MON-221 Recalibrating the Modified Ferriman-Gallwey Score in Middle Eastern Women: Population Study

Abstract

INTRODUCTION Hirsutism is defined as excessive growth of terminal hair in androgen-dependent areas of the body in women. The most widely used scoring system for hirsutism was first developed by Ferriman and Gallwey in 1961, the system was derived from a population study of white women in England and a cutoff point of > 8 defining hirsutism. Unfortunately Ferriman and Gallwey score carries many limitations. One of the main limitations is the racial impact on hair growth, where different races have different degree of hair growth even with the similar androgen levels. Another limitation is that it depends on physician based assessment which may be skewed due to cosmetic treatment aimed at minimizing hair growth appearance in women particularly in the Middle East. The literature is devoid of strong evidence for the use of the modified Ferriman and Gallwey (mFG) score to define hirsutism in Middle Eastern with any particular cut-off. We therefore tried to tackle these two limitations with a large population based study for self-assessment of hair growth amongst women in the Middle East to identify the average hair growth quantity and help with identifying a more relevant cut-off point. METHODS An online survey was launched through social media applications in Middle East targeting women aged 13 and above in the period between 1-31 January 2018. Data were collected regarding self-assessment of hirsutism based on mFG score. The survey included 18 questions that focused on the 9 locations of hair growth outlined in the mFG score. Additional questions aimed to uncover any possible androgen disturbance states. RESULTS 21,445 responses were received, 14,411 (67.2%) of them were adequately completed. The majority of the completed responses were from Saudi Arabia and Kuwait 10,323 (72%). 10,513 (73%) women denied having any hormonal problems, consuming anti-androgens or oral contraceptive pills or having irregular cycles. The 95th percentile of mFG score of those women was 13. 9,989 women had a mFG score >13 with 4,095 (41%) perceived themselves as being hirsute while 524 women had a mFG score ≤13 with 474 (90.5%) believing that they suffer from hirsutism. DISCUSSION AND CONCLUSION This study appears to be the largest of its kind done in this region of Asia to the best of our knowledge. Self-perception of hirsutism appears to be more prevalent amongst the population studied which may reflect underlying social beliefs. Self- perception can help overcome any obstacles of cosmetic therapy that may impair clinical assessment of hair growth and distributions. Middle Eastern women appear to have a greater quantity of body hair growth at baseline. A cut off point using mFG score of >13 may be a better standard for used to define hirsutism and prompting work-up in females originating from this area. Further prospective studies to correlate these findings with clinical assessment are needed.