How Hair Loss Is Assessed: Scalp Exam and Trichoscopy

A hair loss assessment combines a detailed conversation about your health and hair history with a close look at your scalp, often including a gentle pull test and a magnified examination called trichoscopy. Depending on what the physician finds, blood tests or, occasionally, a scalp biopsy may follow. The aim is to identify the cause, because effective care depends on an accurate diagnosis.

Why a proper assessment matters

Hair loss is a symptom with many possible causes, from inherited pattern thinning and stress-related shedding to thyroid disease, iron deficiency, autoimmune conditions and scarring disorders. Several of these can look alike at first glance. Treating the wrong condition wastes time and money and, in some cases, allows a treatable problem to progress.

A structured assessment also gives you a baseline. Knowing exactly how your scalp looks today makes it much easier to judge later whether things are stable, improving or getting worse.

Step one: your history

The conversation is often the most useful part. Expect questions such as:

• When did you first notice a change, and did it start suddenly or gradually?
• Is the main problem shedding, thinning in certain areas, patches or breakage?
• Has there been an illness, surgery, pregnancy, major stress or weight change in the past six months?
• What medicines, supplements and hair products do you use?
• How do you style your hair, and do you use tight styles, heat or chemical treatments?
• Do relatives have similar hair loss?
• Do you have symptoms elsewhere, such as fatigue, changes to periods, acne, skin rashes or nail changes?
• Is your scalp itchy, sore or burning?

It helps to bring a list of medicines and, if you have them, older photos that show how your hair used to look.

Step two: looking at the scalp

Pattern mapping

The physician looks at where the hair is thinning. Pattern hair loss in men usually affects the temples and crown, while in women it often shows as a widening part with the front hairline kept. Diffuse thinning across the whole scalp, round bald patches, or loss along the edges of the hairline each suggest different causes. Standardised scales are sometimes used to describe the extent of pattern thinning, and photographs taken in consistent lighting can be helpful for comparison over time.

The scalp skin is checked for redness, scaling, pustules, scarring or shiny areas where follicle openings have disappeared. Eyebrows, eyelashes, beard, body hair and nails may also be examined, since some conditions affect them too.

The pull test

In a pull test, the physician gently grasps a small bundle of hairs, often around 50 to 60, between the fingers and slides them along to the ends. A few hairs coming out is normal. More than a handful suggests active shedding. It is usually done in several areas and is more informative if you have not washed your hair for a day or so. The test is gentle and should not hurt.

Shed hairs may be looked at more closely. A hair with a small white bulb at the root has come out at the end of its resting phase, while broken hairs, or hairs with an unusual shape, point elsewhere.

Step three: trichoscopy

Trichoscopy is a magnified examination of the scalp and hair using a handheld dermatoscope, a device with a bright light and lens, sometimes connected to a camera. It is quick, comfortable for most people and does not involve any needles.

Under magnification, a physician can see details that are not visible to the naked eye, such as:

• Variation in hair thickness: a mix of thick and fine hairs suggests follicles shrinking, typical of pattern hair loss
• Empty follicle openings and short regrowing hairs: common in shedding conditions
• Exclamation mark hairs and yellow dots: features often seen in alopecia areata
• Loss of follicle openings, redness or scaling around follicles: warning signs of a scarring alopecia
• Broken hairs of varying lengths: which may suggest breakage, pulling or fungal infection

Trichoscopy supports the diagnosis but does not replace clinical judgement. Some findings overlap between conditions.

Step four: tests when needed

Blood work

Blood tests are chosen based on your history and examination, not ordered routinely for everyone. Common ones include ferritin (iron stores), a complete blood count, and thyroid function. Depending on the situation, a physician may also check vitamin D, zinc, hormones such as testosterone in women with signs of excess androgens, or tests for autoimmune conditions. These are often arranged through your family doctor. Our guide to medical causes of hair loss explains why these tests matter.

Scalp biopsy

If the diagnosis remains uncertain, or if scarring alopecia is suspected, a small skin sample may be taken under local anaesthetic, usually by a dermatologist. Scarring conditions benefit from early specialist care, as described in our article on scarring alopecia and early referral.

After the assessment

A good assessment ends with a clear explanation of the likely cause, what is still uncertain, and the options. For some people the right next step is reassurance and time. Others need treatment of a medical condition by their family doctor, a dermatology referral, or a discussion of hair loss treatments such as medication or PRP. You should never feel rushed into a procedure.

Frequently asked questions

Should I wash my hair before the appointment?

Ask the clinic for instructions. Many prefer that you avoid washing for a day beforehand and skip styling products, so the pull test and scalp examination are more accurate.

Does trichoscopy hurt?

No. The device simply rests on or just above the scalp while the physician looks through it or takes images.

Can I stop my medicines before blood tests?

Do not stop any prescribed medicine without talking to your prescriber. If high-dose biotin supplements are part of your routine, mention it, as they can affect some test results.

If you would like your hair loss assessed, HealthPark Medical Aesthetics offers a consultation that includes a history review, scalp examination and a plain discussion of findings. Where blood work, your family doctor or a dermatologist should be involved, we will explain why.