{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:25:44Z","timestamp":1792794344369,"version":"4.5.0"},"reference-count":65,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Australian National Health and Medical Research Council","id":[{"id":"https:\/\/ror.org\/011kf5r70","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centre for Research Excellence for Women Health in Reproductive Life"},{"name":"Monash Graduate Scholarship"},{"name":"Monash International Tuition Scholarship"},{"name":"NHMRC CRE-WHiRL fellowship"},{"name":"University of Lagos, Central Research Grant","award":["CRC\/03\/2018"],"award-info":[{"award-number":["CRC\/03\/2018"]}],"id":[{"id":"https:\/\/ror.org\/05rk03822","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004914","name":"Ferring Pharmaceuticals Grant","doi-asserted-by":"publisher","award":["#2021\/2944"],"award-info":[{"award-number":["#2021\/2944"]}],"id":[{"id":"10.13039\/501100004914","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Foundation for Research and Education Excellence"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Hirsutism, a diagnostic feature of polycystic ovary syndrome (PCOS), is often defined using arbitrary percentile cutoffs, rather than normative cutoffs from population-based data. We aimed to define normative cutoffs for hirsutism in diverse populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Unselected population-based cluster analysis of individual participant data (IPD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PCOS Phenotype in Unselected Populations (P-PUP) study IPD asset of community-based studies, underwent k-means cluster analysis, of directly assessed hirsutism, using the modified Ferriman\u2013Gallwey (mFG) visual scale. The primary outcome was ethnicity-specific normative cutoffs for the mFG score. Medians and cutoffs were compared across ethnic groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 9829 unselected, medically unbiased participants, aged 18-45 years from 12 studies conducted across 8 countries including China, Iran, Italy, Nigeria, Russia, South Korea, Turkey, and the United States. The mFG cutoff scores for hirsutism on cluster analysis varied across ethnicities, ranging from 4 to 8. White Iranians had the highest cutoff score of 8, followed by White Italians and Black Africans of 7. Asian Han Chinese, White Russian, Turkish, and Black Americans shared a cutoff of 5; White Americans, Asian Koreans, Asian Russians, and Mixed Russians shared a cutoff of 4. Comparing medians and mFG cutoffs across ethnicities confirmed the same differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study confirms the 2023 International PCOS Guidelines recommendations defining hirsutism as an mFG score between 4 and 6 for the majority of populations studied, with few exceptions. However, we also highlight ethnic variation in mFG cutoff scores, suggesting that clinicians consider ethnicity in optimal diagnosis and personalized interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvaf030","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T23:20:10Z","timestamp":1740698410000},"page":"228-239","source":"Crossref","is-referenced-by-count":20,"title":["The PCOS Phenotype in Unselected Populations study: ethnic variation in population-based normative cut-offs for defining hirsutism"],"prefix":"10.1093","volume":"192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4127-8642","authenticated-orcid":false,"given":"Asmamaw Demis","family":"Bizuneh","sequence":"first","affiliation":[{"name":"Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne , Victoria 3168 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Ram","family":"Dhungana","sequence":"additional","affiliation":[{"name":"Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne , Victoria 3168 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6271-7803","authenticated-orcid":false,"given":"Larisa V","family":"Suturina","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction Problems , Irkutsk, 664003 ,","place":["Russian Federation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1962-3833","authenticated-orcid":false,"given":"Xiaomiao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , 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