What To Expect From a Hair Pull Test
Reviewed by Jill Johnson, FNP
Written by Our Editorial Team
Hair loss is a common condition that can affect men of all ages and backgrounds. In fact, data from community-based samples suggests that more than 50 percent of men show some signs of hair loss from male pattern baldness by their forties.
If you’re starting to develop a receding hairline, diffuse thinning or similar early signs of hair loss, your healthcare provider may perform a pull test to work out why you’re losing hair.
This type of test involves pulling on your hair to check for active hair shedding. It’s often used as part of the diagnostic process for conditions such as androgenetic alopecia (the medical term for male pattern hair loss) and telogen effluvium (a form of temporary hair shedding).
Below, we’ve explained in more detail what a hair pull test is, as well as what you should expect if your healthcare provider recommends this type of test.
We’ve also talked about your options for treating hair loss after a positive hair pull test, including medications, lifestyle changes and more.
What Is a Hair Pull Test?
A hair pull test is a simple type of in-office test that a primary care provider or dermatologist may use to determine whether you’re actively shedding hair.
The test itself is pretty simple: your healthcare provider will grasp around 20 to 60 hairs between their thumb, index and middle fingers, holding as close to the base of your scalp as possible. To check for hair loss, they’ll tug on the hairs using a small amount of force.
If more than 10 percent of the hairs grasped by your healthcare provider can be pulled out from your scalp, it’s generally viewed as a sign that you’re actively shedding hair.
Hair pull tests are referred to using a variety of terms. Your healthcare provider may refer to this test as a hair loss pull test, a traction test or as Sabouraud's sign.
How Does a Hair Pull Test Work?
To understand why a pull test is effective for diagnosing hair loss, it’s important to quickly cover the basics of how your hair grows, as well as how common forms of hair loss can affect the hair growth cycle.
Every hair on your scalp and other regions of your body grows from a hair follicle — a mini-organ in the dermal layer of your skin. As new hair grows from each follicle, it passes through several distinct phases before detaching and being replaced by a new hair.
The first phase in this process is referred to as the anagen phase. During this phase, hair grows actively until it reaches its final length. In most people, the anagen phase for scalp hair lasts for two to six years, during which the hair is supplied with nutrients and grows continuously.
As each hair exits the anagen phase, it transitions into the catagen phase — a short, transitional period in which the hair stops growing. During this phase, a white node forms on the end of the hair, resulting in what’s referred to as a “club hair.”
Finally, the hair enters the telogen phase, or resting phase. During this phase, the hair remains attached to the scalp for approximately 100 days, after which it’s shed and replaced by a newer hair from the same follicle.
A fourth phase, called the exogen phase, is included in this cycle. In this phase, the strands of hair in the telogen phase are actively shed, resulting in the stray hairs you may notice on your pillowcase or shower drain if you’re prone to hair loss.
It’s normal for between 80 and 90 percent of your hair follicles to be in the anagen phase at any given time, with the rest in the catagen and telogen phases. This allows your hair to constantly replace itself without causing any obvious empty patches or thinning.
Our full guide to the hair growth process explains this growth cycle and its effects on your hair in more detail.
Most conditions that cause hair loss do so by interrupting this process, either in certain parts of your scalp or in all of your hair follicles.
For example, male pattern baldness — the most common form of permanent hair loss in men — harms your hair follicles via a process called miniaturization, in which androgen hormones such as DHT gradually shrink your hair follicles and affect their ability to grow new hairs.
Over time, this process may shorten the anagen phase of your hair growth cycle, meaning your hairs spend less time actively growing.
Other forms of temporary hair loss, such as telogen effluvium, occur when an illness, nutritional deficiency, hormonal change or other physiologically stressful event causes your hair follicles to rapidly enter into the telogen phase of the hair cycle at the same time.
By carefully tugging on 20 to 60 of your hairs as part of a hair pull test, your healthcare provider can quickly identify if you’re experiencing any abnormal shedding of telogen hairs.
In a healthy person without hair loss, it’s normal for less than 10 percent of the pulled hairs (the typical percentage of hairs in the catagen or telogen phases) to fall out. In a person with active hair loss, a much greater percentage of hairs may be shed during this type of test.
In addition to identifying telogen hair shedding, a positive pull test can also help your healthcare provider to identify other forms of hair loss.
For example, if the hairs extracted during the test show thickened root sheaths, your healthcare provider may suspect that you have cicatricial alopecia — a form of scarring hair loss caused by internal inflammation or physical hair follicle damage.
This information can help your healthcare provider to recommend the most appropriate form of treatment for your hair loss. They may also decide to do a trichoscopy, which uses a microscope to examine your follicles up close.
Hims has helped thousands of men regrow their hair
What to Expect During a Hair Pull Test
A hair pull test is a quick and simple procedure that your healthcare provider will usually carry out in their office. To perform the test, they’ll gently pull on 20 to 60 of your hairs, then look for signs of hair loss based on the number of hairs extracted.
Your healthcare provider may instruct you not to shampoo your hair for at least one day before the test. It’s important not to apply any hair styling products, such as hair gel, wax or pomade, before this type of test, as these may affect your hair’s strength and texture.
Hair pull tests usually aren’t painful. You may experience some mild discomfort while your hairs are being pulled on, but this shouldn’t last for more than a few seconds.
If your hair pull test shows signs of a nutritional deficiency, infection, disease or hormonal issue, your healthcare provider may perform a scalp biopsy (removing a tiny sample of skin from your scalp) or ask you to provide a blood sample for analysis.
In addition to checking your hair, your healthcare provider might ask about your general lifestyle and medical history. Make sure to tell your healthcare provider if you:
Have recently noticed your hair loss getting worse.
Suffer from a medical condition that could affect your hair.
Have made changes to your hair care or styling habits.
By giving your healthcare provider a detailed history of your hair loss and general health, you’ll make it easier for them to recommend the most effective hair loss treatment for your needs.
How to Treat Hair Loss
If your hair pull test shows that you’re losing hair, your healthcare provider may suggest taking medication or making changes to your lifestyle and hair care habits to slow down your hair loss or prevent it from becoming worse.
Medications for Hair Loss
Several medications are available for treating hair loss. These include an oral medication called finasteride, which requires a prescription and a topical medication called minoxidil, which can be purchased over the counter.
Finasteride works by preventing the conversion of testosterone into DHT, an androgen hormone that can harm your hair follicles and cause male and female pattern hair loss.Research shows that long-term use of finasteride improves hair density in men with male pattern baldness.
We offer finasteride online, following a consultation with a licensed healthcare provider who will determine if a prescription is appropriate.
Minoxidil works by moving hairs into the anagen phase of the growth cycle. It also stimulates blood flood to the scalp, which may improve the supply of nutrients to hair follicles and promote hair regrowth.
Like finasteride, research shows that minoxidil is effective at promoting hair growth. In fact, one study published in the journal Dermatologic Therapy shows that they’re particularly effective at treating male pattern baldness when used together.
Habits and Lifestyle Changes
Although maintaining a healthy lifestyle won’t treat male pattern baldness, it can help to reduce the severity of some other forms of hair loss. Try to:
Try to limit your exposure to stress. Stress may cause temporary hair loss in the form of telogen effluvium. Try to limit your exposure to stressful situations and use relaxation techniques if you’re feeling overwhelmed.
Eat a balanced, healthy diet. It’s important to get enough of several essential nutrients, such as iron, biotin and protein, to promote hair growth. You can also use supplements such as our Biotin Gummy Vitamins to support thick hair and healthy skin.
Avoid strong hold styling products. Products and styles that pull on your hair follicles can cause a form of hair loss called traction alopecia. Avoid strong hold styling waxes, gels and other products that put tension on your hair follicles.
Treat scalp infections as quickly as possible. Certain scalp infections, such as tinea capitis, can cause hair loss if they’re left untreated. Make sure to talk to your healthcare provider if you notice any signs of a bacterial or fungal infection on your scalp.
Limit habits that damage your hair. Things like coloring your hair at home, drying it on a hot setting or brushing it aggressively can contribute to hair breakage and loss. Try to limit these habits and take a gentler approach to hair care and styling.
Our guide to preventing hair loss shares other techniques and tactics that you can use to avoid shedding and promote normal hair growth.
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No matter the treatment plan, the best place to start is somewhere. Early action is the best hair loss prevention.
Get Help for Hair Loss Online
A hair pull test is a quick and simple procedure that your healthcare provider will use to check if you’re losing hair. It’s over in a few seconds and generally doesn’t cause any issues other than very mild discomfort.
If you’re starting to develop a receding hairline, thinning around your crown or other signs of hair loss, you can take action and protect your hair using our range of hair loss treatments, including medications such as finasteride and minoxidil.
You can also find out more about successfully dealing with hair loss in our detailed guide to the best treatments for thinning hair.