Breast cancer and hair loss

Treatment-related hair loss happens for different reasons. Chemotherapy kills rapidly dividing cells, including hair cells. Hormonal therapies block or lower estrogen, and that can cause hair thinning for some people. Radiation therapy can cause hair loss in the area receiving radiation.

It’s important to know that hair loss doesn’t happen to every person with every treatment, and the hair loss people experience from breast cancer treatments is almost always temporary.

Breast cancer treatments & hair loss

Different treatments can cause hair thinning or loss in different ways:

Chemotherapy

Chemotherapy kills quickly dividing cells, such as cancer cells. But some healthy cells also divide quickly. Hair follicles, for instance, are among the most quickly growing cells in the body, so they are more likely to be affected by chemotherapy. How a chemotherapy drug affects hair often depends on the drug. Not all chemotherapies cause total hair loss. Some cause the hair to thin; others will only barely affect hair. Some chemotherapies affect hair all over the body, such as eyebrows, eyelashes, and pubic hair. The timing and dose of the chemotherapy can also be a factor in how your hair will be affected. Ask your doctor about what you can expect from the recommended chemotherapy and treatment schedule.

For some people, hair may start to grow back during treatment. Usually, hair starts to grow back one to three months after chemotherapy ends. It could be a different color or texture than it was before. Sometimes it stays that way. In other cases, hair returns to exactly the way it was before treatment.

It’s important to know that permanent hair loss is not usually a chemotherapy side effect, but it does happen. The taxane chemotherapies docetaxel (Taxotere) and paclitaxel (Taxol) have been reported to cause permanent hair loss for some people. Research shows that this is more likely with docetaxel. Research has also shown that scalp cooling can reduce the risk of temporary and permanent hair loss for people undergoing chemotherapy, including taxane chemotherapy. If chemotherapy is part of your treatment plan, ask your doctor if there’s an option that does not have a risk of causing permanent hair loss. You may also want to ask about scalp cooling resources, and connect with others who’ve undergone chemotherapy to learn about their experiences.

Hormonal therapy

Hormonal therapy treatments can cause mild to moderate hair loss or thinning because they reduce or block estrogen, which helps hair to grow. Hormonal therapy includes:

• Aromatase inhibitors, tamoxifen, and fulvestrant (Faslodex)
• Ovarian suppression medicines such as goserelin (Zoladex) and leuprolide (Lupron)
• Oophorectomy (surgical removal of the ovaries) for premenopausal women at high risk of developing breast and ovarian cancer because of a BRCA1 or BRCA2 genetic mutation

Hair loss or thinning from hormonal therapy is not as significant as it can be with chemotherapy. With most hormonal therapy medicines, the impact on your hair will continue as long as you are taking the medicine. Hormonal therapy combined with the stress of a breast cancer diagnosis can affect the degree of hair thinning or loss. Not getting enough nutrients, as well as family history and genetic predisposition to hair thinning, can also have an impact.

There are medicines that can help treat hair thinning and loss caused by hormonal therapy and other treatments. Ask your doctor if there are safe options for you. You can also ask about whether your cancer center has a dietician on staff to make sure you’re getting the nutrients that support hair growth.

Targeted therapy

Targeted therapy for breast cancer do not cause complete hair loss, but they may cause hair to become thinner, curlier, or drier than usual. As with other drugs, you can expect the effect on your hair to last for the time that you take the drug. Not all targeted therapies cause hair thinning or hair loss. Targeted therapies that may cause hair loss include medicines such as pertuzumab (Perjeta), lapatinib (Tykerb), palbociclib (Ibrance), ribociclib (Kisqali), alpelisib (Piqray), talazoparib (Talzenna), and abemaciclib (Verzenio). If targeted therapy is part of your treatment plan, ask your doctor if the therapy being recommended for you causes hair loss.

Immunotherapy

Immunotherapy uses the body’s own defense system to fight cancer. The immunotherapy drug pembrolizumab (Keytruda) can cause areas of hair loss. This can happen many weeks to three months after beginning treatment. These effects usually last for the time you are taking the drug.

Radiation therapy

Radiation therapy directs high-energy x-rays to a specific part of the body to kill cancer cells. While chemotherapy can sometimes cause hair loss all over the body, radiation therapy causes hair loss only on the specific part of the body that is being treated. If the radiation is being directed to the breast area, for example, you won’t lose hair on your head. If radiation is being directed at lymph nodes under your arm, you may temporarily lose underarm hair.

Wherever radiation is being directed, if hair loss happens, it can begin about two to three weeks after your first session. Hair usually grows back in three to six months. If the radiation is delivered in high doses, it’s possible that hair regrowth to the area may be thinner, or that it may not return, after radiation is finished. Talk with your doctor about how radiation therapy may impact the hair on the area of treatment.

What are the symptoms of hair loss?

Hair loss will not hurt, although you may feel some scalp tenderness before hair falls out. If you are being treated with a chemotherapy drug that causes significant hair loss, such as doxorubicin (Adriamycin), hair usually falls out two to four weeks after beginning treatment. With other chemotherapy drugs, hair may not fall out until one or two months into treatment. Different chemotherapies, and schedules for receiving it, will affect this timetable. Ask your doctor what to expect for your particular situation.

When hair begins to fall out, you may lose hair in the shower or notice clumps of hair on your pillow or in your comb or brush. For many people, chemotherapy causes hair to fall out at the center or crown of the head first, and hair on the sides of your head may not fall out until later. All your body hair, including your eyelashes, eyebrows, and pubic hair, may eventually be affected.

Hair thinning or loss caused by hormonal therapy happens differently than it can with chemotherapy. It’s usually milder and tends to affect the front of the hairline, and sometimes the crown of the head.

If you are being treated with immunotherapy or targeted therapy, talk with your care team about what to expect with hair thinning, as symptoms can vary depending on the specific treatment.

Managing hair loss

The first step in managing hair thinning or hair loss is to understand how likely it is with your treatment plan. Here are some questions you can ask your care team:

• Does the treatment you are recommending cause hair thinning or hair loss?
• How much hair loss occurs with this treatment?
• What can I do to reduce or manage hair loss?
• When does hair loss typically happen with this treatment?
• When should I expect my hair to grow back?

If your treatment causes hair thinning or loss, it’s important to do what feels best to you, helps you feel confident, and makes you comfortable. With the total hair loss that can happen as a result of some chemotherapies, many people find it empowering to shave their heads, or cut their hair very short, before it falls out. Others may wait until a lot of hair has fallen out before cutting or shaving it. Gradually cutting hair shorter over the course of a few days or weeks helps some people ease into the idea of having no hair.

Here are some ways to be gentle to your hair during cancer treatment:

• Use mild shampoo
• Use soft-bristle hairbrushes
• Use low heat if you use a hair dryer
• Avoid using brush rollers
• Avoid dyeing or perming your hair
• Use a satin pillowcase

If you choose to cover your head when hair falls out, you may want to explore your options ahead of time. You can choose a wig that resembles your natural hair or one that gives you a new look. Other options include hats, caps, or scarves. Many women alternate between all of these.

Heat escapes from the tops of our heads. Without hair, you may feel chilly at times. If you don’t want to cover your head, it is perfectly fine to go bald — just remember to use sunscreen, and have a hat on hand to make sure you’re warm enough.

You may have heard of scalp cooling, a therapy that helps some people keep some or all of their hair during chemotherapy. Scalp cooling involves wearing a cooled headpiece during chemotherapy sessions. Since you’re lowering the temperature of your hair follicles and scalp, the blood flow to the area is slowed. As a result, hair follicles are less exposed to the chemotherapy medicines.

There are two available scalp cooling methods:

• Refrigerated, machine-based scalp cooling systems that keep the cap cold during your treatment session
• Cold caps kept in a cooler on dry ice

Research shows that scalp cooling helps some people keep their hair throughout chemotherapy. Learn more about scalp cooling.

Some research has shown that minoxidil (often sold as Rogaine) can help hair grow back faster after chemotherapy. If you’re interested in trying minoxidil, ask your doctor to confirm that it will be safe for you.

While you may hear about some women using hormone replacement therapy (HRT) to help with hair thinning related to reduced hormone levels, HRT has been shown to increase the risk of breast cancer and is not recommended for people who’ve been diagnosed.

Managing ongoing hair thinning

If you’re facing ongoing treatment, or your hair has not recovered from treatment, it may make sense to see a dermatologist. Some cancer centers have specialists called oncodermatologists who focus on treatment-related changes to the hair, nails, and skin. Even if your hospital does not have an oncodermatologist, most dermatology specialists will understand some of these issues. Ask your oncologist for a referral to a dermatologist who has experience working with hair loss related to cancer treatment. Share the dermatologist’s recommendations with your doctor to make sure they are safe for you.

Dealing with the emotional impact of hair loss

Hair loss can be upsetting for anyone of any gender. If your hair means a lot to you, losing it can be painful. Even if you’ve never felt that your hair was an important part of who you are, losing it can still be distressing.

Hair loss also makes the issue of having cancer more public. For many people, it can bring up feelings of vulnerability and unwanted exposure.

If emotions about hair loss are interfering with your daily life, it can help talk to a mental health professional. Ask your healthcare team to recommend a licensed professional counselor or therapist who specializes in helping women with breast cancer. In-person support groups or online communities may also bring you comfort. It can be reassuring to meet others who know what it’s like, and to know you’re not alone.

Visit these pages to learn more about supportive resources:

• Where to find breast cancer support
• Methods of self-care to deal with stress and anxiety