5 Things to Do If You Fear Hair Loss From Chemo

Patient Expert

You've been diagnosed with breast cancer. Your oncologist says you need chemo. Your first thought? "I'm going to go bald!" Well, possibly not; and being prepared for hair loss, both practically and emotionally, is your best antidote to fear and depression.

1. Find out if hair loss is a side effect of the drugs you're taking.

Some of the chemotherapy drugs prescribed for breast cancer are almost guaranteed to make you bald. Adriamycin, for example, causes complete hair loss, at least on top of your head; you may keep your eyebrows and eyelashes.

Methotrexate, on the other hand, is a lot gentler to your hair; while you may suffer some thinning, chances are you won't lose your hair completely.

How do you know if the specific drugs you're receiving will make you bald? Well, you can't know for sure; we all have our own personal reaction to chemo. But ask your doctor for a complete list of the known side effects of your chemo drugs; this will at least give you a starting point.

In addition, our chemotherapy regimens for breast cancer explores some of the most common chemo combinations, including their side effects.

2. Ask your doctor about cold caps.

A new therapy that battles hair loss is gradually spreading throughout the medical community. The “cold cap” is a tight-fitting cap (think something between a bike helmet and a bathing cap) cooled to -25°F and worn during the administration of chemo. The extreme cold limits blood flow to the scalp, thus preventing the chemo drugs from reaching your hair follicles – which means your hair remains healthy and happy.

As with many new therapies, you may find that your local hospital or cancer center doesn't yet have the required equipment to implement this treatment. But it doesn't hurt to ask your doctor about it; you may be happily surprised.

3. Cut off a substantial lock of your hair and save it.

Even when your hair grows back, it's unlikely it'll ever regain its original color, thickness, and/or healthy appearance.

Many women find their hair grows back straight, when it had been curly; or curly if it had originally been straight. Some women go completely gray; others find their new hair is much darker (or lighter) than it used to be.

The point is, if you lose your hair you have no idea what your new hair will eventually look like.  So it's comforting to keep a piece of your original hair: both for comparison's sake, and simply as a memento of your life before cancer.

4. Consider getting a "chemo cut."

Unless you currently have a very short haircut, think about getting your hair cut short before it all falls out – particularly if you're taking a drug that just about guarantees hair loss.

Most women report losing their hair three to four weeks after their first chemo treatment. If your hair is currently long and lustrous, getting a cute, short cut sometime during those weeks lessens the eventual shock of great handfuls of hair coming out in the shower, or on your hairbrush.

Ask the folks where you're being treated if they know of any local hair salon specializing in "chemo cuts." There may even be a stylist at the hospital you can access. Emotionally, it helps to get your hair cut by someone who knows why you're getting a trim, and the pain you're going through as a result.

5. Decide how you'll deal with the practical aspects of being bald.

OK, you're assuming you'll lose most if not all of your hair. That means you're going to look very different. Decide now how you'll approach this new look.

Many women decide to wear a wig, since it's the best cover up. Wigs these days look great, and you can have them fashioned to look like your current hairstyle. Ask a nurse or social worker about hair-loss services available at your hospital.

Other women don't enjoy the potential discomfort of a wig; hairpieces can be both hot and itchy. A head scarf or hat is usually the more comfortable way to go, although they make it much more obvious you've lost your hair.

Some women simply decide that "bald is beautiful!" This is what I did, after continually running into doorjambs as a result of wearing a baseball cap indoors.

I eschewed a wig, shucked my hat, and simply went au naturel.

Luckily, my colleagues at work were very understanding and relaxed about seeing my bald head every day. But if you're in an "uptight" work force, you might first want to speak with your HR folks and get their input about the best way to spring this new look on your colleagues.


The American Cancer Society's TLC Web site offers a wide array of wigs, hats, scarves, and other hair-loss products.

In addition, most large hospitals and cancer centers have cancer "boutiques" where women can try on wigs, be fitted for a new bra, and shop for breast prostheses, special swimwear, and other breast cancer related products.

See more helpful articles:

Chemotherapy Regimens for Breast Cancer

So You’re Having Chemo...

New Therapy May Prevent Hair Loss Due to Chemo

Chemotherapy: Is It Always the Best Choice?

Getting Ready for Your Hair to Fall Out

Breast cancer survivor and award-winning author PJ Hamel, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.