Short answer: Hirsutism is diagnosed in the clinic. A doctor asks about your symptoms, examines you and scores your hair growth on the modified Ferriman-Gallwey (mFG) scale. Blood tests, starting with total testosterone, then look for the cause.[1] Ultrasound is mainly used to check for PMOS, and CT or MRI scans are only needed when a tumor is suspected. Most women never need them.[1][2]
Hirsutism means coarse, dark hair growing in a male-like pattern, for example on the upper lip, chin, chest or abdomen. It affects about 1 in 10 women.[4] Finding the cause matters, because it guides treatment and, rarely, uncovers a condition that needs prompt care.[4] This guide walks you through each step, from the first appointment to the less common scans, so you know what to expect and what to ask.
How is hirsutism diagnosed?
Most doctors follow the same four steps:
- Medical history. Your doctor asks when the hair growth started, how fast it is changing, whether your periods are regular, which medicines and supplements you take, and whether relatives have similar symptoms. Rapid development or progression of hair growth is a warning sign.[1]
- Physical exam. Your doctor scores 9 body areas from 0 to 4 on the mFG scale.[3] They may also look for acne, scalp hair thinning and signs of virilization, such as a deeper voice or an enlarged clitoris. They may examine your abdomen and do a pelvic exam to check for lumps.[1][6]
- Blood tests to measure androgens (male-type hormones such as testosterone) and rule out other conditions.[1]
- Imaging, such as ultrasound, but only in specific situations.[1]
For Black and white women in the US and UK, the Endocrine Society defines an abnormal score as 8 or more. Cutoffs are lower for some groups, for example from 2 to 7 in Asian women.[1] The 2023 International guideline uses 4-6, depending on ethnicity.[2] You can estimate your own score with our hirsutism self-check before your appointment. Learn more about the Ferriman-Gallwey score.
Should you stop removing hair before your appointment?
Shaving, plucking and waxing hide hair and can make an accurate score impossible.[1][2] Mayo Clinic suggests asking when you book whether you should wait to remove hair until after the checkup.[6] If that feels too hard, take photos of the areas before you remove hair, and tell your doctor how often you remove it.
Does everyone need blood tests?
No. The Endocrine Society suggests testing androgen levels in all women with an abnormal hirsutism score. It suggests against testing in women with regular periods whose unwanted hair is limited to one area and whose score is normal.[1] A 2025 expert review is more cautious: Women who are bothered by unwanted hair should be evaluated for underlying causes, however much hair is visible on examination.[3] If your concern is being dismissed, it is reasonable to ask why testing is or is not needed.
Which blood tests are used for hirsutism?
| Test | What it looks for | When it is used |
|---|---|---|
| Total testosterone | The main androgen. A raised level points to an ovarian or adrenal source. | First test for most women. Best taken early in the morning, ideally on days 4-10 of your cycle.[1] |
| Free testosterone or free androgen index (uses SHBG) | The active, unbound part of testosterone. SHBG (sex hormone-binding globulin) is the protein that binds it. | If total testosterone is normal but hirsutism is moderate or severe, or other symptoms are present.[1][2] |
| 17-hydroxyprogesterone | Non-classic congenital adrenal hyperplasia (NCAH), an inherited adrenal enzyme problem | In women with high androgens, or with a family history or high-risk ethnic background. Taken early in the morning in the first half of the cycle.[1] |
| DHEAS and androstenedione | Androgens made mostly by the adrenal glands | When testosterone is not raised. Less specific than testosterone.[2][1] |
| Prolactin, thyroid tests, cortisol tests | Other hormone conditions that can, uncommonly, cause hirsutism | Only when symptoms suggest them.[1] |
| Pregnancy test | Pregnancy as a cause of missing periods | If your periods have stopped.[1] |
| Anti-Müllerian hormone (AMH) | A marker of the number of small follicles in the ovaries | Can replace ultrasound for diagnosing PMOS in adults.[2] |
How to get accurate results
- Ask about the lab method. The International guideline recommends highly accurate tandem mass spectrometry (LC-MS/MS) for testosterone. It warns that direct immunoassays have limited accuracy at the low levels found in women.[2]
- Tell your doctor if you take the pill. The pill raises SHBG and lowers androgen production, so it is hard to assess androgens while you take it. If testing is essential, the guideline suggests stopping the pill for at least 3 months while using another form of contraception.[2] Don’t stop it without talking to your doctor first.
- Mind the timing. Early morning samples in the first half of your cycle are preferred for testosterone and 17-hydroxyprogesterone.[1]
When is an ultrasound needed?
A pelvic ultrasound can show polycystic ovarian morphology, one of the three features used to diagnose PMOS (formerly PCOS). In adults, 20 or more follicles in at least one ovary is the threshold.[2] PMOS is diagnosed when at least two of three features are present: Irregular ovulation, signs of androgen excess and polycystic ovaries on ultrasound or a high AMH level.[2] If you already have irregular cycles and hirsutism, an ultrasound may not be needed for the diagnosis. Ultrasound is not recommended for diagnosing PMOS in adolescents, because there are no reliable criteria for that age group.[2]
The Endocrine Society also suggests a pelvic ultrasound, preferably transvaginal (with a probe placed in the vagina), for severe or progressive androgen excess, or when ovarian hyperthecosis is suspected.[1] Ovarian hyperthecosis is a condition in which ovarian tissue overproduces androgens. After menopause, it is one possible cause of virilizing symptoms.[7] Read more about the difference between hirsutism and PMOS.
CT, MRI and X-rays: When are scans used?
Scans of the adrenal glands (CT or MRI) and ovaries (transvaginal ultrasound or MRI) are used to find the source of androgens when a tumor is suspected.[1][7] Warning signs include rapid onset or worsening of hair growth, hair growth that keeps progressing despite treatment, and virilization.[1] In women after menopause, a testosterone level above 5 nmol/L is linked to virilization and needs prompt investigation.[7] Some androgen-producing ovarian tumors are too small to see on ultrasound, so further tests may be needed.[1]
Plain X-rays are not part of the hirsutism workup in the guidelines we reviewed. Tumors are rare: They made up 0.2% of 950 women seen for androgen excess at two Italian endocrine clinics.[5]
What the results can show
The Italian study of 950 women referred to specialist clinics found these causes:[5]
| Diagnosis | Share of women | Typical test pattern |
|---|---|---|
| PMOS (formerly PCOS) | 72.1% | Irregular ovulation and/or polycystic ovaries, often with raised androgens |
| Idiopathic hyperandrogenism | 15.8% | Raised androgens, regular ovulation, normal ovaries |
| Idiopathic hirsutism | 7.6% | Normal androgens and regular ovulation |
| Non-classic congenital adrenal hyperplasia | 4.3% | Raised 17-hydroxyprogesterone |
| Androgen-secreting tumors | 0.2% | Often very high androgens, rapid symptoms |
A 2025 review gives similar figures: PMOS in 80-90% of women with hirsutism, idiopathic hirsutism in 5-10%, and NCAH in 1-10% depending on ethnicity.[3] PCOS was officially renamed polyendocrine metabolic ovarian syndrome (PMOS) in 2026.[8] Rarer causes include medications, Cushing’s syndrome and acromegaly.[3] See what causes hirsutism and drugs that can cause hirsutism.
“Idiopathic” means no cause is found. These diagnoses are made only after other conditions have been ruled out.[1] Normal results do not mean your hair growth is imaginary or untreatable.
When to see a doctor quickly
- New thick, dark hair that suddenly starts growing on your face and body[9]
- A voice that is getting deeper, or muscles that are getting bigger[9]
- An enlarged clitoris or other signs of virilization[1]
- Irregular or missing periods along with hair growth
Frequently asked questions
Can a blood test diagnose hirsutism?
No. Hirsutism is diagnosed by examining and scoring your hair. Blood tests help find the cause.[1]
Can you have hirsutism with normal hormone levels?
Yes. In idiopathic hirsutism, androgen levels and ovulation are normal. It accounted for 7.6% of women in a large clinic study.[5]
Do I need an ultrasound for hirsutism?
Not always. It is used to help diagnose PMOS in adults, to investigate severe or progressive androgen excess, or when a tumor is suspected.[2][1]
Can I be tested while on the birth control pill?
Results are hard to interpret on the pill. Your doctor may examine you first and decide with you whether a pill break is worth it.[2]
Key takeaways
- Diagnosis starts with a history, an exam and an mFG hair score.
- Total testosterone, ideally measured with LC-MS/MS, is the first blood test. Other tests depend on your symptoms.
- Ultrasound mainly helps diagnose PMOS. CT or MRI is reserved for suspected tumors, which are rare.
- PMOS (formerly PCOS) is the most common cause, but some women have normal results.
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Sources
- Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257. PubMed 29522147
- Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. PubMed 37580314
- Azziz R, Amiri M, Bril F, et al. Approach to the Patient: Hirsutism. J Clin Endocrinol Metab. 2025;110(10):e3503-e3519. PubMed 40200552
- Escobar-Morreale HF, Carmina E, Dewailly D, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012;18(2):146-170. PubMed 22064667
- Carmina E, Rosato F, Jannì A, et al. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab. 2006;91(1):2-6. PubMed 16263820
- Mayo Clinic. Hirsutism: Diagnosis and treatment. Accessed October 2026. Link
- Lindén Hirschberg A. Approach to Investigation of Hyperandrogenism in a Postmenopausal Woman. J Clin Endocrinol Metab. 2023;108(5):1243-1253. PubMed 36409990
- Teede HJ, Bahri Khomami M, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026;407(10545):2329-2339. PubMed 42119588
- NHS. Excessive hair growth (hirsutism). Accessed October 2026. Link
This article is for education and is not medical advice. Talk to a doctor about diagnosis and treatment.