The Ferriman-Gallwey Score: How Hirsutism Is Actually Measured

What Is the Ferriman-Gallwey Score?

The Ferriman-Gallwey score rates coarse, pigmented terminal hair at nine body sites — upper lip, chin, chest, upper back, lower back, upper abdomen, lower abdomen, upper arms, and thighs — each scored from 0 (no terminal hair) to 4 (extensive growth), for a total that runs from 0 to 36.

A clinician assigns the number by comparing what they see against a set of standard reference photographs, one per site per severity level, published alongside the scale. David Ferriman and John Gallwey first described the method in 1961, scoring 11 body areas rather than nine. The version used today drops two of those sites, which is why almost everyone now means the same thing by “Ferriman-Gallwey score,” “modified Ferriman-Gallwey score,” and “mFG score.”

Note: in May 2026, PCOS was renamed polyendocrine metabolic ovarian syndrome, or PMOS, by a global consensus of more than 50 organisations. Same condition, same hyperandrogenism criteria — only the label changed. This article uses PCOS, since that is still the term most readers search.

What Does “Modified” Mean — Is mFG a Different Test?

No. The modified Ferriman-Gallwey (mFG) score is not a separate or newer instrument; it is the original scale with two of the 11 sites dropped — the forearms and lower legs. A 2010 review in Human Reproduction Update explains why: hair growth at those two sites tracks genetics and ethnic background far more than androgen exposure, so scoring them added noise rather than useful information. Removing them left the nine sites used today, and “Ferriman-Gallwey score,” “modified Ferriman-Gallwey,” and “mFG score” all now refer to that same nine-site version. If a clinician or a lab report mentions any of the three, they mean the same number.

What Score Actually Counts as Hirsutism?

An mFG score of 3 or higher marked a real jump in how women rated their own hair growth, in a 2006 study of 633 unselected Black and white American women attending a routine physical exam rather than a hirsutism clinic. At a score of 3 or above, 69.3% of women called themselves hirsute, compared with 15.8% below it — and the study found no meaningful difference in scores between Black and white participants.

That epidemiological inflection point is looser than the threshold clinicians actually use to flag hirsutism for a workup. The Endocrine Society’s clinical practice guideline sets the working cutoff nearer 8 for women of primarily European or African ancestry, recommends a lower threshold in East Asian women — who grow visibly less terminal hair at a given androgen level — and accepts a higher baseline as normal in women of Mediterranean, Middle Eastern, or South Asian descent. A number on a chart only means something once it is read against the population it came from.

Why Isn’t a Ferriman-Gallwey Score a Self-Test?

mFG scoring is semi-quantitative and depends on a trained eye comparing hair against reference photographs. The same 2010 review found significant inter-observer variability even among clinicians using the identical scale, and noted that more objective methods — photographic densitometry, microscopic hair counts — exist but are too costly and complex for routine use. A mirror check at home substitutes a much less trained, much less consistent observer for the one the scale was built around. A number you assign yourself is not comparable to one your doctor assigns, and it is not the number that belongs in a diagnostic workup.

Who Shouldn’t Rely on a Ferriman-Gallwey Score Alone?

• Anyone who removes hair regularly — shaving, waxing, plucking, threading, laser, or electrolysis — before being scored. The scale measures hair that is visibly present, so recent removal drives the number down without changing the androgen signal underneath it. A clinician should ask about removal habits before scoring, but a self-reported history is not always complete.
• Anyone already on hormonal treatment that suppresses new hair formation. A lowered score in that case reflects treatment response, not baseline androgen status, and cannot retroactively rule PCOS in or out.
• Populations without a locally validated cutoff. The guideline’s regional adjustments cover the major groups studied so far, but a clinician working outside those categories is applying an approximation, not a validated number.
• Anyone with a low or borderline score and no other features. A normal mFG score does not rule out PCOS on its own — some phenotypes, including lean PCOS, can carry biochemical hyperandrogenism with little or no visible hair change.

What Happens After You Get a Ferriman-Gallwey Score?

A raised mFG score is one of three findings the 2023 international PCOS guideline weighs alongside irregular ovulation and polycystic ovarian morphology on ultrasound — meeting two of the three, after other causes are excluded, is what the Rotterdam criteria used across the rest of a PCOS work-up require. If you are wondering how the rest of that workup fits together, and why it rarely wraps up in a single visit, the process usually takes months, not one appointment. Some clinics also order a specialty urine hormone panel like the DUTCH test alongside or instead of standard bloodwork — it is worth knowing what that panel does and does not add before paying for it.

Once hirsutism is confirmed, the treatment question is separate from the measurement question — what actually reduces the hair itself, and how long each option takes to work, is covered in full there, and a direct comparison of removal methods sits in laser versus electrolysis versus eflornithine cream.

Common Questions