Racial and Ethnic Differences in Hirsutism Among Women with Polycystic Ovary Syndrome (PCOS): A narrative review

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women, frequently accompanied by hirsutism—a clinical marker of hyperandrogenism. However, the expression and diagnostic thresholds for hirsutism vary significantly across racial and ethnic groups. This narrative review synthesizes current evidence on ethnic disparities in hirsutism prevalence among women with PCOS, with an emphasis on Asian populations. While 60–90% of Middle Eastern and Caucasian women with PCOS meet the classic modified Ferriman-Gallwey (mFG) threshold of ≥8, less than 30% of East Asian women do—despite similar biochemical profiles. These disparities arise from differences in hair follicle androgen sensitivity, baseline hair density, and cultural grooming practices. The review critiques the universal use of mFG ≥8 and advocates for ethnicity-adjusted cutoffs (e.g., ≥5–7 in East Asians, ≥10–12 in South Asians) combined with biochemical testing. Such tailored approaches enhance diagnostic accuracy, prevent over- or underdiagnosis, and support culturally sensitive clinical care. Future directions include genetic studies, simplified tools, and greater inclusion of diverse populations in PCOS research to improve diagnostic equity and therapeutic outcomes.