Hair Pull Test
Reviewed by
Steven P., FAAD
Board-certified dermatologist
Updated on
Reviewed for accuracy
Table of Contents
What is the Hair Pull Test?
The hair pull test is a clinical method used to evaluate active hair shedding from the scalp. During this test, a healthcare provider or individual gently grasps a small bundle of hair-typically about 60 strands-close to the scalp and pulls upward with gentle, even tension. The number of hairs that come out is then counted. If more than three hairs are released, the result is considered a positive hair pull test, which may indicate abnormal shedding.
This test is commonly used by dermatologists to help distinguish between normal daily shedding and excessive hair loss. It is a quick, non-invasive assessment that can be performed in a medical office or at home. The hair pull test is especially useful for detecting diffuse hair loss, such as that seen in telogen effluvium, but it can also be positive in other hair loss conditions. While the test provides immediate feedback, it should always be interpreted in the context of a full scalp exam and medical history.
Why is the Hair Pull Test Done?
The main purpose of the hair pull test is to determine whether a person is experiencing active hair shedding beyond what is considered normal. This is particularly important for individuals who notice increased hair on their pillow, in the shower, or on their hairbrush. By quantifying the number of shed hairs, the test helps clinicians and patients understand if the shedding is within the expected range or if further investigation is needed.
The hair pull test is also valuable in differentiating between various types of hair loss. For example, telogen effluvium typically presents with diffuse shedding and a positive pull test across the scalp, while other conditions like androgenetic alopecia or scarring alopecia may show different patterns. The test is often one of the first steps in the evaluation of hair loss and can guide the need for additional diagnostic procedures or referrals to a dermatologist.
How to Do the Hair Pull Test at Home
Steps for Self-Testing
Performing the hair pull test at home is straightforward and does not require special equipment. Start with clean, dry hair that has not been washed or brushed for at least 24 hours. Using your thumb and forefinger, gently grasp a small bundle of about 60 hairs close to the scalp. Pull slowly and firmly, but without causing discomfort. Count the number of hairs that come out with the pull.
Repeat the process in different areas of the scalp, such as the top, sides, and back, to check for consistency. If more than three hairs are extracted in a single pull, the result is considered positive. Remember to collect and count only the hairs that come out with the pull, not those that may have already been loose or fallen out earlier.
Things to Remember
Be gentle during the test to avoid breaking hairs or causing unnecessary trauma to the scalp. Pulling too hard can result in false positives by forcibly removing healthy hairs. It is also important to avoid performing the test immediately after washing or brushing, as this can temporarily increase the number of loose hairs and skew the results.
The hair pull test is just one part of assessing hair shedding. Results can vary depending on recent hair care routines, scalp health, and underlying conditions. If you are unsure about your technique or result, consider discussing your findings with a healthcare provider or dermatologist for further evaluation.
What Does a Positive Hair Pull Test Mean?
A positive hair pull test means that more than three hairs are removed when gently pulling a small bundle of hair. This suggests that you are shedding more hair than is typical for healthy scalp function. A positive result can be an early sign of conditions like telogen effluvium, but it is not specific to one type of hair loss.
It is important to understand that a positive hair pull test does not confirm a single diagnosis. Many conditions can cause increased shedding, including androgenetic alopecia, alopecia areata, and certain scarring alopecias. The test indicates that further evaluation is needed to determine the underlying cause. A full assessment by a dermatologist, including a scalp exam and medical history, is essential for accurate diagnosis and treatment planning.
Understanding Club Hairs and the White Bulb
Club hairs are hairs that have reached the end of their growth cycle and are ready to shed. These hairs are characterized by a white, bulb-shaped structure at the root, known as the white bulb. The white bulb is made of keratin and is a normal part of the hair’s telogen (resting) phase.
When performing the hair pull test, the presence of club hairs with a white bulb indicates that the hairs are being shed naturally as part of the hair cycle. In telogen effluvium, most of the shed hairs will have this white bulb. Recognizing club hairs can help differentiate between normal shedding and hair loss caused by breakage or other factors.
How Many Hairs is Normal to Shed?
Most healthy individuals lose up to 100 hairs per day as part of the natural hair growth cycle. This daily shedding is a normal process and does not usually result in noticeable thinning or bald patches. The majority of these shed hairs are in the telogen phase and will have a white bulb at the root.
In conditions like telogen effluvium, the amount of daily shedding can increase significantly, sometimes up to 300 hairs per day. This level of hair loss is often noticeable and may cause concern. However, it is important to remember that increased shedding does not always mean permanent hair loss. Many cases of telogen effluvium are temporary and resolve once the underlying cause is addressed.
Hair Pull Test for Telogen Effluvium
The hair pull test is particularly useful in evaluating telogen effluvium, which is a common cause of rapid, diffuse hair shedding. In telogen effluvium, a significant number of hairs prematurely enter the telogen phase and are shed from all areas of the scalp. A positive hair pull test in multiple scalp regions supports the diagnosis of telogen effluvium, especially when accompanied by a history of recent stress, illness, or other triggers.
However, not everyone with telogen effluvium will have a positive pull test at all times. The result can vary depending on when the test is performed and factors like recent hair washing. The test is most informative when interpreted alongside other clinical findings and a detailed medical history.
What Makes the Shed Hairs Different?
In telogen effluvium, the hairs that come out during the pull test are usually club hairs with a white bulb at the root. These hairs are not broken or damaged but have completed their natural growth cycle and are ready to shed. The presence of many club hairs is a hallmark of telogen effluvium.
In contrast, other hair loss conditions may produce a mixture of hair types during the pull test. For example, alopecia areata can result in both telogen hairs and broken or dystrophic anagen hairs. Scarring alopecias may also show extraction of anagen hairs, which is not typical in telogen effluvium. Identifying the type of shed hairs can help guide further diagnostic steps.
Limitations of the Hair Pull Test
While the hair pull test is a helpful screening tool, it has several limitations. The result can be influenced by how the test is performed, recent hair washing or brushing, and individual hair characteristics. Pulling too hard or testing immediately after hair care routines can lead to inaccurate results. The test also does not distinguish between different causes of hair loss, as multiple conditions can produce a positive result.
Additionally, the hair pull test only assesses active shedding at the moment it is performed. It does not provide information about the underlying cause or the long-term pattern of hair loss. For a comprehensive evaluation, the hair pull test should be combined with a full scalp exam, medical history, and, if needed, laboratory tests or scalp biopsy.
Other Tests Dermatologists May Use
Dermatologists use a variety of tests in addition to the hair pull test to evaluate hair loss. These may include a thorough scalp examination, trichoscopy (scalp microscopy), and laboratory tests to check for nutritional deficiencies, thyroid problems, or other systemic issues. In some cases, a scalp biopsy may be performed to examine hair follicles under a microscope.
The choice of tests depends on the pattern and severity of hair loss, as well as the patient’s medical history. Combining the hair pull test with other diagnostic methods helps ensure an accurate diagnosis and effective treatment plan.
FAQ About the Hair Pull Test
What is a positive hair pull test?
A positive hair pull test occurs when more than three hairs are extracted during a gentle pull of about 60 scalp hairs. This result suggests increased shedding and may indicate conditions like telogen effluvium, but it is not specific to one type of hair loss.
Can I do the shedding test daily?
It is not necessary or recommended to perform the hair pull test daily. Frequent testing can irritate the scalp and may not provide meaningful information, as daily variations in shedding are normal. If you are concerned about ongoing hair loss, consult a healthcare provider for a comprehensive evaluation.
Will washing my hair affect the result?
Yes, washing or brushing your hair shortly before the test can increase the number of loose hairs, potentially leading to a false positive result. For the most accurate outcome, perform the hair pull test at least 24 hours after your last wash or brushing session.
Can other conditions give a positive hair pull test?
Several hair loss conditions can result in a positive hair pull test, including androgenetic alopecia, alopecia areata, and scarring alopecias. The test indicates increased shedding but does not pinpoint the exact cause. Further evaluation is needed to determine the underlying condition.
How accurate is the hair pull test?
The hair pull test is a useful screening tool but has limitations. Its accuracy depends on proper technique and timing. It should be interpreted alongside a full scalp exam and medical history for the most reliable results.
Should I stop any products before testing?
There is no need to stop using your usual hair care products before performing the hair pull test. However, avoid applying heavy styling products or oils immediately before the test, as they can affect grip and accuracy.
How soon should I see a dermatologist if I have lots of shedding?
If you experience sudden, severe, or persistent hair shedding, schedule an appointment with a dermatologist promptly. Early evaluation can help identify the cause and start appropriate treatment, especially if you notice other symptoms like scalp irritation or patchy hair loss.
Fact Checked
Updated: December 30, 2025
Reviewed for accuracy against authoritative clinical sources and peer reviewed dermatology references. Educational content only.
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Reviewed by
Steven P., FAAD
Board-certified dermatologist
Updated on
Reviewed for accuracy
