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Choice      Trichologist       Hair loss tests

Hair loss tests

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To get in general an answer to the question whether it is time for you to really get concerned about your hair loss, you can try to conduct by yourself and/or with somebody's help quite popular hair loss tests, usually performed by Trichologists. Those are hair pull, hair wash and modified hair wash, as well as growing hair tests for an approximate determination of the extent and form of patient's ongoing hair loss. The hair pull test is, in essence, very simple. A Trichologist takes a few strands between his thumb and forefinger and pulls on them gently. Anagen growing hairs should remain rooted in place while hairs in Telogen should come out easily. By knowing how many hairs were pulled and the number that came out, you can roughly work out the percentage of hair follicles in a Telogen state. So if you pull on 20 hairs and 2 come out, then the frequency of Telogen hair follicles is 10%. As a (very) rough guide, a 10% Telogen frequency is an average norm, 15% shows a potential problem and 20% means an ongoing hair loss. Though, it shall be kept in mind, that hair pull tests may vary from person to person as some people can be naturally high shedders, but these people may also be rapid hair growers, so they have no net hair loss. And also it is possible to have a development of alopecia not from an increase in shedding, but rather a failure of new Anagen hairs to grow after Telogen hairs have been naturally shed. In this instance, Telogen hair follicle frequency is normal, but scalp hairs get gradually, progressively thinner, as it happens with inherited hair loss. However, although the hair pull test seems simple in principle, it contains many potential "traps" and some wrong conclusions can be drawn if the test is not properly conducted or limitations are fully understood.
  • The most basic problem with the hair pull test is that the results can vary depending on what you did with your hair in the preceding hours. If you washed your hair this will remove many of Telogen hairs. The washing process helps massage Telogen hairs out of their follicular canals. If you performed a hair pull test a few hours after hair wash the result will be false. For this reason, if you see Trichologist about hair loss, you should not wash your hair ideally for up to 4 days prior and at least in the preceding 24 hours.
  • The frequency of Telogen shedding varies from day to day. So you might have a positive hair pull test result on one day, but a few days later the pull test might be negative, etc. Ideally, to get a more accurate picture of shedding, the hair pull test should be done several times and an average of the daily results calculated to even on a day to day variability.
  • Hair pull testing may also show an increase in shedding in spring and fall as these are natural high shed seasons. This shall be taken into consideration when interpreting the results.
  • The results of a hair pull test may vary over the scalp, so more Telogen hairs may be pulled out on top than at the sides for example. To get a global picture, the hair pull test needs to be done a few times in different locations.
  • Hair pull tests will vary from person to person as some people can be naturally high shedders, but these people may also be rapid hair growers so they have no net hair loss.
Most Trichologists use a variation on the hair pull test called hair wash test and modified hair wash test. It involves washing your hair and collecting and counting all the hair fibers that come out during washing. The test suffers from the potential problems of the hair pull test above, however it does provide the advantage that the result is a reflection of what is going on over the entire scalp and not just in one or another specific spot on it. Also, this test makes it possible to determine how many hairs you shed per day. Eventually this test has been advanced with an idea of not simply collecting and counting all the hair fibers sheded, but also separating these fibers into several groups based on their lengths and counting hairs in each group too. Those lengths are for hairs up to 3cm, from 3 to 5cm abd over 5 cm in lengths, which are abeing assumed Vellus-like, Intermediate and Terminal hairs, accordingly. This allows to get much better idea on what hairs are being shed the most, thus, helps to get clearly better understanding on what more particular kind of hair loss is present in a patient. As this test requires more time to wash, collect and count hairs, it became a common practice to have patients perform it at home and provide information. This test, once again, may have certain exceptions for accuracy as the hair pull test, however, it is more accurate and also much more informative in comparison to hair pull test.
There is also somewhat different variation of the hair pull test, used by Trichologists, called growing hair test. The difference is that instead of pulling out a few strands of hair, a Trichologist cuts them off at their "roots" as close to scalp as possible. The hairs are then stuck on to a slide, usually with see through sticky tape, such as double-sided scotch tape. A Trichologist or technician would count hair fibers, then take a ruler and measure the lengths of each hair fiber, while noting on those, which are really thin. For example, there were 125 hair fibers cut off and out of them 25 of different lengths were really thin, while from 100 thicker fibers 10 were 1-2cm, 15 - 2-3cm, 10 - 3-4cm, 15 - 4-5cm, 10 - 5-6cm, and remaining 40 hair fibers were longer than 6cm. It is assumed, that thin fibers represent Vellus-like hairs and thicker - Terminal hairs. So, out of those 100 thicker hairs, 10 which have 1-2cm long fibers grew out 1-2 months ago, practically immediately replacing the lost 1-2 month ago hair fibers, which opened them up a space. And 2-3cm long hair fibers grew out 2-3 months ago replacing the lost 2-3 month ago hair fibers, etc. While for Vellus-like hairs this is not applicable, since those grow way slower. Thus, if out of 100 thicker hair fibers in our example 10 are 1-2cm long, this means that 1-2 month ago the hair loss resulted in 10% of a total scalp hairs or 10% Telogen frequency rate; 2-3 month ago the hair loss resulted in 15% Telogen frequency rate and so on. This test, once again, may have certain exceptions for accuracy, same to the hair pull test, however, it is still way more accurate and also informative in comparison to hair pull test.
Overall the hair pull, wash and especially modified wash and growing hair tests provide certain specific information and the results obtained must be put into context with other studies performed and associated information.

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