<p>Polycystic ovary syndrome (PCOS) is consistently associated with depressive and anxiety symptoms. Though prior studies have linked PCOS with poor body image and reduced quality of life including perceived threats to womanhood, few studies have directly examined these psychosocial impacts of PCOS as explanations of mental health risks. We examined the psychosocial impacts of one specific PCOS symptom, hirsutism, which refers to excess, male-patterned body and facial hair, and its association with depressive and anxiety symptoms. We argue that gender identity could differentiate psychosocial impacts of hirsutism, and thereby mental health risk. Taking a gendered approach we examined 1) gender identity (i.e., cisgender women, gender diverse) differences in body image concerns and the impact on quality of life associated with hirsutism, and 2) whether gender identity moderated the mediating effects of these psychosocial impacts in explaining how hirsutism is linked to depressive and anxiety symptoms. Data were collected via an online survey of 122 (<i>n</i> = 69 cisgender women, <i>n</i> = 53 gender diverse) individuals diagnosed with PCOS. Results revealed that hirsutism significantly explained cisgender women’s but not gender diverse individuals’ body image concerns and negative impact on quality of life, which, in turn, explained mental health in cisgender women but not in gender diverse individuals. Findings support a gendered impact of hirsutism on mental health risk, which has implications for the treatment of PCOS.</p>