Clinician vs. self-assessment of mFG hirsutism scores in PCOS: can patient self-assessment serve as a reliable screening and triage tool?

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. 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. 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. 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.