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Evidence: Assessment of Clinical Hyperandrogenism
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Recommendations – PCOS‐related hyperandrogenism
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A comprehensive history and physical examination should be completed for symptoms and signs of clinical hyperandrogenism, including acne, female pattern hair loss and hirsutism
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CR
Health professionals should be aware of the potential negative psychosocial impact of clinical hyperandrogenism and reporting of unwanted excess hair growth or female pattern hair loss should be considered important in assessment and management, regardless of apparent clinical severity
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Standardized visual scales are preferred when assessing hirsutism such as the modified Ferriman Gallway score (mFG) with a level >3 and more often >5 indicating hirsutism, acknowledging that self‐treatment is common and can limit clinical assessment
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The Ludwig visual score is preferred for assessing female pattern hair loss, whilst no universally accepted visual instruments are available for assessing acne
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CPP
The mFG cut‐off scores for defining hirsutism are the same across ethnicities, yet the prevalence and degree of hirsutism severity varies by ethnicity
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As ethnic variation in vellus hair density is notable, over‐estimation of hirsutism may occur if vellus hair is confused with terminal hair; only terminal hairs should be considered in pathological hirsutism, with terminal hairs clinically growing >5 mm in length if untreated, varying in shape and texture and generally being pigmented
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Teede et al Human Reproduction 2018
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