Hair Loss


Hair loss or thinning is a potential side effect of some breast cancer treatments, including certain types of:

  • chemotherapy
  • hormonal therapy
  • targeted therapy
  • immunotherapy
  • radiation therapy

Different treatments can cause very different types and amounts of hair loss (which doctors call “alopecia”). In most cases, hair grows back after treatment is finished. But some people may experience longer term or permanent hair loss or thinning.

Whether hair loss is mild or more severe, it can be traumatic. Like many people, you might feel that the hair on your head is a big part of your identity. Losing it can make you feel self-conscious and exposed. You might assume that your hair loss signals to everyone that you’re a cancer patient.

It may help to know that there are steps you can take to help prevent treatment-related hair loss, promote hair regrowth, make the experience of hair loss a little less stressful, and feel more confident about your appearance. One thing that can make hair loss easier is knowing what to expect. Ask your doctors if the treatments you’ll be receiving are likely to cause hair loss, to what degree, and when it may occur.


Chemotherapy and Hair Loss

Certain chemotherapy medicines used to treat breast cancer can cause the hair on your head to become thin or to fall out completely. Some chemotherapy medicines can also cause hair loss on other parts of your body, such as your eyebrows and eyelashes, pubic hair, and hair on your legs, arms, or underarms.

Whether you lose your hair and how much you lose depends on a variety of factors. This includes the type, combination, and dose of chemotherapy medicines you get, as well as other medical conditions (such as thyroid disease), nutrition status, and stress. The timing of chemotherapy treatments also affects hair loss. Some types of chemotherapy are given weekly and in small doses, which may minimize hair loss. Other types of chemotherapy are scheduled every 3 to 4 weeks in higher doses and may be more likely to cause more hair loss.

Talk with your doctors before chemotherapy begins so you know what to expect in your individual situation. If you find out that you will be receiving chemotherapy medicines that are likely to cause hair loss, you may want to look into the possibility of using a scalp cooling system or manual cold caps during your infusion sessions to help limit the amount of hair you lose. Read more about preventing hair loss with Cold Caps and Scalp Cooling Systems.

Some of the chemotherapy medicines used to treat breast cancer that can cause hair loss are:

  • Taxane chemotherapy medicines, including Taxol (chemical name: paclitaxel), Taxotere (chemical name: docetaxel), and Abraxane (chemical name: albumin-bound or nab-paclitaxel)
  • Anthracycline chemotherapy medicines, including Adriamycin (chemical name: doxorubicin), Doxil (chemical name: liposomal doxorubicin), and Ellence (chemical name: epirubicin)
  • Cytoxan (chemical name: cyclophosphamide)

Why does chemotherapy cause hair loss?

The reason chemotherapy can cause hair loss is that it targets all rapidly dividing cells — healthy cells as well as cancer cells. Hair follicles, the structures in the skin from which hair grows, include some of the fastest-growing cells in the body. If you’re not in cancer treatment, cells in your hair follicles divide every 23 to 72 hours. But as chemotherapy does its work against cancer cells, it also damages hair follicle cells. Within a few weeks of starting certain chemotherapy medicines, you may lose some or all of your hair. The hair loss can happen gradually or fairly quickly.

When does hair grow back after chemotherapy?

How long it takes for the hair on your head to grow back after chemotherapy (and other body hair, such as pubic hair, eyelashes, and eyebrows if you lost those, too) varies a lot from person to person. Here’s a typical timetable for hair regrowth on the head:

  • 3–4 weeks after chemotherapy ends: soft fuzz
  • 1 month to 6 weeks after: real hair starts to grow
  • 2–3 months after: about an inch of hair
  • 3–6 months: about 2–3 inches of hair
  • 12 months: 4–6 inches of hair

The hair on your head may be a different color, texture, or volume when it grows back. If you were dyeing or chemically treating your hair before you started chemotherapy, you might be surprised to see what your natural hair looks like when it grows back. In many cases, hair eventually returns to the way it used to be after the effect of chemotherapy on the hair follicle wears off. But some people have incomplete hair regrowth. And sometimes permanent baldness and loss of eyebrows and eyelashes can occur, particularly in people who received Taxotere.


Hormonal therapy and hair loss

Some hormonal therapies used to treat breast cancer can cause mild to moderate hair loss, or hair thinning, often at the frontal hairline, the middle part, or the crown of the head. These medicines include:

  • tamoxifen, a selective estrogen receptor modulator (SERM)
  • Faslodex (chemical name: fulvestrant), an estrogen receptor downregulator (ERD)
  • Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), and Femara (chemical name: letrozole), which are called aromatase inhibitors (AIs)

Hormonal therapies work either by lowering estrogen levels or by blocking the effects of estrogen in breast tissue. Researchers don’t know exactly why hormonal therapies cause hair loss, but by lowering estrogen levels they reduce the growth of hair follicles.

If you experience hair loss as a side effect of hormonal therapy, it may take between 6 months and 2 years before you notice it. Often the hair loss will level off after the first year or so. But the thinning will last as long as you keep taking the medicine, which is often from 5 to 10 years. Hair will usually start growing back a few months after you stop taking hormonal therapy.


Targeted therapy and immunotherapy and hair loss

Some targeted therapies that are used to treat breast cancer can cause changes to the texture and color of your hair, or hair loss that is usually mild. These include:

  • Ibrance (chemical name: palbociclib)
  • Kisqali (chemical name: ribociclib)
  • Perjeta (chemical name: pertuzumab)
  • Piqray (chemical name: alpelisib)
  • Talzenna (chemical name: talazoparib)
  • Verzenio (chemical name: abemaciclib)

If you experience some hair loss, it is likely to start soon after you start taking the targeted therapy. Your hair probably won’t start growing back until several months after you stop taking the medicine. Taking an aromatase inhibitor (Arimidex, Aromasin, or Femara) and certain targeted therapies at the same time increases the risk that you’ll develop hair loss.

Immunotherapy generally doesn’t cause hair loss, but hair loss has occurred in a small percentage of the people who take the immunotherapy Tecentriq (chemical name: atezolizumab).


Radiation treatment and hair loss

Radiation therapy uses a high-energy beam to damage quickly growing cells in your body. The goal is to target cancer cells, but some normal cells (including those of the hair follicles) get damaged as well.

Radiation only causes hair loss on the particular part of the body treated. If radiation is used to treat the breast, there is no hair loss on your head. But there might be loss of hair around the nipple, if you have hair there.

Radiation to the brain, used to treat breast cancer that has spread (metastasized) to the brain, can cause hair loss on your head. Depending on the dose of radiation, your hair may be patchier when it grows back or it may not grow back.


How to prevent and manage hair loss

If you’re receiving treatment for breast cancer that can cause hair loss, it’s important to know you have options. Below, you can learn about ways to prevent and manage hair loss as a side effect of breast cancer treatments.


Managing Hair Loss From Chemotherapy

If chemotherapy medicines that will cause hair loss are part of your breast cancer treatment plan, there are steps you can take to prepare, possibly lessen hair loss, and protect your hair as it grows back.

  • Cold Caps and Scalp Cooling Systems: Cold caps and scalp cooling systems are tightly fitting hat-like devices filled with a cold gel or liquid coolant. Cold caps and scalp cooling systems have helped many people keep some or quite a bit of their hair during chemotherapy.
  • Wigs: Many people find that wearing a wig is a good solution for them if they experience hair loss from breast cancer treatment. A wig can provide a sense of normalcy, consistency, and privacy during cancer treatment. Experimenting with different wig styles and colors can also be quite fun! Not sure if a wig is right for you or where to begin looking for one? Forge can help. Give our Client Services Coordinator, Janet Dees, a call at (205) 990-5367 or [email protected].
  • Scarves, Hats, and Turbans: Many people find that scarves and hats are the easiest, most comfortable, and versatile solution for managing hair loss from breast cancer treatment. Scarves and hats can hide your hair loss, help keep you warm, protect you from the sun, and they can be stylish and fun to wear.


Managing ongoing hair thinning

Breast cancer treatments such as hormonal therapy, targeted therapy, and chemotherapy can cause some people to have ongoing mild to moderate hair loss. If you’re concerned that your hair isn’t growing back or is noticeably thinner than in the past, it’s a good idea to see a dermatologist. If possible, seek out one who specializes in hair loss or an “onco-dermatologist” who focuses on problems with the hair, skin, and nails that can develop during cancer treatment. The dermatologist will order blood tests to check whether there are other reasons for your hair loss besides the effects of breast cancer treatments. Thyroid problems, nutritional deficiencies, and other factors can play a role in hair loss.

For mild to moderate hair loss, dermatologists often recommend Rogaine (chemical name: minoxidil), an over-the-counter medication that promotes hair growth. It’s safe for people with a history of breast cancer and moderately effective. But check with your oncologist before you start using minoxidil. In most cases, you can use it while you take hormonal therapy or targeted therapy, but not during chemotherapy treatment. Look for products labeled “5% minoxidil foam” (generic versions are fine) that you apply to your scalp when your hair and scalp are dry. It’s ok for women to use minoxidil products labeled for men. Minoxidil is thought to stimulate hair growth by, among other things, improving blood flow in the scalp and prolonging the growth phase of each hair follicle.

Some dermatologists may recommend certain nutritional supplements to help speed up hair growth, such as Nutrafol and Viviscal Hair Growth supplements. Always check with your oncologist before you start taking a nutritional supplement. Biotin supplements should be avoided because they can cause you to have incorrect results from lab tests (such as cardiovascular diagnostic tests and hormone tests).

Some of the other products you might want to try for mild to moderate hair loss include:

  • Hair products designed to cover bald spots and thinning areas of your hair, such as Bumble and Bumble hair powder, Bumble and Bumble color sticks, Nanogen Keratin Hair Fibres, and Toppik hair fibers.
  • Shampoos formulated for thinning hair such as Nioxin, Actiiv Hair Science, and others may or may not be effective in promoting thicker, stronger hair in your individual situation. But they’re also not harmful unless they happen to irritate your scalp. Volumizing shampoos may be a better option because they can make the hair appear fuller.


The emotional impact of hair loss

Hair loss can be traumatic in part because it’s so visible. You may feel that it reveals to the world that you’re a cancer patient, threatening your privacy. And you may have to deal with it around the same time that you’re facing other unwanted changes to your body and appearance due to treatment.

Of course, not everyone reacts to treatment-related hair loss in the same way. For some, it can be devastating, especially at the beginning. For others, it’s a big inconvenience but it doesn’t affect them as deeply.


Hair loss and your children

If you have young children, you may be concerned about how they’ll react to seeing you lose your hair as a side effect of chemotherapy. Experts say that no matter the age of your kids, it’s best to prepare them before your hair falls out with honest, age-appropriate information about what to expect.

Since kids often follow your lead, try not to get too upset yourself during the conversation. Reassure them that your hair will grow back. It might also make them feel better to participate in some of the things you’re doing to prepare, such as picking out hats, scarves, or other head coverings, or shaving off your hair.


Hair loss and your job

There tends to be a lot less stigma with being open about a cancer diagnosis in the workplace than there was even a generation ago. If you’re planning to continue working or to job hunt during treatment, you’re likely to find that many colleagues are understanding about what you’re going through.

Still, it’s up to you to decide how comfortable you feel telling your colleagues or others you interact with in your job about your diagnosis and treatment. If you’ve lost your hair and you want to maintain your privacy at work, you might choose to wear a wig that looks as close as possible to your natural hair and to otherwise conceal your hair loss (such as by penciling in your eyebrows). If you’re not as concerned about privacy, you might wear a scarf or choose not to hide your hair loss.

How you decide to handle hair loss at work might also depend on your job role and industry. For instance, if you work in a field in which your appearance is front and center more, you might decide that concealing your hair loss on the days you go into work helps you feel more confident.


If you have any questions or concerns, please contact Forge’s Client Services Coordinator, Janet Dees, at (205) 990-5367 or [email protected]. Si hablas español y quieres más información, por favor contacta a Yadira Robayna, al (205) 990-5375 O al [email protected].