Hair Loss or Alopecia

Approved by the Cancer.Net Editorial Board, 09/2023

Hair loss is a common side effect of many cancer treatments. This is because the cancer treatments can harm the healthy cells that help hair grow. The medical term for hair loss is alopecia.

It is a common misconception that all cancer treatments cause hair loss. Whether or not your hair is affected by cancer treatment depends on the type of treatment and the dose. Before you begin treatment, ask your doctor if the recommended treatment plan can cause changes to your hair.

Cancer treatments can cause hair to fall out completely, change texture and appearance, or get thinner. It can affect hair all over your body, including your head, face, arms, legs, underarms, and pubic area. Lost hair usually grows back after treatment ends, but it may not grow back the same as it was. For example, it can grow back thinner or with a different texture than you had before. Hair changes, such as thickness and texture, may or may not be permanent.

Changes to your hair and hair loss during cancer treatment can be challenging. You may feel like you do not look like yourself. Managing side effects like hair loss and the emotions that come with it are an important part of cancer care and treatment. This is called palliative and supportive care. Talk with your health care team about how you can cope with treatment-related hair loss.

What causes hair loss when you have cancer?

Most commonly, hair loss is caused by certain types of chemotherapy and radiation therapy to certain areas of the body. But other treatments, such as targeted therapy, immunotherapy, hormone therapy, and a bone marrow (stem cell) transplant can also cause hair loss and hair changes. There can also be other reasons for hair loss or hair changes, such as thyroid problems or low iron levels.

Chemotherapy. Chemotherapy is the most common cause of hair loss during cancer treatment. This is because chemotherapy is a systemic treatment, meaning it affects the whole body. Chemotherapy impacts cells that grow quickly, like cancer cells. But this also affects healthy hair cells.

Not all types of chemotherapy cause hair loss. There are many types of chemotherapy that do not affect your hair and others that cause other changes to your hair, like hair thinning.

How much hair you lose depends on which chemotherapy you are given and the dose. It also depends on whether you get your chemotherapy as a pill, through an IV, or on the skin. The amount of hair loss also varies from person to person. You and someone else taking the same drug for the same cancer can still lose different amounts of hair.

Hair does not usually fall out as soon as you start chemotherapy. It usually takes several weeks or cycles of treatment and tends to fall out 1 or 2 months into treatment.

Learn more about the side effects of chemotherapy.

Radiation therapy. Radiation therapy only affects the hair on the part of the body were the radiation is aimed. For example, if you have radiation therapy to the pelvis, you could lose pubic hair. Hair loss depends on the dose and method of radiation therapy. It usually grows back after several months, but it may be thinner or a different texture. With very high doses of radiation therapy, hair may not grow back. Learn more about the side effects of radiation therapy.

Immunotherapy and targeted therapy. Immunotherapy and targeted therapy do not usually cause complete hair loss. But many of these treatments can cause hair to become thinner, curlier, or drier than usual. Learn more about the side effects of immunotherapy.

Hormonal therapy. Sometimes, hormonal therapy for cancer can cause your hair to thin. This may happen several months to years after starting the treatment. Hormonal therapy does not usually cause complete hair loss. Learn more about the side effects of hormone therapy.

Does hair grow back after cancer treatment?

Most of the time, hair grows back after cancer treatment ends. For example, hair usually starts to grow back 1 to 3 months after chemotherapy ends. It often takes 6 to 12 months to grow back completely. It may grow back thinner, coarser, curly, or a different color. Hair usually goes back to normal over time. However, sometimes hair changes caused by cancer treatment are permanent. This includes hair loss.

People who take a type of chemotherapy treatment called taxanes, which includes the drugs paclitaxel (Taxol) and docetaxel (Taxotere), may be more likely to experience hair loss that lasts longer than 6 months after treatment ends. Black people may also be at a higher risk of hair loss that lasts longer than 6 months after treatment ends. Permanent patchy hair loss has also rarely been reported.

Coping with hair loss related to cancer treatment

Losing your hair can cause more than a change in your physical appearance. It can be an emotional challenge that affects your self-image and quality of life. It is important to be kind to yourself during this stressful time.

People feel differently and cope with hair loss in different ways. Thinking about how you feel most comfortable in managing hair loss before, during, and after treatment may help. And, your choices may change over time.

Talking about your feelings with a counselor, a family member, or a friend may provide comfort. It may also be helpful to connect with other people who have experienced hair loss, such as through an online support group, and find out what worked best for them in coping with it.
It may be helpful to prepare your family and friends about you possibly losing hair. This is especially true for children. They may feel less fearful and anxious if the change in your appearance is something they expect. This, in turn, can help you feel better.
You may choose to cut your hair shorter. A shorter hairstyle may make thin hair look fuller. Any hair loss may also look less dramatic. And when your hair starts growing back, it takes less time to grow into the shorter hairstyle.
Some people decide to shave their head in advance or once hair loss begins. This can help wigs or other head coverings fit better. Hairdressers can help with this.
If you want to wear a scarf, hat, or other head coverings, get some of those items in advance. This can make you feel more prepared for when hair loss starts happening. Select those made from soft materials that don't itch. It may be helpful to have items in both lighter and heavier materials, for your comfort and different temperatures.
Some people choose to not cover their thinning hair or bald head, finding it more comfortable or easier to manage in daily life.

Can hair loss related to cancer treatment be prevented?

It may be possible to prevent hair loss or hair thinning related to cancer treatment. Talk to your health care team about your options. These may include:

Scalp cooling. Wearing a cap that cools the scalp can help prevent hair loss from drugs given through a vein. This treatment is called scalp cryotherapy, cold cap therapy, and scalp hypothermia. You wear the cap before, during, and after chemotherapy.

The cold makes the blood vessels in the skin of your head narrower. Less blood and less of the chemotherapy reaches your hair follicles through the blood vessels. Keeping your scalp very cold also helps prevent damage to the hair follicles.

Scalp cooling is currently approved for people of any age being treated with chemotherapy for most cancers. However, it is not recommended for people with leukemia or some other blood-related cancers. People with any hair type can use scalp cooling. However, there is less research about how well scalp cooling works with tightly curled Afro-textured hair. Learn more about scalp cooling.

Medications. An over-the-counter topical medication called minoxidil may help thinning hair from hormonal therapy or targeted therapy. It may also help if your hair does not grow back completely after chemotherapy, radiation therapy, or a bone marrow (stem cell) transplant.

There are also prescription medications you can take by mouth. These include spironolactone (Aldactone) and finasteride (Propecia, Proscar).

If your hair is thinning during cancer treatment but the cause is unclear, your doctor may look for other causes, such as low blood counts, vitamin deficiencies, and hormonal imbalances.

Tips for caring for your hair and scalp during cancer treatment

Here are some tips for how to take care of your hair and scalp while you are receiving cancer treatment:

Choose a gentle, fragrance-free shampoo. Avoid washing your hair every day. Wash gently. If your hair tangles, consider using products like a gentle conditioner or detangler spray.
Pat your hair dry to prevent damage. Avoid pulling on your hair as much as possible. Style it gently with a soft brush or wide-toothed comb.
When outdoors, use sun protection on your scalp, such as sunscreen, a hat, or a scarf.
Avoid high-heat styling, chemical curling or straightening, and permanent or semi-permanent hair color.
Choose a soft, smooth pillowcase.
Talk with your health care team if you are interested in taking biotin, a type of B vitamin.

Talk with your health care team before using any products, including creams or lotions, that claim to help hair grow back.

Using wigs and hairpieces

You may choose to wear a wig or hairpiece when you start losing your hair. Here are some tips that might help.

Try finding a shop that sells wigs and hairpieces specifically for people with cancer. You might also schedule a home appointment or order through a catalog.
Have your wig or hairpiece fitted properly. This will help keep it from irritating your scalp.
If you want one that looks like your natural hair, it's best to choose a wig or hairpiece before your hair falls out. Or you may want a wig or hairpiece in a different style or color you have always wanted to try. A hairdresser can help you style the wig or hairpiece.
Check with your health insurance company, to see if your insurance plan covers the cost of a wig or hairpiece. Wigs and hairpieces may also be classified as a tax-deductible medical expense. Your doctor may have to write a prescription for a wig or hairpiece so you can submit it to your insurance company.
Free or loaner wigs or hairpieces may be available through your cancer center or other community organizations. Ask an oncology social worker or your nurse for resources.

Caring for hair that grows back after cancer treatment

When your hair begins to grow back, it may be much thinner and more easily damaged than your original hair. It may also be a different texture or color. The following tips may help you take care of the hair that grows back. You can also ask your hairdresser for suggestions.

Limit hair washing to 2 times a week.
Massage your scalp gently to remove dry skin and flakes.
Use a wide-tooth come instead of a brush for your hair. When styling your hair, limit the amount of pinning, curling, or blow-drying with high heat.
Avoid permanent or semi-permanent hair color for at least 3 months after treatment ends.
Avoid curling or straightening your hair with chemical products such as permanent wave solutions until it grows back. You may need to wait up to a year before you can chemically curl or straighten your hair. Before trying chemical products again, test a small patch of hair to see how it reacts.
Avoid weaves, braids, or extensions until your hair has time to grow. It is generally recommended to wait until there is 2 to 4 inches of new hair.

Questions to ask the health care team

You may want to ask your cancer care team the following questions about hair loss.

Is my specific cancer treatment plan likely to cause hair loss?
If so, when will my hair loss happen? Will I lose hair over time or all at once?
How should I care for my hair and scalp during hair loss?
When will my hair grow back? What can I expect when my hair does return?
Is there a counselor, oncology social worker, or other team member who can help me cope with this hair loss?
Are there any programs that provide free or low-cost wigs or other head coverings?