If you’ve been losing more hair than usual, a hair pull test might be one of the first tools your dermatologist uses to investigate what’s going on beneath the surface. You can even perform the test at home to assess how much hair you’re losing.
This simple exam can reveal whether your hair is shedding excessively and help point toward potential causes. Once the cause is determined, you can begin effective hair growth treatments that help slow or reverse hair loss.
Understanding how and why this test works—and what it can and can’t tell you—is essential for anyone concerned about hair loss.
What Is a Hair Pull Test?
The hair pull test is a clinical diagnostic procedure used by dermatologists and trichologists to assess active hair shedding.
During the test, the provider gently grasps a small bundle of hair, typically about 50–60 strands, and tugs lightly to see how many hairs come out. If more than a few hairs are easily released, it may indicate a shedding disorder.
The test is noninvasive and helps identify conditions such as telogen effluvium, alopecia areata, or other forms of diffuse hair loss.
Purpose of the Hair Pull Test
The main purpose of the hair pull test is to evaluate whether a person is experiencing excessive or abnormal hair shedding. It helps dermatologists determine if hair follicles are prematurely entering the telogen (shedding) phase of the growth cycle.
In a normal hair growth cycle, about 90% of your hair is actively growing (anagen phase), while the remaining 10% is resting (telogen phase) before falling out.
If the test reveals a higher percentage of telogen hairs, it may signify a hair loss condition that requires further investigation and treatment.
This test provides immediate, low-cost insight into active hair loss patterns, guiding further diagnostic workup or treatment decisions.
When Is a Hair Pull Test Used?
Dermatologists often use the hair pull test during the initial consultation for hair loss concerns. It's a starting point to determine the severity of shedding and whether additional tests, such as a scalp biopsy or blood work, are needed to pinpoint the underlying cause.
The test is also used to monitor the progress of hair loss treatments over time. By comparing the number of hairs pulled at each visit, doctors can assess if the treatment is effectively reducing shedding and promoting regrowth.
Is the Hair Pull Test Painful?
The hair pull test is generally not painful. Patients may feel mild tugging or brief discomfort, especially if the scalp is already irritated or sensitive.
However, the force applied is gentle and controlled, making the test well-tolerated by most individuals, including those with tender or inflamed scalps.
Limitations of the Hair Pull Test
While helpful, the hair pull test has limitations. It doesn’t pinpoint the exact cause of hair loss and cannot distinguish between scarring and non-scarring alopecia. Results can be influenced by recent hair washing, brushing, or styling.
It may also produce false negatives if the test is performed too late in the shedding cycle. For a complete diagnosis, the hair pull test should be used in conjunction with other methods, such as scalp exams, lab work, or scalp biopsies.
Hair Pull Test and Hair Growth Cycles
Hair grows in a continuous cycle consisting of three main phases: anagen (growth phase), catagen (transitional phase), and telogen (resting/shedding phase).
At any given time, the majority of scalp hairs (about 85–90%) are in the anagen phase, which lasts several years. A smaller percentage enters the catagen phase, followed by the telogen phase, which typically involves 10–15% of hairs and lasts around 2–3 months.
During telogen, hair naturally detaches and sheds to make way for new growth. The hair pull test is designed to detect abnormal numbers of hairs in the telogen phase.
If more than a few hairs are easily removed during the test, it may suggest that an unusually high proportion of follicles have prematurely entered the telogen phase—an indicator of conditions such as telogen effluvium or stress-induced hair loss.
How To Perform a Hair Pull Test
Although it is possible to perform a hair pull test at home, it’s best to have the test done by a dermatologist. Professionals know how much force to apply, how to identify telogen hairs under magnification, and how to interpret results accurately.
A self-test can offer preliminary insight, but it may not be reliable without proper technique and clinical expertise.
What To Avoid Before a Hair Pull Test
To ensure the accuracy of the hair pull test, there are a few things to keep in mind:
- Don't perform the test on wet hair, as it's more prone to breakage and may give a false positive result.
- Avoid using styling products or treatments that can affect the hair's texture or strength, such as oils, gels, or heat styling tools, before the test.
- Don't conduct the test too frequently, as excessive pulling can cause traction alopecia, a form of hair loss caused by repeated tension on the hair follicles.
If you're unsure about performing the test correctly, it's best to have a professional do it to ensure reliable results.
Step-by-Step Instructions for the Hair Pull Test
To conduct a hair pull test at home:
- Begin with dry, clean hair that hasn't been styled with products.
- Separate a section of hair about the width of a pencil (approximately 50–60 strands).
- Grasp the section close to the scalp between your thumb and first two fingers.
- Gently but firmly tug the hair away from the scalp.
- Count and examine the number of hairs that come out.
- Repeat in different areas of the scalp (top, sides, and back) for a more comprehensive evaluation.
It's important to be consistent with the amount of hair grasped and the firmness of the pull for accurate results.
How Many Hairs Are Too Many?
It’s normal to shed 50 to 100 hairs per day as part of the natural hair growth cycle. However, during a hair pull test, shedding more than 6 hairs from a gentle tug on a cluster of 50–60 hairs may indicate active hair loss.
Keep in mind that occasional shedding doesn’t always mean something is wrong. Factors such as recent stress, illness, poor diet, or hair washing frequency can temporarily increase shedding without signaling a chronic condition.
What the Hair Pull Test Results Mean
Interpreting the results of a hair pull test involves more than simply counting shed hairs. A dermatologist considers how many hairs are released, examines their growth phase, and evaluates patterns of shedding.
Understanding whether the result is positive or negative can help determine if active hair loss is occurring and guide further evaluation.
Understanding a Positive Hair Pull Test
A positive hair pull test means that more than a normal amount of hair is shedding. Generally, losing up to 10% of the hairs pulled (4–6 strands out of 50–60) is considered normal. Anything beyond that may indicate active hair shedding and warrant further investigation.
However, a positive test doesn't always mean you have a hair loss condition. Temporary shedding can occur due to stress, diet changes, medication side effects, or postpartum hormone fluctuations. A dermatologist can help determine if your hair loss is a cause for concern.
What a Negative Hair Pull Test Indicates
A negative hair pull test, where only a few hairs come out with each pull, generally indicates that your hair is in the normal growth cycle. It suggests that you're not experiencing excessive shedding and that your hair loss, if any, is likely not a significant issue.
However, a negative test doesn't necessarily rule out all forms of hair loss. Conditions such as androgenetic alopecia, where hair follicles gradually shrink and produce finer, shorter hairs, may not always result in a positive pull test.
If you're still concerned about hair thinning or receding, it's best to consult with a dermatologist for a more comprehensive evaluation.
Common Conditions Detected by the Hair Pull Test
A positive hair pull test may indicate an underlying hair loss disorder. While the test doesn’t provide a definitive diagnosis, it can help identify patterns consistent with several common conditions.
Recognizing the cause of excessive shedding is essential for determining appropriate treatment and preventing further hair loss.
Androgenetic Alopecia
Androgenetic alopecia, or pattern hair loss, is a genetically driven condition caused by sensitivity to dihydrotestosterone (DHT). It leads to gradual thinning, often in predictable patterns, such as a receding hairline in men or diffuse thinning in women.
Although the hair pull test may not always be positive, early cases can show increased shedding.
Treatment options include prescription-strength minoxidil, oral or topical finasteride, dutasteride prescription products (for stubborn or severe cases), spironolactone for women, a low-level laser hair helmet, and platelet-rich plasma (PRP) therapy.
Telogen Effluvium
Telogen effluvium is a temporary form of hair shedding triggered when a large number of hair follicles enter the telogen (resting) phase prematurely. Common causes include physical or emotional stress, illness, surgery, childbirth, or sudden dietary changes.
With this condition, a positive hair pull test is typical. Treatment focuses on identifying and resolving the underlying trigger rather than medical intervention. Hair usually regrows over several months once the cause is addressed.
Anagen Effluvium
Anagen effluvium refers to sudden hair loss during the growth (anagen) phase, often due to chemotherapy, radiation, heavy metal poisoning, or toxic exposures that impair rapidly dividing hair cells. The hair pull test may reveal dystrophic anagen hairs.
Unlike telogen effluvium, this type of loss is more abrupt and severe. Management involves stopping the offending agent when possible, and in some cases, hair regrowth begins once the treatment is discontinued.
Alopecia Areata
Alopecia areata is an autoimmune condition where the immune system mistakenly attacks hair follicles, leading to sudden patchy hair loss. A positive hair pull test is often observed at the edges of active patches.
The condition may resolve spontaneously, but treatments such as corticosteroid injections, topical immunotherapy, or JAK inhibitors may help stimulate regrowth and reduce inflammation, especially in more persistent or widespread cases.
Traction Alopecia
Traction alopecia results from prolonged tension on the hair, often due to tight hairstyles such as braids, ponytails, or extensions. Chronic pulling damages the follicles and can lead to permanent loss if not addressed early.
The hair pull test may be positive in areas under tension. Treatment involves eliminating the source of traction and allowing the scalp to recover. In advanced cases, dermatologic procedures such as PRP or hair transplantation may be considered.
Other Ways Hair Loss Is Diagnosed
While the hair pull test is a helpful screening tool, it’s only one part of a comprehensive hair loss evaluation.
After discussing family history, dermatologists often begin with a detailed review of recent medical conditions or lifestyle changes to identify potential triggers such as stress, illness, medications, or hormonal changes.
A close scalp examination helps assess inflammation, scarring, or pattern changes. Blood tests may be ordered to check for thyroid dysfunction, nutrient deficiencies, or autoimmune disorders.
Additional diagnostic tools include the card test (to evaluate hair shaft miniaturization), scalp biopsy (for scarring or unclear cases), and trichoscopy, a noninvasive method using magnification to examine hair follicles and scalp features in detail.
These combined approaches help determine the underlying cause and guide appropriate treatment.
Hair Pull Test - A Helpful Tool in Diagnosing Hair Loss
Hair loss can be distressing, but with the right evaluation and care, it is often manageable—and even reversible. While the hair pull test offers immediate clues, it’s only one piece of the diagnostic puzzle.
A dermatologist brings the expertise needed to interpret results accurately and develop a personalized treatment plan. If you’re noticing unusual shedding, don’t wait—talk to a specialist who can determine whether a hair pull test is the right first step.
Talk to a board-certified dermatologist to discuss your goals and find the solution that is best for you.
Frequently Asked Questions
What is the pull test?
The pull test is a simple diagnostic tool used to evaluate active hair shedding. A dermatologist gently tugs on a small section of hair to see how many strands come out, helping assess conditions such as telogen effluvium, androgenetic alopecia, or alopecia areata.
What is the hair pull test for?
The hair pull test is used to assess the severity of hair loss and identify conditions such as telogen effluvium, alopecia areata, or androgenetic alopecia. It's commonly used to assess hair loss patterns and decide if further testing or treatment is needed from a dermatologist.
How much hair is normal to pull test?
In a normal hair pull test, it’s typical to lose fewer than 3–5 hairs from a group of around 50–60 strands. If more hairs are easily pulled out, it may indicate excessive shedding or a hair loss condition that requires further medical evaluation and treatment.
How can I do a hair pull test at home?
To perform a hair pull test at home, grasp about 50–60 hairs between your thumb and fingers near the scalp, then gently tug. Count any hairs that come out. If more than 5–6 hairs come out, it may suggest abnormal shedding, though professional evaluation is recommended.
