What To Expect From a Hair Pull Test

If you’re developing a receding hairline, diffuse thinning, or similar early signs of hair loss, your healthcare provider may perform a hair-pull test or tug test to figure out why you’re losing hair.

A hair-pull test is when a medical professional literally pulls on your hair to check for excessive or active hair shedding.

It’s often used to help diagnose conditions like androgenetic alopecia (the medical term for male pattern hair loss), telogen effluvium (a form of temporary hair shedding), and other causes of hair loss like alopecia areata and scarring alopecia.

We’ll explain in detail what a hair-pull test is, what to expect when getting one done, how to perform hair-pull tests, and your options for treating hair loss.

A hair-pull test is a simple in-office test a primary care provider or dermatologist may use to determine whether a patient is actively shedding hair. The assessment is sometimes referred to as a hair loss pull test, a traction test, or a Sabouraud’s maneuver.

During the test, the healthcare provider will grasp around 20 to 60 hairs between their thumb, index, and middle fingers, holding as close to the base of the scalp as possible. To check for hair loss or excessive shedding, they’ll tug on the hairs using a small amount of force.

A hair-pull test checks to see how many hairs are released from the scalp with minimal force. If more than 10 percent of the grasped hairs are pulled out, it’s generally viewed as a sign you’re actively shedding hair.

Additionally, the test can help your provider check for brittle or broken hairs or hair shaft abnormalities. It can also be used to gauge the success of a hair transplant procedure.

By carefully tugging on 20 to 60 of your hairs as part of a hair-pull test, healthcare providers can quickly identify when patients are experiencing abnormal shedding of telogen hairs (strands that aren’t in active growth).

In a healthy person without hair loss, it’s normal for less than 10 percent of the pulled hairs to fall out.

For someone with active hair loss, a much greater percentage of hairs might be shed in a hair-pull test.

Beyond identifying telogen hair shedding, a positive pull test can help medical providers discover or pinpoint other forms of hair loss and follicular issues.

For instance, hairs extracted during the test might show thickened root sheaths (the lower part of the follicle that protects growing strands). In that case, a healthcare provider may suspect cicatricial alopecia, a form of scarring hair loss caused by internal inflammation or physical hair follicle damage.

Some providers may also do a trichoscopy, which uses a microscope to examine follicles up close to check for damage.

This information can help providers recommend the most appropriate treatment for the type of hair loss patients are facing.

A hair-pull test is a quick, straightforward procedure a healthcare provider will usually carry out in their office. To perform the test, they’ll gently tug on a cluster of 20 to 60 hairs, then look for signs of hair loss based on the number of hairs extracted.

Your healthcare provider might tell you not to shampoo your hair for at least one day before the test, based on the American Academy of Dermatology’s guidelines. It’s important not to apply any hair styling products, such as hair gel, wax, or pomade, before this type of test, as they can affect your hair’s strength and texture.

Hair-pull tests usually aren’t painful. You might experience mild discomfort while your hairs are being pulled, but this shouldn’t last 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 want to do blood tests or a scalp biopsy (removing a tiny skin sample from your scalp).

Besides checking your hair, your healthcare provider might ask about your general lifestyle and medical history. Make sure to tell them if you:

• Have been diagnosed with any scarring or nonscarring alopecia types by another medical professional

• 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

• Have noticed skin lesions or other issues on your scalp

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.

Understanding the natural hair growth cycle can help you get an idea of what the results of your hair-pull test mean.

Each strand of hair 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 a few distinct phases before detaching and being replaced by a new hair.

Here’s a breakdown of the hair-growth phases:

• The first phase is referred to as the anagen phase. In this stage, hair grows actively until it reaches its final length. In most people, the anagen phase for scalp hair lasts 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. This is a short, transitional period when an individual 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). In this stage, the hair remains attached to the scalp for roughly 100 days, after which it’s shed and replaced by a new hair from the same follicle.

• A fourth phase is called the exogen phase. 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 in the shower drain if you’re prone to hair loss.

It’s normal for 80 to 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 interrupt the natural hair growth cycle, either on certain parts of the scalp or in all hair follicles.

Loose anagen syndrome, for instance, causes normally active anagen-phase hairs to be more prone to falling out.

Male pattern baldness — the most common form of permanent hair loss in men — harms your hair follicles through a process called miniaturization. This is when the androgen (male sex hormone) DHT (dihydrotestosterone) gradually shrinks hair follicles and affects their ability to grow new hairs.

Over time, this process may shorten the anagen phase of the hair growth cycle, meaning strands spend less time as anagen hairs — and less time actively growing.

Other forms of temporary hair loss, such as telogen effluvium and anagen effluvium, happen when an illness, nutritional deficiency, hormonal change, or other physiologically stressful event causes hair follicles to rapidly enter into the telogen phase.

If your hair-pull test shows you’re losing hair, your healthcare provider may suggest taking medication or making changes to your lifestyle and hair care habits to slow down hair loss or prevent it from worsening.

Medications for Hair Loss

Several medications are available for treating hair loss. These include an oral medication called finasteride, which requires a prescription, and topical minoxidil, which can be purchased over the counter.

Finasteride

Finasteride works by preventing the conversion of testosterone into DHT — the main culprit of male 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 can determine if a prescription is appropriate.

Minoxidil

Minoxidil works by moving hairs into the anagen phase of the growth cycle. It also stimulates blood flow 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 encouraging hair growth. In fact, one study published in the journal Dermatologic Therapy shows that these medications are particularly effective at treating male pattern baldness when used together.

We offer minoxidil solution (a liquid) and minoxidil foam online, as well as bundled finasteride, minoxidil, and other proven hair growth products in our Hair Power Pack. 

Habits and Lifestyle Changes for Healthy Hair

Although maintaining a healthy lifestyle won’t treat male pattern baldness, it can help reduce the severity of some other forms of hair loss. Try to:

• Reduce and manage 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 crucial to get enough of several essential nutrients — such as iron, biotin, and protein — to promote hair growth. You can also use supplements like our biotin gummies 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. Steer clear of 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 left untreated. 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, blow drying it on a hot setting, or brushing it aggressively can contribute to hair breakage and loss. To preserve the hair you still have, try to take a gentler approach to hair care and styling.

Our guide to preventing hair loss shares other techniques and tactics to avoid shedding and promote normal hair growth. 

Here’s what to keep in mind about a hair-pull test:

• A hair-pull test is a quick and simple procedure a healthcare provider can 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.

• The test involves tugging at a group of 20 to 60 hairs to see how many come out from the scalp. If more than 10 percent of the hairs are released, it could indicate active hair loss.

• Knowing how to perform a hair-pull test and interpret the results can help healthcare providers accurately diagnose different forms and causes of hair loss.

Starting to develop a receding hairline, thinning around your crown, or other signs of hair loss? Take action and protect your hair with science-backed hair loss treatments from Hims, including FDA-approved 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.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.