There was always a need for a precise examination that permits to quantify the degree of hair loss to evaluate the pathology and, consequently, to follow up on the therapy reults, so a microscopic analysis method called "trichogram" has been developed. As eventually more microscopic techniques were developed the original trichogram these days might be called "standard" or "classic" trichogram. In essence, a trichogram involves taking 50 to 100 hairs from different parts of the scalp. The procedure is straightforward. The area from which the hair will be plucked is selected by the trichologist. The surrounding hair is combed out of the way and held in place with hair clips. The special clamp is then used to pluck out the selected hair bundle in the direction of the natural hair growth in that location. The hair is then stuck on to a slide, usually with see through sticky tape or sometimes embedded in clear glue, and the clamp is released. The hair are then examined under a microscope in order to determine which percentage of the hair are in each of the three phases of the hair growth cycle, Anagen, Catagen, or Telogen/Exogen. Basically, Anagen hair fibers usually have living cells on the root end, and often a sheath of living cells (called the the root sheath) around the lower hair fiber. Telogen hairs have a club end to them and they do not have any living cells attached to the root. Catagen hairs can be a bit more difficult to differentiate but usually these hair fibers have a tapered end to the root. Anagen and Telogen plucked hairs may sometimes be difficult to distinguish based on their microscopic appearance - at least for those inexperienced in microscopic hair fiber examination. However, the citrulline-containing proteins of the root sheath that is attached to plucked Anagen hair fibers develop a red color when stained with a dye called 4-dimethylaminocinnamaldehyde. Plucked Telogen hairs do not have any associated root sheath material and so do not stain red. This histochemical stain helps improve the accuracy of the Telogen/Anagen count. The hair fibers can also be measured to find out how thick they are. This helps to determine whether the hair fibers are normal Terminal hairs, or intermediate hairs (thin hair fibers) associated with chronic forms of hair loss like Pattern Baldness and Telogen Effluvium. In order to determine at what rate baldness will progress, the proportion of Anagen hairs (which are in their growing-phase) is compared to the proportion of Catagen and Telogen hairs (which are about to fall out). As a (very) rough guide, a 10% Telogen frequency is excellent, up to 25% is typical (the percentage of hair normally in the Anagen phase is slightly higher with women and children than with men), over 35% is a potential problem. By repeating the trichogram over a time period, a hair loss condition can be followed. Equally, if a treatment is being used, the effects of the treatment in terms of changing the frequency of Telogen hairs, can be measured. The Trichologist may also take the hairs from specific sites depending on the suspected hair loss problem. For example, if pattern baldness is suspected, the Trichologist will take hairs from two spots, one on top of the head where the alopecia should be active, and one from the back of the scalp where pattern baldness should not be active. This enables the measurements made to the two hair samples from different locations to be compared to each other. With pattern baldness, the Trichologist would expect to see more Telogen hair on top of the scalp than at the back of the scalp. If the Telogen rate is about the same in both locations then the trichogram result suggests that some other condition, like Telogen Effluvium, may be involved. So a trichogram can provide a fair amount of information in a quantitative form about hair growth and hair loss and it can also show how effective a hair loss treatment is. However, because the hair for examination is plucked out, the trichogram is not popular with most patients. Although the procedure is quite short and the pain associated with plucking the hair does not last long, few people are willing to submit to a trichogram. So the trichogram as a simple method of quantifying hair loss is becoming less popular with Trichologists too. If you plan to have a trichogram done, there are two things you must do to make sure you get an accurate measurement. First, you should not wash your hair at least couple days preceding the test. Washing helps massage out old Telogen hair so washing shortly before the trichogram is done can give an abnormally low Telogen hair frequency. You should also avoid permanent hair cosmetic treatments, like perms, dyes, or straightening hair, up to 8 weeks before the test is conducted. These permanent hair cosmetic treatments are relatively damaging to hair fiber and can result in increased hair breakage that can interfere with the evaluation.