Hair Loss and Regrowth After Chemotherapy

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Hair Loss Background

When does hair fall out after chemo and how long does it take to grow back?

This varies person to person. Generally speaking, hair loss caused by chemotherapy happens around two to four weeks after the start of treatment or around the start of your second chemotherapy cycle. Often people may find they start losing their hair in clumps during a shower, while brushing hair, or discover it on their pillow after sleep.

The extent and pace of hair loss depends on a number of treatment factors, such as the type of chemo drug, dosage, frequency of treatments, and how the chemo is administered.

Be sure to ask your doctor and/or nurse about your chemotherapy regimen and whether it’s known to cause hair loss. 

For the most part, thankfully, chemotherapy does not cause permanent hair loss. In rare cases, however, some higher-dose radiation therapy targeting the head may result in permanent hair loss.

Hair regrowth timelines after chemo vary, but many patients report hair regrowth beginning as early as a couple weeks after treatment, usually starting with thin or fuzzy growth. Full normal hair growth rates may take up to a month or more. For some, the average is hair growth six weeks after chemo.

Will hair look the same when it regrows after chemo?

In some cases hair can carry a different color or texture after regrowth, which may be permanent for some patients. This is often known as “chemo curls” and can affect even people who previously had straight hair before cancer treatment.

Styling & Solutions

When should I cut my hair or shave my head?

This is a very personal decision. Most The Patient Story contributors with longer hair said they wanted to cut their hair to avoid feeling a dramatic loss.

Many shared their fear of seeing large clumps of their hair on their pillows and on the floor; cutting their hair shorter helped them feel lighter and less anxious. 

Three of 5 quality-of-life measurements, including feeling less physically attractive, showed benefit for women who received scalp cooling.

Meaning This self-contained cooling system was associated with a lower risk of hair loss among women receiving non–anthracycline-based chemotherapy for early-stage breast cancer.

The Patient Story contributor and breast cancer survivor, Margaret Abe Koga, tried the cold caps. In her post about hair loss, she talks about how the cold caps helped save about 60% of her hair. However, she also described it as “the hardest part” of her chemo treatment. 

By the end, by the last cap, I was just wiped out and it’s like a brain freeze that entire time and a headache. So that was probably the most painful part.

With that said, Margaret still encourages everyone who’s interested in saving at least some of their hair to look into the cold caps or cooling caps as an option, acknowledging also that the technology is advancing to make it more comfortable for patients to wear.

The cost depends on which company you rent from. Margaret reported them to be roughly $1500 during her three-month chemotherapy treatment.

What can I wear on my head when I am bald?

There are so many styling options! Here are just a few favorites of our The Patient Story community:

● Light beanie: keeps head warm, not too hot
● Wig: a good one that fits well can look like your real hair (cons: can be itchy, hot)
● Baseball cap: very comfortable, easy to wear
● Baseball cap with hair attached to sides: this is non-Hodgkin lymphoma survivor Stephanie Chuang’s favorite because it’s comfortable and can look like your real hair. Your scalp won’t be bothered by the cap material which is usually cotton.
● Scarves: nice and light, some are beautifully-patterned so you can be a fashionista while covering up
● Rocking the bald look! Keyla reminds us that you can look absolutely beautiful going out without anything on your head. May sound cliche but all you need is truly your confidence.

What kind of wigs are there?

Construction:

• machine-made (pre-custom)
• hand-tied (full-custom)

Material:

• synthetic (man-made)
• human hair
• combination of the two

How much do wigs cost and does insurance cover them?

Synthetic wigs tend to be the most popular because they are usually much cheaper (and less required care) than the other two choices. The synthetic styles range from about $25 to a few hundred dollars compared to around $1,000-$3,000 for a human hair wig. Wigs made of both material hit somewhere in between.

Insurance may cover part or all of the cost of the wig, especially if your doctor about writes a prescription for an “extra-cranial prothesis” to submit on an insurance claim.

There are non-profits and organizations out there that help specifically with providing free or partially-cost-covered wigs. Don’t forget to check with your own cancer center which may collect donated wigs for patients. Here are some other resources: 

• American Cancer Society has different programs available depending on where you are. You may also call 1-800-ACS-2345.
• Friends are By Your Side offers free wigs for people diagnosed with cancer around the world. It also gives styling services and advice.
• Lolly’s Locks “works with wig-providers across the country to serve a diverse population of cancer patients because we know cancer has no boundaries. In just four years, we have provided wigs to over 475 women in 47 states.”

Other FAQs

Why does chemotherapy cause my hair to fall out?

Does every chemotherapy cause hair loss?

Chemotherapy is known to cause hair loss but it depends on a number of factors:

• which chemo drug
• dosage
• frequency of chemo
• how the chemo is given

Be sure to ask your doctor and/or nurse about your chemotherapy regimen and whether it’s known to cause hair loss. 

Does chemo cause eyelashes and other body hair to fall out?

The hair on the head tends to fall out more quickly than the other areas during chemotherapy. However, depending on which cancer treatment you undergo, you may experience hair loss on other parts of your body, including but not limited to:

• armpit
• leg hair
• pubic
• eyebrows
• eyelashes
• arm hair
• armpit

For Keyla Scrogham, who was diagnosed with non-Hodgkin lymphoma, the loss of the eyelashes and eyebrows bothered her most:

The hair loss on my face was more difficult because I have always had very thick eyelashes and eyebrows so I didn’t enjoy that by any means, but they start to grow back between each cycle so I know they’ll come back quickly. It’s definitely nice not having to shave my legs though!

Can other cancer treatments cause hair loss?

Radiation therapy that targets the head may lead to hair loss. It’s possible depending on the dose of radiation that the hair may grow back differently.

Does it hurt when hair starts to fall out?

Your hair follicles may become “inflamed” from the chemo so depending on how sensitive the scalp is, there may be some pain.

Our The Patient Story contributors have a mixed response, but more than not have described feeling some sensation on their scalp when the hair begins to fall out.

Arielle, who was diagnosed with non-Hodgkin lymphoma, said it hurt when her hair began to fall out in this response:

Your scalp hurts. At least for me it did. It was so painful. So I had very very white-gray hair naturally, now it’s a bit darker grown back in, but you could see the red of my scalp and I just wanted it off. It was painful. No one tells you that. In the medical system no one tells you that because it’s not “important.”

What’s important is curing you of cancer but what’s important to us as cancer patients, as the person who is dealing with it is to know how to navigate all those pieces of the puzzle.

And to be able to anticipate some of it. This may not happen to you but I wanted to give you a head’s up.

How does the hair loss impact you personally?

There was a range of response in terms of how our The Patient Story community members were impacted by the hair loss. Most said they were emotionally drained by the prospect of losing their hair and that anxiety or fear of being bald was because it made them “look sick.”

However, they also said they were relieved to shave it all off. For some, it felt like taking back some control in their lives. 

Real patient stories of hair loss during chemo

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References:

1. Hair Loss (alopecia). National Cancer Institute. https://www.cancer.gov/about-cancer/treatment/side-effects/hair-loss. Accessed Aug. 9, 2018.
2. Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer. Journal of the American Medical Association (JAMA). Accessed Aug. 6, 2018.
3. What to Do About Hair Loss (alopecia). National Cancer Institute. https://www.cancer.gov/publications/patient-education/radiation-side-effects. Accessed Aug. 10, 2018.
4. Chemotherapy-Induced Hair Loss (Alopecia). Journal of the American Medical Association (JAMA). https://jamanetwork.com/journals/jamaoncology/fullarticle/2628766
5. Chemotherapy and Hair Loss. MD Anderson Cancer Center. https://www.mdanderson.org/patients-family/diagnosis-treatment/emotional-physical-effects/hair-loss.html. Accessed Aug. 10, 2018.
6. Preventing Hair Loss During Chemotherapy is Now Possible, but Insurance Coverage is Inconsistent. https://www.forbes.com/sites/victoriaforster/2018/08/08/preventing-hair-loss-during-chemotherapy-is-now-possible-but-insurance-coverage-is-inconsistent/#47f8e8f77473. Accessed Aug. 10, 2018.

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