Cancer treatments such as chemotherapy and radiotherapy can make your hair fall out. There are many ways of dealing with this. You may not mind your bald head, but if you do want to cover up there are many types of wigs or hairpieces, hats, turbans, or scarves that you can use.

Chemotherapy is a treatment which uses anti-cancer drugs to destroy cancer cells. The drugs work by attacking the cancer cells and disrupting their growth. Unfortunately, they can also affect the normal cells in the body, including the cells of the hair follicles. This causes hair loss, also known as alopecia. Unlike cancer cells, however, the normal cells quickly recover, so if you lose your hair due to chemotherapy it will grow back when your treatment is over. Before you start chemotherapy, your doctor or chemotherapy nurse will discuss the possibility of hair loss and other side effects with you.

Not all chemotherapy drugs make your hair fall out, and sometimes the loss is so small it is hardly noticeable. Some people, however, have temporary, partial or complete baldness. Some chemotherapy drugs make other body hair fall out, such as eyebrows, eyelashes, beard, moustache, chest, underarm, leg and pubic hair. The amount of hair that falls out, if any, depends on the drug or combination of drugs used, the dosage given and the way that your body reacts to the drug.

"Think of the joy of several months free of the chore of waxing or shaving your legs, underarm or bikini line."

If your hair is going to fall out, it usually starts within a few weeks of starting the chemotherapy, although very occasionally it can start within a few days. The first thing you may notice is that your hair starts to come out when you brush, comb or wash it. You may also find hair on your pillow in the morning. We offer advice about looking after your hair during this time.

For some people their hair may just thin and become dry and break easily. For other people the hair may carry on falling out over a couple of weeks so that they become completely bald. Sometimes the hair comes out very quickly over 1–2 days, which can be very shocking. Your scalp may feel tender or sore as the hair falls out.

Preventing hair loss during chemotherapy

By cooling the scalp it is sometimes possible to reduce the amounts of chemotherapy drugs that reach the hair follicles. This reduces, and in some cases prevents, the hair from falling out. It is done by using a 'cold cap' or a machine which cools the scalp. There are many different ways of cooling the scalp so the methods used vary from one hospital to another. Some hospitals do not have facilities for scalp cooling.

Types of scalp cooling

Some commercially made 'cool caps' contain a gel that stays cold for a long period of time. The caps can be applied easily and kept in place by Velcro. Usually the cold cap needs to be worn for some time before the chemotherapy drugs are given. It is worn while the treatment is given and then for up to two hours afterwards. The cap can be very uncomfortable and heavy and may give you a headache. However, the chemotherapy staff will do all they can to make you as comfortable as possible. Some types of scalp cooling use a machine (like a commercial hair dryer) that circulates a coolant through the cap.

Unfortunately cold caps are only effective when used with certain chemotherapy drugs. Also they may not be advisable when treating some types of cancer. Your doctor or chemotherapy nurse will be able to tell you if scalp cooling is available and whether it is appropriate for you.

How will my hair grow back after chemotherapy?

Your hair may begin to grow back before you finish your treatment. At first the hair is very fine but you will probably have a full head of hair after 3–6 months. You may find that your new hair is curlier or finer than it was before. It may also be a slightly different colour, or sometimes a mixture of dark and grey hair.

Very rarely, after high doses of chemotherapy the hair does not grow back, but this is unusual.

Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to normal cells.

Unlike chemotherapy, radiotherapy causes hair loss only in the area being treated. For example, if you have radiotherapy to your head, you will probably lose some hair from your scalp in the area where the radiotherapy beam goes into and out of your scalp. If you are having treatment for breast cancer, and the radiotherapy includes your armpit, the hair under your arm is likely to fall out.

Will my hair grow back after radiotherapy?

Your hair is likely to grow back after radiotherapy, although it may not be as thick as it was before. The time it takes to grow back depends on the amount of radiotherapy that you have had and the length of your treatment. On average it takes 6–12 months for your hair to grow back after you have finished your treatment.

Some people have permanent hair loss after radiotherapy, or find that the hair that grows back is patchy. If you have patchy hair loss on your head you may want to continue wearing a wig or some other type of headwear. You can also consider hair weaving. Your doctor or radiographer will discuss the possibility of permanent hair loss, and other side effects, with you before you start your treatment.

Other types of cancer treatment including hormonal therapies or biological therapies can sometimes make your hair thinner or dry and brittle.

Your doctor, specialist nurse, or the nurses at Cancerbackup can let you know whether any treatment you are having is likely to affect your hair.