroids and proteins. The sweat itself is odourless. The smell comes from bacteria on the skin and in hair follicles digesting those fatty secretions. In people with apocrine bromhidrosis, something in that process is out of balance: overactive glands, perhaps, or an overabundance of specific odour-producing bacteria. "Fifteen minutes after a shower, they've already started smelling," Callewaert says.

Hayat spent thousands of dollars searching for relief. She saw endocrinologists, gynaecologists, cardiologists—a whole team trying to understand what was happening in her body. Nothing worked. Over-the-counter and prescription remedies made no difference. Yet there is no diagnostic threshold that defines when body odour becomes bromhidrosis, which makes it difficult to estimate how common the condition is. A 2024 review described it as prevalent in the west and taking a "significant" toll on patients' social and psychological wellbeing. Yet there is very little focused medical attention or specialised support. Angela Ballard, a registered nurse and communications director for the International Hyperhidrosis Society, calls it "underserved." An estimated 50 percent of the 1.6 million women entering menopause annually in the US alone experience increased underarm sweat and odour. "There is not a lot of information," Ballard says, "and I think that's indicative. People are ashamed. They don't talk about it with their healthcare providers, even their friends."

For Hayat, the social consequences became as disabling as the condition itself. At 50, she learned to drive and bought a car to avoid public transport—a significant undertaking in New York. She began flying business class for the extra space. "Economically, it was a sacrifice, but for my wellbeing, it was perfect to be as far away as I could from people," she says. Her family insisted she didn't even smell, that it was all in her head. But she couldn't trust them over the feedback she received in public. Her world contracted. Before menopause, she went to theatres, movies, clubs, restaurants. For more than a decade, she went nowhere except work. At the office, colleagues were far from sympathetic. A younger co-worker made a show of using room spray in her presence. She overheard others waving their hands in front of their noses, talking about her. The environment became so hostile that she considered suicide. Eventually, she turned to her employer's human resources department, which moved swiftly to support her, relocating her away from those colleagues and offering to take action against them for bullying. She declined, but the support helped.

Ellie, 30, had wanted to be a teacher but couldn't imagine standing in front of a classroom, sweating and fearing she smelled bad. She now works as an accounting assistant. "There were several career paths I wanted to pursue but didn't," she says. She was nearly dissuaded from having children, fearing she would pass on her conditions. But she has a daughter now. "While excessive sweating and body odour is extremely unfortunate, it is not a reason to not want to live," she says. Doctors have been generally dismissive, so she developed her own coping strategies: wearing only cotton socks, never leaving the house without a full change of clothes. "I swear I've tried every deodorant on the market." The assumptions from others sting most—that she is either oblivious to how she smells or wilfully doing nothing about it. "Don't think we don't realise," she says. "Odds are, we're trying everything we can to mask it, and get rid of it, but sometimes there is no way."

Callewaert's research shows that people who know or fear they have body odour are actually more attentive to personal hygiene than others. But the anxious striving to manage bromhidrosis can worsen it by further imbalancing the microbiome and stoking sweat production. "They have stress and, as such, they have odour, and because they have odour, they have more stress: it's self-enforcing," he says. Over time, bromhidrosis becomes as much psychological as physiological. People self-isolate, worsening their wellbeing. They develop anxiety or depression. "On average, their quality of life is lower," Callewaert says. The stigma persists despite body odour being a natural part of life. Doctors can be dismissive, instructing patients to simply apply more deodorant. "People are being brushed off very easily because 'it's not life-threatening,'" Callewaert says. But a subtle change in body odour has been associated with diabetes, Parkinson's disease and cancer. "Knowing that body odour can be a symptom for underlying diseases, it's a real sign that needs to be picked up."

Callewaert argues that widespread antiperspirant use since the mid-20th century has worsened body odour at the population level, killing beneficial bacteria while encouraging stress-resistant, odour-producing bacteria to bounce back stronger. Modern lifestyles—poor nutrition, high stress, unhealthy guts—compound the problem. He has been developing patented probiotic deodorants as a potential solution. For now, Ballard calls for greater understanding and compassion. Instead of assuming someone who smells has skipped showers, we might consider their experience. "Maybe they have bromhidrosis, and it took a lot for them to get out the door to go to work and live their lives," she says. Hayat, recently retired, experienced a decade of menopause before her symptoms began to ease. "It got better, thank God," she says. "It's still not 100% managed—it's just that I learned to get by." She urges compassion too. "You can be smelling like roses now, but eventually, for whatever reason, your body's gonna change."