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How to Avoid Hair Loss | Breast Cancer Guidelines

Side Effects
Jennifer Griggs
Breast Medical Oncologist
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July 19, 2020
How to Avoid Hair Loss | Breast Cancer Guidelines

Hair loss is a common side effect of chemotherapy used in the treatment of breast cancer. Hair thinning can also occur with some hormonal therapy.

Not all chemotherapy causes hair loss. New methods that involved cooling of your scalp during chemotherapy may help decrease hair loss. Insurance may cover the costs of scalp cooling. Your hair will start growing back when your chemotherapy treatments are done.

This article will explain in detail the different options you have to try to avoid hair loss. First, let’s talk about why chemotherapy causes hair loss and what to expect.

What Causes Hair Loss?

The chemotherapy drugs used to treat breast cancer are designed to target cells that divide rapidly in your body. Cancer cells are the key target of chemotherapy. Hair follicles also have cells that divide rapidly and are also affected by chemotherapy. Not all chemotherapy causes hair loss.

Hormonal therapy, used in the treatment of breast cancer that has the estrogen receptor (ER) and/or progesterone receptor (PR), can cause hair thinning in some people.

1. Hair Loss from Chemotherapy

If you are receiving chemotherapy, you can generally expect to start losing your hair two to four weeks after you start undergoing your cancer treatments. Most people will notice gradual thinning. You might wake up in the morning and notice excessive hair on your pillow or it could start to fall out as you brush or shampoo your hair. Some people have some tenderness of the scalp and notice, for example, that it hurts slightly when they put their head on a pillow. This tenderness lasts only a little while.

You may also lose hair on your legs, in your armpits, or elsewhere. If you lose your eyelashes or eyebrows, this hair loss happens at the very end of chemotherapy. Eyebrows and eyelashes also grow back in very quickly. Each person is different—you might lose all your hair or have only thinning.

Most people find that the worst part of hair loss is the time when they actually lose their hair. Wearing a wig, a scarf, a baseball cap, or a combination of all of these options at different times will let you feel yourself as much as possible. Your insurance may pay for part of the cost of a wig if you send in the bill for the wig along with a prescription from your oncologist.

Your hair will start to regrow after the last chemotherapy treatment. After about 3 months, your hair will be long enough that, if you’ve been wearing a wig, you will be comfortable going out in public without it. It is not uncommon for the color or texture of the hair to change when it grows back. If you had curly hair or the other way around. Coarse hair might turn baby soft fine.

2. Hair Loss from Chemotherapy

Radiation therapy for breast cancer does not cause hair loss.

A special case is breast cancer that spreads, or metastasizes, to the brain and requires treatment with radiation treatment. Radiation therapy to the scalp will cause hair loss. Your hair will grow back in, but it can take a little longer than it would after chemotherapy.

3. Hair Thinning from Hormonal Therapy

Hormonal therapy, one of the mainstays of treatment of breast cancer that has hormone receptors, can lead to hair thinning in some people. Examples of hormonal therapy used in the treatment of breast cancer that can lead to hair thinning include the following:

  • Anastrozole (Arimidex)
  • Fulvestrant (Faslodex)
  • Letrozole (Femara)
  • Tamoxifen (Nolvadex)

How to Avoid Hair Loss from Chemotherapy

There is no magic way to avoid hair loss if you are undergoing chemotherapy. Depending on the drugs used, hair loss is often inevitable. Some people have found certain ways to slow or reduce hair loss.

As with any treatment, you will want to discuss the following with your oncologist because you do not want to do anything that might interfere with the effectiveness of your cancer treatments or intensify unpleasant side effects. Also remember that everyone is an individual so what works for one might not for another.

1. Scalp Cooling Treatments

What is scalp cooling? Scalp cooling caps, which cause what you may heard called scalp hypothermia, can be used during chemotherapy to help reduce hair loss.  A scalp cooling cap is extremely close-fitting. It is placed on your head while chemotherapy is being given. A chilled liquid inside the cap cools the scalp to reduce the amount to blood flowing to this area. This reduces the amount of chemotherapy that makes it to the hair follicles.

Many of the newer types of scalp cooling caps are a two-piece system. With a two-piece system, the cap on your head is controlled by a computer. A second cap that has been made from neoprene is put over the cooling cap to hold it in place and offer insulation, so the cold does not escape.

How well does scalp cooling work? Clinical studies have shown that the newer computer-controlled caps help about 50% of people who use them. In those people, only half of the hair is lost.

How do I know if scalp cooling will work for me? There are several factors that appear to affect how well scalp cooling caps will work:

  • Thickness of the hair. Many people who have thick hair appear to lose far more hair than those with thinner hair. Researchers hypothesize that the more dramatic hair loss occurs because the thicker hair insulates the scalp, so it does not effectively cool down. This leads to more dramatic effects than someone with thinner hair.
  • Scalp Cooling Cap Size. The fit of the cap matters. If the cooling cap is too loose, it will not effectively cool the scalp and will be less effective than a tight-fitting cap. In such a situation, the hair loss that does occur is often patchy. The patches appear to result from the skull cap not applying even pressure all over the skull.
  • Specific chemotherapy received. Caps are known to be less effective in people receiving anthracyclines, including doxorubicin and epirubicin. These drugs are commonly used in the treatment of breast cancer.

What are the possible side effects of scalp cooling? As with any treatment, side effects need to be considered. The side effects of scalp cooling caps generally minimal and include:

  • Scalp discomfort
  • Headaches
  • Chills
  • Neck and/or shoulder discomfort

What are the other downsides of scalp cooling? Some experts have concern that cancer cells in the scalp may be protected from chemotherapy and later grow. However, none of the clinical trials of scalp cooling systems have shown this to be the case, however.

The cost of scalp cooling systems. In most cases, insurance companies will not cover scalp cooling caps. The cost is between $1500 and $3000 depending on how many chemotherapy treatments you receive. You’ll need to check to see if your insurance company will pay for all or a part of the cost. The Rapunzel Project ( is a non-profit organization that can help people cover the costs of scalp cooling systems.

The scalp cooling systems also require effort on your part and that of the treatment center staff. For some people, this adds more stress to a time in their life that is already stressful.

Weighing the Pros and Cons. You will want to discuss the pros and cons of using a scalp cooling cap with your cancer care team. You will also want to find out if the treatment center where you will receive your chemotherapy has experience with using scalp cooling caps and if they have been successful with the devices.

Choosing a Cooling Cap System – Newer cooling cap systems such as those created by DigniCap and Paxman have gained clearance from the US Food and Drug Administration (FDA). However, older scalp caps for hypothermia can still be rented from medical supply stores, obtained from cancer treatment centers, or purchased online and might prove just as effective as the newer hypothermia cap systems.

2. Avoiding Certain Drugs

As mentioned above, not all drugs used in breast cancer treatment cause hair loss. In many cases, you might be given a combination of more than one drug to treat your cancer. Your oncologist can let you know how likely it is that your planned treatment will cause hair thinning or loss.

The American Society of Clinical Oncology lists the following chemotherapy drugs as the most likely to cause hair loss or thinning:

  • Cyclophosphamide (Neosar)
  • Docetaxel (Taxotere)
  • Paclitaxel (Taxol)
  • Doxorubicin (Adriamycin)
  • Epirubicin (Ellence)
  • Carboplatin (Paraplatin)
  • Fluorouracil (5-FU)
  • Gemcitabine (Gemzar)
  • Vincristine (Marqibo, Vincasar)
  • Vinorelbine (Alocrest, Navelbine)
  • Cisplatin (Platinol)

Hair Thinning from Hormonal Therapy

Hormonal therapy, one of the mainstays of treatment of breast cancer that has hormone receptors, can lead to hair thinning in some people. Examples of hormonal therapy used in the treatment of breast cancer that can lead to hair thinning include the following:

  • Anastrozole (Arimidex)
  • Fulvestrant (Faslodex)
  • Letrozole (Femara)
  • Tamoxifen (Nolvadex)

3. Caring for Your Scalp to Prevent Hair Loss

None of the following have been studied in clinical trials. However, here are some tips that may help your hair stay healthy for as long as possible as you start chemotherapy and while you take hormonal therapy.

  • Do not wash your hair every day.
  • Use a conditioner to reduce the likelihood of tangles.
  • Gently pat hair dry with a towel.
  • Use only a soft bristle brush or a wide-toothed comb to style your hair.
  • Avoid chemical dyes, straighteners, or any form of high heat styling

Final Thoughts…

Currently, your best chance of avoiding hair loss during cancer treatments is using scalp cooling, which will help about 50% of people keep about half of their hair.  

If you do lose your hair, recognize that it is normal to be distressed. It is not vanity that is making you distressed. Rather, hair may be part of your identity...what makes you unique. Even knowing that your hair will eventually grow back cannot take away the difficulty of hair loss. Be kind to yourself. Share your feelings with a trusted friend. Do whatever you can to take care of yourself during this difficult time.


  1. Rugo et al., Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer JAMA. 2017;317(6):606-614.
About The Blog Author
A long-time practicing oncologist and professor at the University of Michigan, Jennifer has received several awards for her medical excellence and published over 150 original research articles as well as numerous editorials and book chapters. She is also a speaker and advocate, committed to improving the quality of medical care and reducing the barriers to equity among the disenfranchised.
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