Modified Ferriman-Gallwey Score Calculator
Modified Ferriman-Gallwey Score Calculator
Nine body areas, each 0 to 4, total 0 to 36. The current threshold is 4 to 6, not the 8 that most pages still quote — and this one tables the older figure beside it, with its provenance, so a reader who has been told 8 can see exactly where it came from.
Modified Ferriman-Gallwey score
9 areas → 0–36Upper lip 2, chin 1, lower abdomen 1, thigh 1, all other areas 0
How the score is built
Areas: upper lip · chin · chest · upper back · lower back · upper abdomen · lower abdomen · upper arm · thigh
- 0 to 4
- 0 is no terminal hair and 4 is frank male-pattern growth in that area. Only terminal hair counts — coarse and pigmented, over about 5 mm if untreated. Vellus hair is not graded
- nine, not eleven
- Ferriman and Gallwey graded 11 sites in 1961 and also defined an “hormonal” score using 9 of them, excluding the forearm and the lower leg, because hair at those two sites proved insensitive to androgen. The nine-area version is what is now universally meant by the modified score
- the visual scale
- the score is meant to be read off a standardised diagram with a photographic atlas, which the 2023 guideline recommends explicitly. A score assigned from memory or from a written description is a different measurement from one assigned against the atlas
- self-scoring
- the Endocrine Society notes that self-scoring “can be clinically useful, but correlates only modestly with scoring by a trained observer”. A self-scored total is a screening signal, not the measurement the thresholds were derived on
- self-treatment
- waxing, shaving, laser and electrolysis all lower the score without changing the androgen state, and the 2023 guideline flags this in the recommendation itself. Ask what has been removed before reading a low total as reassuring
Worked example
Upper lip 2, chin 1, lower abdomen 1, thigh 1, all other areas 0
2 + 1 + 0 + 0 + 0 + 0 + 1 + 0 + 1 = 5
By the 2023 PCOS guideline this is hirsutism: the threshold is 4 to 6, depending on ethnicity
By the older figure of 8 or more it is not
Both statements are about the same nine areas and the same patient
This is the band the page exists for: 5 is the score most likely to be called normal by a source quoting an out-of-date threshold
Read it as satisfying the clinical hyperandrogenism criterion, then work through the rest of the Rotterdam criteria
The nine areas, and the two the original score also graded
| Area | In the modified nine-area score | In the original 1961 eleven-site score |
|---|---|---|
| Upper lip | Yes | Yes |
| Chin | Yes | Yes |
| Chest | Yes | Yes |
| Upper back | Yes | Yes |
| Lower back | Yes | Yes |
| Upper abdomen | Yes | Yes |
| Lower abdomen | Yes | Yes |
| Upper arm | Yes | Yes — listed as “arm” |
| Thigh | Yes | Yes |
| Forearm | No | Yes |
| Lower leg | No | Yes |
Where the thresholds come from — and why 8 is still quoted
| Threshold | Population it was derived in | Source | Basis |
|---|---|---|---|
| 4 to 6 | General, varying with ethnicity | 2023 International Evidence-based PCOS Guideline, recommendation 1.3.5 | Current recommendation. A range, not a single number, chosen because the older figures were too high in most populations |
| 8 or more | United States and United Kingdom black or white women | Endocrine Society hirsutism guideline 2018 | 95th centile of that reference population. This is the figure most calculators and textbooks still print |
| 9 to 10 | Mediterranean, Hispanic and Middle Eastern women | Endocrine Society hirsutism guideline 2018 | 95th centile of those populations — higher, not lower, than the commonly quoted 8 |
| 6 or more | South American women | Endocrine Society hirsutism guideline 2018 | 95th centile |
| 2 or more | Han Chinese women | Endocrine Society hirsutism guideline 2018 | 95th centile — the lowest published threshold, and a quarter of the commonly quoted figure |
| 7 or more | Southern Chinese women | Endocrine Society hirsutism guideline 2018 | 95th centile. The two Chinese figures show the spread within one broad grouping |
The cut-off moved, and most of the web did not
Search for a Ferriman-Gallwey threshold and you will be told 8. That figure is not invented and it is not useless — it is the 95th centile of the modified score in United States and United Kingdom black and white women, as the Endocrine Society’s 2018 hirsutism guideline sets out. But it is the 95th centile of those populations, and the same guideline lists five other figures from five other populations: 9 to 10 for Mediterranean, Hispanic and Middle Eastern women, 6 for South American women, 7 for Southern Chinese women, and 2 for Han Chinese women. A threshold that ranges from 2 to 10 depending on who is being scored is not a constant, and quoting 8 as though it were will over-call hirsutism in one population by a factor of four and under-call it in another.
The 2023 International Evidence-based PCOS Guideline resolved this downward. Recommendation 1.3.5 reads: “A modified Ferriman-Gallwey score (mFG) of 4-6 should be used to detect hirsutism, depending on ethnicity, acknowledging that self-treatment is common and can limit clinical assessment.” Three things in that sentence matter. The number is lower than the one in circulation, which means a woman scored at 5 and told she does not have hirsutism has been told something the current guideline contradicts. It is a range rather than a value, so the guideline has not replaced one universal constant with another. And the clause about self-treatment is part of the recommendation, not a caveat appended to it: waxing, shaving, laser and electrolysis lower the score without touching the androgen excess that produced the hair, so a low total in a woman who has been removing hair for years carries almost no information. Ask what has been treated before reading the number.
There is a second, quieter point in the guideline that changes what this calculator is. The practice points under 1.3.7 ask clinicians to use standardised visual scales — the modified Ferriman-Gallwey score assessed against a photographic atlas — and to count only terminal hairs, meaning coarse pigmented hairs over about 5 mm if untreated. A total assembled from memory, or from a patient’s own reading of a written description, is a different measurement from the one the thresholds were derived on. The Endocrine Society puts it directly: self-scoring “can be clinically useful, but correlates only modestly with scoring by a trained observer”. Use a self-scored total as a reason to examine, not as the examination.
What the score is for is narrower than it looks. It quantifies clinical hyperandrogenism, which is one of the three Rotterdam criteria for PCOS — and the 2023 guideline treats hirsutism on its own as predictive of biochemical hyperandrogenism in adults, so a score at or above threshold can satisfy that criterion without a blood test. It does not do the reverse. A score below threshold does not exclude biochemical hyperandrogenism, and the guideline says the biochemical assessment is of greatest value precisely in patients with minimal or no hirsutism. Nor does the score distinguish causes: PCOS, non-classic congenital adrenal hyperplasia, Cushing’s syndrome and an androgen-secreting tumour all raise it. What distinguishes them is the history — rapid onset or virilisation points away from PCOS — together with a total testosterone, a free androgen index and a 17-hydroxyprogesterone. Finally: female pattern hair loss and acne are not scored here and, in isolation, are weak predictors of androgen excess.
Frequently asked questions
What modified Ferriman-Gallwey score means hirsutism?
The 2023 International Evidence-based PCOS Guideline recommends a score of 4 to 6, depending on ethnicity. The figure of 8 or more that most sources still quote is the 95th centile of the score in United States and United Kingdom black and white women specifically, and does not transfer to other populations — published thresholds range from 2 for Han Chinese women to 9 to 10 for Mediterranean, Hispanic and Middle Eastern women.
Why is my score below 8 but still called hirsutism?
Because 8 is out of date as a universal threshold. It was derived as a 95th centile in two specific populations, and the current PCOS guideline recommends 4 to 6 instead. A score of 5 is hirsutism by the 2023 recommendation and is not by the older figure — both statements describe the same nine areas, which is why the source of a threshold matters as much as the number.
Which nine body areas does the modified score use?
Upper lip, chin, chest, upper back, lower back, upper abdomen, lower abdomen, upper arm and thigh, each graded 0 to 4 for a total of 0 to 36. The original 1961 Ferriman-Gallwey score graded eleven sites; the forearm and the lower leg were dropped because hair growth at those sites did not track androgen levels.
Can I score myself?
You can, and it is useful as a reason to seek assessment, but it is not the same measurement. The Endocrine Society notes that self-scoring correlates only modestly with scoring by a trained observer, and the PCOS guideline asks for the score to be assessed against a standardised photographic atlas. Hair removal also lowers the score without changing the underlying cause, so tell whoever assesses you what you have been treating.
Does a high score mean PCOS?
Not on its own. The score quantifies clinical hyperandrogenism, which is one of three Rotterdam criteria and two are needed. It also does not identify a cause: non-classic congenital adrenal hyperplasia, Cushing’s syndrome and androgen-secreting tumours all raise it. Rapid onset over months, or any virilisation such as voice change or clitoromegaly, points away from PCOS and warrants prompt investigation.
Does a normal score rule out androgen excess?
No. The 2023 guideline states that biochemical assessment of hyperandrogenism is of greatest value in patients with minimal or no hirsutism — precisely because the score can be normal while androgens are raised. Hair follicle sensitivity to androgen varies widely, and cosmetic hair removal suppresses the score independently of the hormone.
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References
- Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447–2469. doi:10.1210/clinem/dgad463 — recommendation 1.3.5: “A modified Ferriman-Gallwey score (mFG) of 4-6 should be used to detect hirsutism, depending on ethnicity”; 1.3.6 on ethnic variation; 1.3.7 on standardised visual scales and terminal hairs over 5 mm.
- Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233–1257. doi:10.1210/jc.2018-00241 — population-specific thresholds (United States and United Kingdom black or white ≥8; Mediterranean, Hispanic and Middle Eastern ≥9–10; South American ≥6; Han Chinese ≥2 to Southern Chinese ≥7), the 95th-centile basis, and the limits of self-scoring.
- Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961;21(11):1440–1447. doi:10.1210/jcem-21-11-1440 — 11 sites graded in 430 women aged 15–74; the authors’ own nine-site “hormonal” score excluded the forearm and leg.
- Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol. 1981;140(7):815–830 — the paper usually credited with putting the nine-area modified score into routine clinical use.
- Hassa H, Tanir HM, Yildirim A, Senses T, Eskalen M, Mutlu FS. The hirsutism scoring system should be population specific. Fertil Steril. 2005;84(3):778–780 — names the original eleven sites and the rationale for excluding forearm and lower leg.
Medical Disclaimer: The tools and content provided here are for educational and reference purposes only. They are not intended to substitute for professional medical advice, diagnosis, or treatment. Clinical decisions should always be based on the comprehensive assessment of a qualified healthcare professional.