Pull test

The pull test is a quick bedside diagnostic for active hair shedding. With clean, dry hair (not washed for 24 hours, since fresh washing dislodges already-shed hairs and skews results), the examiner grasps a small bunch of about 50 to 60 hairs near the scalp and pulls steadily but gently along the length.

Interpretation:

• 0 to 3 hairs out: normal background shedding.
• 4 to 6 hairs out: borderline.
• 6 or more hairs out: positive pull test, consistent with active shedding (typically telogen effluvium or another diffuse process).

The pull test answers a binary question (is something acute happening?) but does not give the cause. A positive pull test plus a recent trigger (illness, surgery, childbirth, severe stress, weight loss, medication change) usually points at telogen effluvium and reassurance plus targeted bloodwork.

A negative pull test does not rule out pattern hair loss, which is gradual rather than synchronously shedding. Pattern loss is a chronic miniaturisation process and typically gives a normal pull test.