The Ferriman Gallwey classification of hirsutism and its pattern

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Ferriman Gallwey Evaluation of Hirsutism

The Ferriman Gallwey Index was originally designed for anthropological research (Ferriman DM, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol 1961:21:1440–1447). It is simply a representation of hair growth in a male pattern on a woman shown in four different degrees of severity in 11 different body parts; namely the upper lip, chin, chest, upper back, lower back, upper abdomen, lower abdomen, arm, forearm, thigh, and lower leg.

The Ferriman Gallwey scoring system is used to score the degree of excess male pattern body hair by doctors. The scorecard of every body location under survey begins from 0 (no excessive terminal hair growth) to 4 (extensive terminal hair growth) and the numbers are added up to a maximum count of 36. While most experts refer to a modified score of 8 or more to diagnose hirsutism, some suggest a final tally of 6 or more is enough to indicate hirsutism. Based on this score pattern and other clinical tests, hirsutism can be evaluated as mild, moderate or severe.

Although more objective tools are available (including photographic evaluation, microscopic measurement of hair diameter with extensive counting of shafts, computerized assessment of photographic measures, and others), these are complex, expensive, or difficult to use. The ease of use and low cost of the Ferriman Gallwey system make it a potentially attractive instrument for use in the clinic.

In patients with polycystic ovary syndrome (PCOS), it has been shown to validly reflect androgen excess compared with expensive and elaborate objective methods, including microscopic measurement of hair diameter with extensive counting of individual shafts. Although intraobserver agreement is reported to be less than 3 points, surprisingly, interobserver reproducibility has not been reported.


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