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Degree of Facial and Body Terminal Hair Growth in Unselected Black and White Women: Toward a Populational Definition of Hirsutism

Department of Obstetrics and Gynecology (C.M.D., R.A.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Department of Obstetrics and Gynecology (C.M.D., R.A.), The David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California 90095; and Departments of Biostatistics and Biomathematics (K.S.W., A.A.B.) and Obstetrics and Gynecology (R.A.), University of Alabama at Birmingham, Birmingham, Alabama 35294

Address all correspondence and requests for reprints to: Ricardo Azziz, M.D., M.P.H., M.B.A., Cedars-Sinai Medical Center, Department of Obstetrics and Gynecology, 8635 West Third Street, Suite 160 W, Los Angeles, California 90048. E-mail: azzizr{at}cshs.org.

Context: Hirsutism (i.e. facial and body terminal hair growth in a male-like pattern in women) is the principal clinical sign of hyperandrogenism, although its definition remains unclear.

Objective: The purposes of the present study were to define 1) the degree of facial and body terminal hair, as assessed by the modified Ferriman-Gallwey (mFG) score, in unselected women from the general population; 2) the effect of race (Black and White) on the same; and 3) the normative cutoff values.

Design and Setting: We conducted a prospective observational study at a tertiary academic medical center.

Patients/Participants: Participants included 633 unselected White (n = 283) and Black (n = 350) women presenting for a preemployment physical exam.

Interventions: Interventions included history and physical examination.

Main Outcome Measures: Terminal body hair growth was assessed using the mFG scoring system; nine body areas were scored from 0–4 for terminal hair growth distribution.

Results: The mFG scores were not normally distributed; although cluster analysis failed to identify a natural cutoff value or clustering of the population, principal component and univariate analyses denoted two nearly distinct clusters that occurred above and below an mFG value of 2, with the bulk of the scores below. Overall, an mFG score of at least 3 was observed in 22.1% of all subjects (i.e. the upper quartile); of these subjects, 69.3% complained of being hirsute, compared with 15.8% of women with an mFG score below this value, and similar to the proportion of women with an mFG score of at least 8 who considered themselves to be hirsute (70.0%). Overall, there were no significant differences between Black and White women.

Conclusions: Our data indicate that the prevalence and degree of facial and body terminal hair growth, as assessed by the mFG score, is similar in Black and White women and that an mFG of at least 3 signals the population of women whose hair growth falls out of the norm.

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