Skip to main content
Log in

Interobserver variability of modified Ferriman–Gallwey hirsutism score in a Turkish population

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

The aim of the study was to evaluate the interobserver variability of modified Ferriman–Gallwey (mFG) hirsutism scores on each body area in a Turkish population.

Design

A cross-sectional study of simultaneous mFG scoring design was used. Observers did not make any interview with the subjects and were masked to the previous score results. Analyses included percentage of agreement, kappa coefficients, the Bland and Altman plot, confidence intervals, minimum and maximum kappa coefficients.

Setting

The study was performed at a teaching and research hospital.

Patients

Hundred and twenty-one Turkish women without any complaints of excessive body hair were studied.

Interventions

Interventions included two special trained physicians, simultaneous and independent mFG scoring.

Main outcome measures

The main outcome measures were mFG scores in each body area.

Results

Agreement analysis demonstrated that the scores of the two physicians were quite concordant. The mean kappa value for nine body area was 0.744 and the highest kappa values from the upper back and the lowest kappa values from the upper lip revealed к = 0.847, к = 0.585, respectively. The highest (upper lip) and the lowest (arm) mean range scores for the two researchers among the 9 areas were 1.46–1.55 and 0.17–0.12, respectively. Only 68.6 and 67.8% of the mFG scores observed by each of the two observers were equal or below 8.

Conclusion

The mFG scoring system was found to be clinically useful. The upper lip was observed to have the highest score of androgen sensitive area of the body as well as the highest interobserver variability. The cut-off value to establish the diagnosis of hirsutism should be population-specific.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ferriman D, Gallwey JD (1961) Clinical assessment of body hair growth in women. J Clin Endocrinol 21:1440–1447

    CAS  Google Scholar 

  2. Kelestimur F, Everest H, Unluhizarci K, Bayram F, Sahin Y (2004) A comparison between spironolactone and spironolactone plus finasteride in the treatment of hirsutism. Eur J Endocrinol 150:351–354. doi:10.1530/eje.0.1500351

    Article  PubMed  CAS  Google Scholar 

  3. Sert M, Tetiker T, Kirim S (2003) Comparison of the efficiency of anti-androgenic regimens consisting of spironolactone, Diane 35, and cyproterone acetate in hirsutism. Acta Med Okayama 57:73–76

    PubMed  CAS  Google Scholar 

  4. Muderris II, Bayram F, Guven M (2000) A prospective, randomized trial comparing flutamide (250 mg/d) and finasteride (5 mg/d) in the treatment of hirsutism. Fertil Steril 73:984–987. doi:10.1016/S0015-0282(00)00470-2

    Google Scholar 

  5. Harborne L, Fleming R, Lyall H, Sattar N, Norman J (2003) Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome. J Clin Endocrinol Metab 88:4116–4123. doi:10.1210/jc.2003-030424

    Article  PubMed  CAS  Google Scholar 

  6. Sahin Y, Dilber S, Kelestimur F (2001) Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism. Fertil Steril 75:496–500. doi:10.1016/S0015-0282(00)01764-7

    Article  PubMed  CAS  Google Scholar 

  7. Bayram F, Muderris II, Guven M, Kelestimur F (2002) Comparison of high-dose finasteride (5 mg/day) versus low-dose finasteride (2.5 mg/day) in the treatment of hirsutism. Eur J Endocrinol 147:467–471. doi:10.1530/eje.0.1470467

    Google Scholar 

  8. McKnight E (1964) The prevalence of hirsutism in young women. Lancet 1:410–413. doi:10.1016/S0140-6736(64)92789-8

    Article  PubMed  CAS  Google Scholar 

  9. Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA (1979) The association of obesity with infertility and related menstrual abnormalities in women. Int J Obesity Int J Obes 3:57–73

    CAS  Google Scholar 

  10. Barth JH, Catalan J, Cherry CA, Day A (1993) Psychological morbidity in women referred for treatment of hirsutism. J Psychosom Res 37:615–619. doi:10.1016/0022-3999(93)90056-L

    Article  PubMed  CAS  Google Scholar 

  11. Sonino N, Fava GA, Mani E, Belluardo P, Boscaro M (1993) Quality of life of hirsute women. Postgrad Med 69:186–189

    Article  CAS  Google Scholar 

  12. Ferriman D, Gallwey JD (1961) Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 21:1440–1447

    PubMed  CAS  Google Scholar 

  13. Lorenzo EM (1970) Familial study of hirsutism. J Clin Endocrinol 31:556–564

    Article  Google Scholar 

  14. Hatch R, Rosenfield RL, Kim MH, Tredway D (1981) Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 140:815–830

    PubMed  CAS  Google Scholar 

  15. Redmond GP (1995) Clinical evaluation of the woman with an androgenic disorder. In: Redmond GP (ed) Androgenic disorders. Raven Press, New York, pp 1–20

    Google Scholar 

  16. Hines G, Moran C, Huerta R, Folgman K, Azziz R (2001) Facial and abdominal hair growth in hirsutism: a computerized evaluation. J Am Acad Dermatol 45(6):846–850. doi:10.1067/mjd.2001.117386

    Article  PubMed  CAS  Google Scholar 

  17. Derksen J, Moolenaar AJ, Van Seters AP, Kock DF (1993) Semiquantitative assessment of hirsutism in Dutch women. Br J Dermatol 128(3):259–263. doi:10.1111/j.1365-2133.1993.tb00168.x

    Article  PubMed  CAS  Google Scholar 

  18. Knochenhauer ES, Hines G, Conway-Myers BA, Azziz R (2000) Examination of the chin or lower abdomen only for the prediction of hirsutism. Fertil Steril 74(5):980–983. doi:10.1016/S0015-0282(00)01602-2

    Article  PubMed  CAS  Google Scholar 

  19. Tellez R, Frenkel J (1995) Clinical evaluation of body hair in healthy women. Rev Med Chil 123(11):1349–1354

    PubMed  CAS  Google Scholar 

  20. Hatch R, Rosenfield RL, Kim MH, Tredway D (1981) Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 140:815–830

    PubMed  CAS  Google Scholar 

  21. Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R (1998) Prevalence of the polycystic ovarian syndrome in unselected black and white women of the Southeastern United States: a prospective study. J Clin Endocrinol Metab 83:3078–3082. doi:10.1210/jc.83.9.3078

    Article  PubMed  CAS  Google Scholar 

  22. Aono T, Miyazaki M, Miyake A, Kinugasa T, Kurachi K, Matsumoto K (1977) Responses of serum gonadotrophins to LH-releasing hormone and oestrogens in Japanese women with polycystic ovaries. Acta Endocrinol (Copenh) 85:840–849

    CAS  Google Scholar 

  23. Ewing JA, Rouse BA (1978) Hirsutism, race and testosterone levels: comparison of east Asians and Euroamericans. Hum Biol 50:209–215

    PubMed  CAS  Google Scholar 

  24. Wild RA, Veseley S, Bebee L, Whitsett T, Owen W (2005) Ferriman Gallwey self scoring I: performance assessment in women with policystic ovary syndrome. J Clin Endoc Methods 90(7):4112–4114. doi:10.1210/jc.2004-2243

    Article  CAS  Google Scholar 

  25. Zhao JL, Chen ZJ, Shi YH, Geng L, Ma ZX, Li Y et al (2007) Investigation of body hair assessment of Chinese women in Shandong region and its preliminary application in polycystic ovary syndrome patients. Zhonghua Fu Chan Ke Za Zhi 42(9):590–594

    PubMed  Google Scholar 

  26. DeUgarte CM, Woods KS, Bartolucci AA, Azziz R (2006) Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism. J Clin Endocrinol Metab 91(4):1345–1350. doi:10.1210/jc.2004-2301

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Murat Api.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Api, M., Badoglu, B., Akca, A. et al. Interobserver variability of modified Ferriman–Gallwey hirsutism score in a Turkish population. Arch Gynecol Obstet 279, 473–479 (2009). https://doi.org/10.1007/s00404-008-0747-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-008-0747-8

Keywords

Navigation