Screening for Androgen Excess in Women: Accuracy of Self-Reported Excess Body Hair Growth and Menstrual Dysfunction

J Clin Endocrinol Metab. 2020 Oct 1;105(10):e3688-e3695. doi: 10.1210/clinem/dgz264.


Context: Epidemiologic studies of polycystic ovary syndrome (PCOS) are limited, especially in populations where diagnostic resources are less available. In these settings, an accurate, low-cost screening tool would be invaluable.

Objective: To test the use of a simple questionnaire to identify women at increased risk for PCOS and androgen excess (AE) disorders.

Study design: Prospective cohort study from 2006-2010.

Setting: Community-based.

Participants: Women aged 14 to 45 years.

Intervention: A screening telephone questionnaire consisting of 3 questions was tested, where participants were asked to self-assess the presence/absence of male-like hair and menstrual irregularity. Participants were then invited to undergo a direct examination, including completing a medical history and undergoing a modified Ferriman-Gallwey (mFG) hirsutism score, ovarian ultrasound, and measurement of circulating total and free testosterone, DHEAS, TSH, prolactin and 17-hydroxyprogesterone levels.

Main outcome measure: Accuracy of questionnaire in predicting PCOS, AE, and irregular menses.

Results: Participants with self-assessed irregular menses and/or excess hair were labeled "Possible Androgen Excess (Poss-AE)" and those self-assessed with regular menses and no excess hair were labeled "Probable Non-Androgen Excess (Non-AE)." The study was completed in 206/298 (69%) of the Poss-AE and in 139/192 (73%) of the Non-AE. Of Poss-AE and Non-AE subjects, 82.5% and 15.8%, respextively, presented with PCOS. The calculated sensitivity, specificity, positive predictive value, and negative predictive value of the 3-question telephone survey to predict PCOS was 89%, 78%, 85%, and 83%, respectively.

Conclusions: A simple telephone questionnaire, based on self-assessment of body hair and menstrual status, can be used with a high predictive value to identify women at risk for AE disorders, including PCOS, and to detect healthy controls. This approach could be an important tool for needed epidemiologic studies.

Keywords: Androgens; epidemiology; hirsutism; irregular menses; polycystic ovary syndrome; screening.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Androgens / blood*
  • Androgens / metabolism
  • California
  • Female
  • Hirsutism / blood
  • Hirsutism / diagnosis*
  • Hirsutism / epidemiology
  • Humans
  • Menstruation Disturbances / blood
  • Menstruation Disturbances / diagnosis*
  • Menstruation Disturbances / epidemiology
  • Middle Aged
  • Polycystic Ovary Syndrome / blood
  • Polycystic Ovary Syndrome / epidemiology*
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Self Report / statistics & numerical data
  • Self-Assessment*
  • Telephone
  • Young Adult


  • Androgens