Clinician vs. self-assessment of mFG hirsutism scores in PCOS: can patient self-assessment serve as a reliable screening and triage tool?
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OBJECTIVES: The aim of this study was to examine the discrepancy between patient- and clinician-assessed modified Ferriman-Gallwey (mFG) hirsutism scores across four PCOS phenotypes and nine body sites, and to evaluate whether patient self-assessment could serve as a reliable tool for preliminary hirsutism screening and outpatient triage. METHODS: This prospective observational study included 157 Han Chinese female patients aged 18-36 years, who were diagnosed with PCOS according to the Rotterdam criteria at an outpatient gynecological endocrinology clinic. All participants completed a self-assessment questionnaire, scoring terminal hair growth across nine body areas using the mFG scale. These self-assessed scores were compared with clinician-assessed scores independently obtained by two trained physicians who were blinded to patient self-assessment results. RESULTS: Patient self-assessed mFG scores were significantly higher than clinician-assessed scores in the overall PCOS cohort and phenotypes A and B (all P < 0.05), while no significant score differences were detected in phenotypes C and D. Despite higher self-assessed scores, Cohen's kappa coefficients ranged from 0.551 to 0.855 across phenotypes, indicating moderate to almost perfect diagnostic agreement. Analyses for phenotype D were purely descriptive due to inadequate statistical power. Bland-Altman analysis demonstrated minimal mean scoring bias across all groups, yet the wide 95% limits of agreement (LoA) indicated poor precision for individual-level assessment. The borderline range of self-assessed mFG (5-10), where the cumulative concordance rate fell below the 90% threshold, showed a rate of only 70.6% and was the primary zone of concern. By contrast, patients with scores less than 5 and more than 10 had a concordance rate greater than 90%. ROC curve analysis verified the excellent diagnostic performance of self-assessment (overall AUC = 0.922), with clinician-assessed scores used as an internal reference. CONCLUSION: For Han Chinese women with PCOS, self-assessed mFG scoring is a reliable tool for preliminary hirsutism screening and outpatient triage but cannot fully replace clinician assessment. We recommend confirmatory clinician review for patients with self-assessed mFG scores in the borderline zone.