Baseline Hirsutism Assessment
Clinician visually scores nine body sites for terminal hair.
- 9: Scoring Sites (standardized body zones)
- 0–4: Score Range (per zone severity)
- 36: Max Total Score (sum of all zones)
- 1961: Scale Origin (Ferriman & Gallwey)
Nine standardized zones
Lip, chin, chest, back, abdomen, arms, thighs are scored.
Terminal vs vellus hair
Only coarse pigmented terminal hair counts toward scoring.
Vellus hair is fine, short, and never scored.
Exam consistency
Same lighting and rater reduce scoring variability.
Ferriman-Gallwey Score Calculation
Nine zone scores sum into one severity total.
- <8: Normal Cutoff (no significant hirsutism)
- 8–15: Mild Range (visible excess hair)
- 16–25: Moderate Range (clinically significant)
- 26–36: Severe Range (marked hair growth)
Summing the zones
All nine zone scores add to one total score.
Severity thresholds
Higher totals signal stronger androgen influence.
Score of 8 or more defines clinical hirsutism.
Population variation
Cutoffs shift slightly by ethnicity and baseline hair.
Spironolactone & Cyproterone Acetate Initiated
Drugs block androgen receptors inside the hair follicle.
- 100–200mg: Spironolactone Dose (daily oral dosing)
- 25–100mg: Cyproterone Dose (often cycled with estrogen)
- AR: Receptor Target (androgen receptor blockade)
- 3–6mo: Onset of Effect (follicle cycle dependent)
Receptor blockade
Spironolactone competitively blocks testosterone at the receptor.
Cyproterone mechanism
Cyproterone also directly blocks the androgen receptor.
Follicles need months to shift into finer hair cycles.
Monitoring needs
Potassium and liver function are checked periodically.
COC Suppresses Ovarian Androgen Production
Estrogen-progestin pills lower ovarian testosterone output.
- ↑: SHBG Increase (binds free testosterone)
- ↓: Ovarian Androgen (LH-driven output suppressed)
- 2 drugs: Combined Regimen (anti-androgen plus COC)
- 3mo: Synergy Onset (faster than monotherapy)
Ovarian suppression
Estrogen-progestin lowers LH and ovarian androgen output.
SHBG rises
Higher SHBG binds more circulating free testosterone.
Combined therapy outperforms either drug given alone.
Cycle regulation
COC also regularizes menstrual cycles during treatment.
Hair Growth Reduction After Combined Therapy
Six or more months show visible hair thinning.
- 6–12mo: Response Timeline (minimum for visible change)
- up to 75%: Score Reduction (with sustained therapy)
- High: Relapse Risk (if therapy is stopped)
- 6mo: Follow-up Interval (rescoring recommended)
Delayed visible change
Hair follicle cycles are slow to respond.
Sustained therapy
Continuous treatment beyond a year deepens the response.
Stopping treatment often allows hair regrowth within months.
Rescoring practice
Repeat Ferriman-Gallwey scoring tracks real progress objectively.