Ferriman-Gallwey Score
Clinical scoring of hirsutism
What it is
The Ferriman-Gallwey (FG) score is a clinical rating tool used to evaluate and quantify hirsutism — the presence of terminal (dark, coarse) hair growth in typically male-pattern areas in women. It is a marker of clinical hyperandrogenism, the second Rotterdam criterion for PCOS diagnosis.
The score was originally described by Ferriman and Gallwey in 1961, then revised and simplified into the modified mFG score (9 areas instead of the original 11).
How the score is calculated
A clinician evaluates 9 body areas and assigns each a score from 0 (no terminal hair) to 4 (extensive dense hair growth):
- Upper lip
- Chin
- Chest (peri-areolar and sternal)
- Upper abdomen
- Lower abdomen
- Arms
- Thighs
- Upper back
- Lower back
The maximum total score is 36. A higher score indicates clinically significant hirsutism.
Clinical hyperandrogenism threshold
The threshold for abnormal hirsutism varies by ethnicity, as baseline hair density differs across populations:
- Caucasian and Mediterranean women: threshold > 6 – 8
- Women of East Asian descent: threshold > 2 – 4 (naturally lower hair density)
- General threshold used in practice: > 4 – 6 per ESHRE guidelines
A low score does not rule out biochemical hyperandrogenism: hirsutism can be absent even with elevated testosterone, particularly if the person removes hair regularly or based on their individual genetic skin profile.
Limitations of the score
The Ferriman-Gallwey score is subjective: inter-observer reproducibility is moderate. It is also sensitive to hair removal — if you regularly remove hair in certain areas, the score will underestimate the true degree of hirsutism. It has not been equally validated across all ethnic populations.
For these reasons, a biochemical panel (testosterone, DHEA-S, SHBG) is often performed alongside the score, even when the FG result is within normal range.
Key takeaways
- 9 body areas scored 0-4, maximum total 36
- Clinical hirsutism threshold: > 4-6 (varies by ethnicity)
- Rotterdam criterion 2 (clinical hyperandrogenism)
- Subjective and sensitive to hair removal — combine with biochemical testing
- Modified mFG score: 9 areas (current standard version)