Guidelines Revised for Hair Pull Test Used in Assessing Hair Loss

One of the tools that can be used in assessing whether or not someone is experiencing certain types of hair loss is known as a hair pull test. This involves exactly what you'd expect: a small cluster of hairs is gently pulled to see how many fall out.

Unfortunately, this is not a hugely scientific way to diagnose a hair loss condition, especially when the accepted normal level of hairs that might be expected to come out on a healthy head of hair has long been something experts have quibbled over.

Now, doctors in Canada claim they have new evidence that shows how currently accepted “normal” levels do not paint an accurate picture.

Not necessary for all conditions

Hair pull tests are seldom performed for some types of suspected hair loss. In cases of Androgenetic Alopecia - more commonly known as Male Pattern Baldness and Female Pattern Hair Loss - for example, a visual inspection is usually all an expert needs to make a diagnosis, as hair thinning is restricted to areas around the top of the scalp and hairline only. It does not affect the hair at the back or sides of the head.

With other conditions such as the temporary condition Telogen Effluvium, signified by a generalised shedding from all over the scalp  the cause of hair loss can sometimes be less obvious. In these instances a pull test has some merit. But this is only true, argues the Canadian team, if doctors have an accurate idea of how much hair loss was normal for someone with no diagnosed form of alopecia, during a gentle tug of their locks.

“The hair pull test lacks validation and has unclear pretest guidelines,” states the Canadian team, “so we sought to quantify normal hair pull test values and elucidate the effect of pretest hair washing and brushing.”

For many years, people who were about to undergo a hair pull test at a clinic were told not to wash or brush their hair for four or five days before undertaking the pull test.

After recruiting 182 volunteers who did not have a hair loss condition, it was found that the mean number of hairs lost during a pull test on a cluster of around 50-60 hairs was 0.44 hairs. It made no difference whether the participant had recently washed or brushed their hair or not.

These findings illustrate that the existing guidelines namely that losing 10 per cent of your hairs during a pull test is indicative of a hair loss condition are much too high. The team states that its study has newly quantified the hair pull test and that normal levels should now be lowered to up to two hairs, which equates to approximately four per cent instead of 10. Whether or not someone has washed or brushed their hair, they state, should also no longer be deemed relevant.

Not affected by tight hairstyles

Interestingly, the team states that hair pull values in their test were not affected by tight hairstyles although it is unclear how they define this as there are hundreds of thousands of documented cases of very tight hairstyles leading to Traction Alopecia. This is a treatable condition in most cases, and occurs when the hair follicles are damaged from being placed under too much strain. This is usually caused by frequently wearing tight hairstyles such as braids, high ponytails and cornrows, as well as hair extensions and weaves.

Anyone who suspects that they may be losing more hair than usual over a prolonged period would be well advised to seek out expert help, as most conditions have a better prognosis when diagnosed early. A tricho-check hair loss consultation at Belgravia, which lasts just over half an hour and is free of charge, is undertaken by an experienced, specialist nurse. They ask important background questions as well as making a thorough investigation of the scalp.

For those people who are unable to visit Belgravia's Central London hair loss clinics in person, this can also be done using our online consultation form which allows photo uploads to aid the diagnostic process.

All hair loss treatments are then devised on a client-by-client basis to ensure maximum chances of halting hair fall and, when possible, encouraging new growth.