Important Information: Please Read Before Proceeding
- Your Doctor’s Advice is Final: Always follow the advice of your treating doctor and healthcare team. Their medical guidance is based on your specific health condition and should be considered final.
- For Informational Purposes Only: This content is written by a practicing oncologist to help you understand your health. However, it is for general information only and is not a substitute for a direct consultation with your own qualified doctor.
- Empowering Patients: Our goal is to empower you with knowledge so you can ask better questions and have more informed discussions with your healthcare team about your treatment options.
- Do Not Self-Medicate: Never use the information on this website to make decisions about your treatment or to self-medicate. This can be very dangerous.
- Regarding Translations: Articles translated into languages other than English are done using automated artificial intelligence (AI). These translations may have errors or inaccuracies. Please consult the original English article for the most accurate information or clarify these with your treating team.
A 60-year-old woman sat across from me, devastated by her breast cancer diagnosis. When I explained the need for chemotherapy, one Marathi word, “विद्रुप” (vidrup) captured her fear. It is a word that suggests the harshest kind of disfigurement, something not just disfigured, but grotesque, mutilated. That one word, gave voice to what many patients dread about chemotherapy. I must admit, my first reaction was surprise. Why use such a strong word for what I thought of as a reversible side effect of chemotherapy? But her choice of words was a powerful reminder that what seems trivial to us can be deeply devastating to patients. Cancer treatment associated hair loss is one such side effect. The moment I reassured her, “This is temporary. Your hair will grow back,” the relief on her face was unmistakable.
This patient’s fear is a common and profound one. The dread of hair loss is so overwhelming that some patients consider refusing life-saving chemotherapy. This is because the burden of alopecia is not merely cosmetic, but deeply psychological. Internally, it causes a distressing alteration of self-image that serves as a constant reminder of the illness. Externally, it results in a sudden loss of privacy, as this visible side effect reveals a personal health battle to the world.
The goal of this article is to provide clear information on why cancer treatments can cause hair loss and to offer a practical guide for managing both the physical and emotional aspects of this side effect.
Pattern of Cancer Treatment-Related Hair Loss
The general medical term for hair loss is alopecia. When caused by cancer therapy, the pattern, location, and extent of hair loss depend entirely on the type of treatment you receive. Contrary to the common fear of sudden overnight hair loss, treatment-induced alopecia is a gradual process of increased shedding that occurs over days and weeks.
Alopecia is most commonly caused by chemotherapy and radiotherapy. Chemotherapy-induced alopecia, results in widespread hair loss across the entire body, and radiation-induced alopecia, only affects the specific area being treated.
A common and understandable fear is that hair loss from chemotherapy will be permanent. Please be reassured: for most patients, this is a temporary side effect. While your new hair might have a different texture or color at first, you should expect it to grow back fully after treatment.
Many patients worry that their hair will fall out all at once. It is important to understand that this is not what happens. Even when hair loss is rapid, it occurs over a period of days and weeks. The process usually begins with noticing more hair shedding than usual. You might notice:
- Increased hair on your pillow, in your hairbrush, or in the shower drain.
- Tenderness or a sensitive feeling on your scalp.
- Visible thinning of your hair as the shedding increases.
- Loss of eyelashes and eyebrows, or thinning/loss of facial hair.
- Complete loss of hair on your scalp and possibly other parts of your body.
Why Does Treatment Cause Hair Loss?
Cancer treatments kill any cell that divides fast. It can n ot tell the difference between a normal cell and a cancer cell. Normal cells that divide fact are also killed. This includes cancer cells, hair follicle, cells that form the blood, cells that line the mouth, throat and the intestine and in males cells that form the sperms.
Hair originated from a small organ in the skin, the hair follicle. Hair have periods of growth (anagen) and a period when there is not growth (telogen). Hair is sensitive to the effects of cancer treatment during anagen but not telogen. Scalp hair has the longest anagen. Hair on the other parts of the body have shorter anagen. Scalp hair is lost the earliest. Hair from other parts like facial hair eyebrows, eyelashes and body hair are lost later than scalp hair. Recovery follows the same pattern. Scalp hair re-growing the earliest and the fastest and other following. It is normal for it to take several months for eyebrows and eyelashes to fully regrow, so patience with this process is key.
Let’s look at how different types of treatment relate to hair loss.
A. Chemotherapy:
Chemotherapy is the most common cause of treatment-related hair loss. Chemotherapy drugs travel throughout the whole body through blood. For this reason they affect hair follicles all over your body. The likelihood of hair loss varies depending on the specific chemotherapy drug.
- Drugs that commonly cause significant hair loss include: Cyclophosphamide, Daunorubicin, Docetaxel, Doxorubicin, Epirubicin, Idarubicin, and Paclitaxel.
- Other drugs that can also cause hair loss include: Carboplatin, Etoposide, and Ifosfamide.
- The following drugs may also cause hair thinning: Capecitabine, Fluorouracil (5-FU), Gemcitabine, Methotrexate, and Vincristine.
Don’t assume the chemotherapy you will be administered will cause hair loss. Discuss with your oncologist. Your oncologist can tell you the likelihood and pattern of hair loss as well as the pattern of recovery with your prescribed chemotherapy regimen.
B. Radiation Therapy:
Radiation therapy can cause hair loss, but only in the specific area where the radiation beam is aimed. For example, if you receive radiation to your brain, you will likely lose hair on your head. If you receive radiation to your chest or pelvis, you will not lose the hair on your head. The hair loss is localized to the treatment field. Whether the hair grows back depends on the dose of radiation received.
C. Immunotherapy:
Immunotherapy works differently from chemotherapy. It uses your body’s own immune system to fight cancer. Widespread, complete hair loss is not a common side effect of most immunotherapy drugs. Some patients might experience mild hair thinning or, in rare cases, an inflammatory condition that causes patchy hair loss. However, it is not the same type of predictable, total hair loss seen with many chemotherapy drugs.
D. Targeted Therapy:
Targeted therapies are drugs that focus on specific molecules involved in cancer cell growth. Their effect on hair is very variable and depends on the specific drug. Some targeted therapies can cause hair to become thin, dry, brittle, or curly. In some cases, they can even cause changes in hair color. Complete hair loss is less common than with chemotherapy, but significant thinning can occur.
E. Hormonal Therapy:
Hormonal therapies do not typically cause the sudden, complete hair loss seen with chemotherapy. For women on anti-estrogen therapies (like tamoxifen or aromatase inhibitors – anastrozole, letrozole and examestane), the effect is usually a gradual thinning of scalp hair over many months or years, similar to age-related hair thinning.
Androgen Deprivation Therapy (ADT) for prostate cancer, can effect hair. ADT typically experience thinning of body and facial hair. However, ADT can have an unexpected and opposite effect on the scalp. Because it blocks the hormone responsible for male pattern baldness (the common type of genetic hair loss in men that causes a receding hairline and thinning at the crown), some men may notice that the hair on their head actually becomes thicker or starts to regrow.
F. Surgery:
Surgery does not cause hair loss as a direct side effect. You will not lose your hair from having an operation to remove a tumor. If an incision is made on your head, the small area around the cut will be shaved for the procedure, but this is not the same as treatment-induced alopecia.
Managing Hair Loss
Managing hair loss is a team effort. The team includes you, your medical team, your loved ones and caregivers. Here are some ways we can approach it.
A. Your Treatment is Unique – Talk to Your Doctor
Your doctor is your best source of information. Ask them if your specific treatment plan is likely to cause hair loss. The rest of this section outlines different management strategies, including medical options and practical self-care.
B. A Medical Option to Consider: Scalp Cooling
You may have heard about a technology called “scalp cooling” or “cold caps.” This is a medical procedure designed to help reduce hair loss from certain types of chemotherapy. It involves wearing a special cap that is kept very cold before, during, and for a period after your chemotherapy infusion.
The idea is that the cold temperature constricts the blood vessels in your scalp. This reduces the amount of chemotherapy medicine that reaches your hair follicles, which may help them survive the treatment.
However, there are very important limitations to consider:
- It does not guarantee success. For some, it works very well. For others, it only reduces hair loss to thinning, and for some, it may not work at all. Its effectiveness, at least to an extant, depends on the type and dose of chemotherapy drugs you receive.
- It is not suitable for everyone. Scalp cooling is not recommended for certain cancers (like leukemias or lymphomas).
- It can have side effects. Wearing the intensely cold cap can cause headaches, dizziness, and a general feeling of being very cold and uncomfortable during treatment.
- Availability and cost can be issues. Not every cancer center offers this technology, and it may not be covered by all insurance plans.
The most important step is to discuss this with your oncologist. They can tell you if scalp cooling is a safe and potentially effective option for your specific situation.
C. Following the Medicine Plan Correctly
It is important to continue with your prescribed cancer treatment. While hair loss can be very distressing, it is a side effect that can overcome. Never stop a treatment because of a side effect without first speaking to your doctor. Stopping chemotherapy cancer reduce the chances of cure.
D. Practical Self-Care Strategies for Your Scalp
- Be Gentle: Before hair loss starts, treat your hair and scalp gently. Use a mild shampoo and a soft-bristled brush. Avoid hair dyes, perms, and harsh styling products.
- Consider a Short Haircut: Many patients find it emotionally easier to cut their hair short before it begins to fall out. It can feel less dramatic than losing long hair.
- Protect Your Scalp: Your scalp will be exposed and sensitive. Protect it from the sun with sunscreen (SPF30 or higher) or a hat. In cold weather, wear a hat or scarf to stay warm.
- Use Gentle Skin Care: Use a gentle, fragrance-free moisturizer on your scalp to prevent dryness and irritation.
E. Wigs, Scarves, and Head Coverings
Many people choose to cover their heads during hair loss. Wigs, scarves, hats, and turbans are all excellent options. Many cancer centers have resources to help you find a wig that looks and feels natural. Exploring these options before hair loss begins can help you feel more prepared and in control.
F. A Special Note on Eyebrows, Eyelashes, and Facial Hair
While scalp hair loss gets a lot of attention, for many people, losing eyebrows and eyelashes is even more upsetting. They are central to our facial expressions and how we recognize ourselves. This is something that becomes obvious only when the eyebrows are lost. Here are some tips to help you “look normal” and feel more comfortable:
- For Eyebrows: You can use an eyebrow pencil, powder, or gel to gently draw in your brows. Using eyebrow stencils can help you find a a natural-looking shape. If you are considering semi-permanent options like microblading, it is critical to discuss this with your oncologist before treatment begins. Procedures that break the skin carry an infection risk that is very high during therapy.
- For Eyelashes: Losing eyelashes can make your eyes feel unprotected. A soft eyeliner pencil can be used to create the illusion of a lash line. False eyelashes are an option, but be very careful. The glue can irritate sensitive skin. Check with your medical team first, and perhaps save them for special occasions.
- For Facial Hair: For men who lose a beard or mustache, keeping the skin clean and well-moisturized is the best approach. Use gentle, non-irritating shaving creams and after-share balms.
When Should You Call Your Doctor Immediately?
Hair loss itself is not a medical emergency. However, you should contact your doctor or nurse right away if you notice any of the following on your scalp or face:
- Sores that are open or weeping fluid
- Pus or signs of an infection
- Severe redness or a rash
- Extreme pain or tenderness on the scalp
Your healthcare team is your partner through every step of this journey. Always reach out to them with your concerns however trivial they may seem.
Hair loss is a deeply distressing side effect, but it is one that can be managed. It should never be a reason to abandon a potentially curative treatment. Before making any decisions speak openly with your oncology team about your concerns. Together, you can explore all options, including coping strategies, medical interventions to reduce hair loss, or even alternative treatments if appropriate. Above all, remember the fact that with the vast majority of therapies, hair loss is temporary. The benefits of completing your cancer treatment will far outweigh this difficult, but manageable, side effect.