Ferriman–Gallwey (FG) Hirsutism Score
The Ferriman–Gallwey assessment is a visual scoring method used to quantify male-pattern terminal hair growth in women by summing scores across 9 androgen-sensitive body sites. [1]
Nine Body Areas Scored
Terminal hair is assessed at the following 9 body sites: [1]
- Upper lip. [1]
- Chin. [1]
- Chest. [1]
- Upper back. [1]
- Lower back. [1]
- Upper abdomen. [1]
- Lower abdomen. [1]
- Upper arms. [1]
- Thighs. [1]
Scoring Method per Body Area
Each body area is scored using a 0-to-4 scale based on visual estimation of the amount of terminal hairs present. [1]
- 0 = no terminal hairs. [1]
- 1 = some barely visible terminal hairs. [1]
- 2 = more than just a few, but not that of a male. [1]
- 3 = similar to that of a not very hirsute male. [1]
- 4 = equivalent to a hirsute male. [1]
Total Score Range and Calculation
The total FG (modified FG, mFG) score is calculated by summing the 9 site scores. [1]
- Total score range = 0 to 36. [1]
Total Score Indicating Hirsutism
A commonly used clinical cutoff is a total mFG score of 8 or more to indicate hirsutism in Black or White women in the United States and the United Kingdom. (Endocrine/clinical practice statement cited in review) [1]
Alternative Cutoffs and Population Variability
Cutoff values can vary by ethnicity and population prevalence of terminal hair growth. [1] The Turkish interobserver variability study reported that a substantial proportion of mFG scores were ≤8 in women without excessive body hair, supporting the need for population-specific cutoff selection. [2]
AAFP categorizes total mFG scores as follows: <8 as normal, 8 to 15 as mild hirsutism, and >15 as moderate to severe hirsutism. [3]
Practical Interpretation Notes
The mFG scale is semiquantitative and subject to interobserver and intraobserver variability. [1] The assessment depends on the presence of terminal (coarse, pigmented) hair rather than vellus hair. [1]