Ferriman-Gallwey Score: Self-Assess Hirsutism at Home (PCOS / PMOS)
The Ferriman-Gallwey score is the internationally accepted clinical tool for quantifying hirsutism — androgen-dependent terminal hair growth in women. Rate 9 body zones on a 0–4 scale, get your total out of 36, and receive a clinical interpretation with ethnicity-adjusted thresholds.
Click a body zone to select it, then choose the grade (0–4) that best matches your current hair growth.
Active zone
👄 Upper Lip
Total score
0 / 36
No clinically significant hirsutism
Your score falls within the normal range. Subjective perception of excess hair can exist without clinical hirsutism. A dermatologist can discuss cosmetic options if you’re bothered by hair growth.
Self-assessment tool based on Hatch et al., 1981 (modified Ferriman-Gallwey score). Does not replace medical advice. No data sent to our servers.
What Is the Ferriman-Gallwey Score?
The scale was first published in 1961 by David Ferriman and James Gallwey, who proposed a scoring system covering 11 androgen-sensitive body areas. Their original version was designed to give clinicians a reproducible, semi-objective measure of hirsutism — excess terminal hair growth driven by androgens such as testosterone and DHEAS. Each zone was graded 0 (no terminal hair) to 4 (complete coverage), giving a theoretical maximum of 44.
In 1981, Hatch, Rosenfield, Kim and Tredway published a modification that reduced the scale to 9 zones, removing the lower leg and forearm (which show less androgen sensitivity and significant racial variation). This modified Ferriman-Gallwey (mFG) scale — with a maximum score of 36 — became the clinical standard adopted in international guidelines, including those of the Endocrine Society (2018) and the European Society of Endocrinology.
Today the mFG score is used both to determine whether hirsutism is clinically significant (i.e. likely androgen-driven rather than merely cosmetically distressing) and to monitor response to treatment over time. A reduction of 3 or more points after 6–12 months of treatment is considered clinically meaningful.
How to Rate Yourself Honestly
The accuracy of your self-assessment depends on a few simple conditions. First, assess your hair as it grows naturally — not immediately after waxing, shaving, threading, or laser treatment. For the score to reflect your underlying androgen activity, you should ideally allow at least 6 weeks of uninterrupted regrowth before scoring. If you are currently mid-treatment (e.g. laser), score based on your recall of what the zone looked like before starting.
Use natural light where possible. Assess each of the 9 zones independently — do not let your overall impression of your body hair influence individual zone grades. Focus on terminal hair (dark, coarse, pigmented) rather than vellus hair (fine, light, barely visible). The Ferriman-Gallwey scale specifically measures androgen-sensitive terminal hair growth, not all body hair.
For each zone, read the grade descriptions carefully and select the one that best matches what you currently observe. When in doubt between two grades, choose the lower one — this tool is designed to prompt a clinical conversation, not to over-alert.
Score Thresholds by Ethnicity
One of the most clinically important nuances of the Ferriman-Gallwey scale is that the threshold for "clinically significant hirsutism" is not universal — it varies meaningfully by ethnicity, reflecting differences in baseline androgen receptor sensitivity and hair follicle density across populations.
| Population | Threshold | Notes |
|---|---|---|
| East Asian | > 5 | Lower baseline body hair density means a score of 5–6 already warrants investigation. |
| Caucasian (European) | > 8 | The most commonly cited threshold in Western clinical guidelines. |
| Mediterranean / Middle Eastern | > 9–10 | Higher baseline hair density; a score below 10 may be constitutional rather than pathological. |
| South Asian | > 10 | Similar to Mediterranean populations; research in South Asian cohorts suggests a higher normal range. |
Sources: Escobar-Morreale et al. (2012), Endocrine Society Clinical Practice Guideline (2018), Revised 2023 international evidence-based PCOS guideline (Teede et al.).
This ethnic variability is one reason why the score cannot be interpreted in isolation. A score of 7 in a woman of East Asian background is clinically significant; the same score in a woman of Italian background may fall within the constitutional norm. Your doctor will consider your ethnicity, symptoms, and hormone levels together.
What to Do With a High Score
A Ferriman-Gallwey score above the ethnicity-adjusted threshold warrants a hormonal workup. This does not mean you have PMOS or another condition — it means clinical investigation is appropriate. The first-line tests typically requested are:
- Total testosterone and free testosterone — the most direct measure of androgen excess. Free testosterone (or calculated free testosterone using SHBG) is more sensitive than total.
- SHBG (sex hormone-binding globulin) — low SHBG increases free androgen availability even when total testosterone is normal.
- DHEAS (dehydroepiandrosterone sulphate) — an adrenal androgen marker; elevated levels may indicate adrenal rather than ovarian origin.
- 17-OH-progesterone — to screen for late-onset congenital adrenal hyperplasia (CAH), which can mimic PMOS.
- Pelvic ultrasound — to assess ovarian morphology (antral follicle count, ovarian volume) as part of the Rotterdam criteria for PMOS diagnosis.
If your score is moderate (8–14), a referral to a gynaecologist or endocrinologist is appropriate. If your score is severe (>15), or if you have additional symptoms (very irregular cycles, sudden onset of hirsutism, signs of virilisation such as clitoromegaly or voice deepening), specialist evaluation should be sought within 4–6 weeks, as these features can indicate rare but serious causes such as androgen-secreting tumours.
Bring a printed copy of your score to your appointment. Use our appointment preparation tool to help structure the conversation with your doctor.
Idiopathic Hirsutism vs PMOS in 2026
Not all clinically significant hirsutism is caused by elevated androgens. Approximately 50% of women with a Ferriman-Gallwey score above threshold have normal serum androgen levels — this is called idiopathic hirsutism. The proposed mechanism is increased 5α-reductase activity in the hair follicle, which converts testosterone to the more potent dihydrotestosterone (DHT) locally, even when circulating levels are normal.
Among women with biochemical hyperandrogenism, PMOS (formerly PCOS) is the most common cause, accounting for roughly 70% of cases. The remaining 30% include:
- Late-onset congenital adrenal hyperplasia (CAH) — caused by 21-hydroxylase deficiency; screened with a morning 17-OH-progesterone (ideally in the early follicular phase).
- Ovarian hyperthecosis — a form of severe ovarian androgen excess, usually presenting with higher testosterone levels than typical PMOS.
- Androgen-secreting tumours — rare but important to exclude in cases of rapid onset or severe hirsutism; diagnosed via imaging and very elevated testosterone (>5–6 nmol/L).
- Androgenic medications — anabolic steroids, danazol, some progestogens (notably levonorgestrel, norethisterone), and minoxidil can cause or worsen hirsutism.
- Cushing syndrome — excess cortisol from adrenal or pituitary origin; screened with 24h urinary cortisol or 1 mg overnight dexamethasone suppression test.
The 2023 international PMOS guideline (Teede et al.) recommends evaluating for all of the above before attributing hirsutism to PMOS, particularly when the presentation is atypical (rapid onset, very high androgens, or features of virilisation).
Hirsutism Treatments
Management of hirsutism depends on the underlying cause, the degree of distress, and whether the patient is seeking hormonal or non-hormonal approaches. Treatment broadly falls into two categories: cosmetic and medical.
Cosmetic approaches
These address visible hair without affecting the hormonal driver. Options include laser hair removal (most effective for dark hair on light skin; multiple sessions required), intense pulsed light (IPL), electrolysis (suitable for all skin and hair types but time-intensive), waxing, threading, and depilatory creams. Topical eflornithine cream (Vaniqa) slows regrowth by inhibiting ornithine decarboxylase in the hair follicle — it does not remove hair but reduces regrowth rate when used alongside laser or other physical methods.
Medical (hormonal) treatments
When hirsutism is driven by androgen excess, addressing the underlying hormonal cause is the most effective long-term approach:
- Combined oral contraceptives (COCs) — first-line pharmacological treatment for most women with PMOS-related hirsutism. They suppress ovarian androgen production and increase SHBG (reducing free testosterone). Pills containing anti-androgenic progestogens (cyproterone acetate, drospirenone, dienogest) are preferred. Read more about birth control and PCOS.
- Spironolactone — an aldosterone antagonist with potent anti-androgenic properties. Used off-label at 50–200 mg/day; effective for both hirsutism and acne in PMOS. Requires contraception (teratogenic risk). Read more about spironolactone and PCOS.
- Finasteride — a 5α-reductase inhibitor; reduces DHT at the follicle level. Used off-label for hirsutism and androgenic alopecia. Also teratogenic — requires effective contraception.
- Metformin — improves insulin sensitivity and modestly reduces androgen levels in PMOS; effect on hirsutism is less direct than COCs or spironolactone.
Medical treatments require 6–12 months to show meaningful effect on hair growth (because individual hairs have long anagen cycles). The Ferriman-Gallwey score is a useful monitoring tool: a decrease of ≥3 points at 12 months is generally accepted as a clinically meaningful response. See our guide to acne, hair growth and hair loss in PCOS.
Frequently Asked Questions
Is the Ferriman-Gallwey score reliable for self-diagnosis?▼
The Ferriman-Gallwey score is a validated clinical tool, but self-assessment introduces subjectivity. Studies show moderate inter-rater variability even between trained clinicians. Use this tool to track changes over time and to inform a conversation with your doctor — not to reach a diagnosis on your own. A clinician's in-person assessment remains the gold standard.
Can I use this tool if I'm already on treatment for hirsutism?▼
Yes, but score your current hair as it is today, on treatment. If you want to compare with your baseline, score from memory what your hair was like before starting treatment, and note both figures when speaking with your doctor. Treatment effects on hair growth typically take 6–12 months to fully manifest — do not be discouraged by a slow initial response.
My hair growth reduced on the pill — should I score current or pre-pill hair?▼
Score what you see now. If you have stopped the pill recently (within 6 months), your score may not reflect your underlying androgen-driven baseline, as it can take several months for androgens to return to pre-treatment levels. For the most clinically useful score, allow at least 6 weeks of natural regrowth (without waxing or laser) before assessing each zone.
Does a score of 7 mean I don't have PMOS?▼
Not necessarily. PMOS (formerly PCOS) is diagnosed using the Rotterdam criteria, which include irregular cycles, polycystic ovarian morphology on ultrasound, and biochemical or clinical signs of hyperandrogenism. A Ferriman-Gallwey score of ≤7 does not exclude PMOS — androgens can act at the receptor level without being elevated in serum (idiopathic hirsutism), and PMOS can present without hirsutism at all (particularly in lean PMOS phenotypes).
How do doctors use this score in clinical practice?▼
Clinicians use the Ferriman-Gallwey score as part of the initial assessment for suspected hyperandrogenism. It helps determine whether further blood tests (testosterone, SHBG, DHEAS) and imaging (pelvic ultrasound) are warranted. It is also used to monitor treatment response — a reduction of ≥3 points after 6–12 months of treatment is generally considered clinically meaningful. In research settings, it serves as a primary outcome measure in clinical trials of anti-androgenic therapies.
Does this tool store my data?▼
No. All calculations run entirely in your browser. No scores, no zone grades, and no personal data are sent to any server. The optional PDF export is also generated locally using the jsPDF library — nothing leaves your device.
References: Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961;21:1440–1447. — Hatch R et al. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol. 1981;140(7):815–830. — Escobar-Morreale HF et al. Epidemiology, diagnosis and management of hirsutism. Nat Rev Endocrinol. 2012;8(2):97–109. — Teede HJ 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.