Does Chemotherapy Always Cause Hair Loss?

With some chemotherapy treatments, patients can lose most or all of their hair. But once treatment ends, your hair will grow back.

While patients undergoing chemotherapy are, of course, most concerned about their health, many also wonder if the treatment will result in the loss of their hair. 

“Hair loss can feel very stigmatizing and impactful to a lot of people,” says Christopher Foss, MD, a hematologist-oncologist with USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC.  

Knowing what to expect can help mitigate the impact. Here, Dr. Foss shares some insights into chemotherapy-related hair loss — and subsequent hair growth. 

Why does chemotherapy cause hair loss and hair thinning?

Chemotherapy is very effective at eradicating cells in our body that rapidly divide and grow. “The problem is, it doesn’t always differentiate between the rapidly dividing cancer cells and the normal cells in our body,” Dr. Foss says.

That’s why chemotherapy can result in collateral damage of normal cells — including those in our hair. “Hair follicles have some of the fastest-growing cells in the body,” Dr. Foss says.

Chemotherapy also affects other fast-growing cells like those in our taste buds, so treatment can affect our ability to taste as well.

When hair loss from chemotherapy begins

Hair loss doesn’t happen immediately after the first treatment.

Typically, patients begin noticing hair loss around a couple of weeks after the initial treatment. They might notice strands of hair on their pillow in the morning or more hair coming out when they shower.

Shortly afterward, patients might experience full hair loss, depending on their treatment therapy.

Not all chemotherapy causes hair loss

Some types of chemotherapy drugs result in hair loss, but not all. Depending on the regimen, chemotherapy might result in little to no loss of hair.

Chemotherapy drugs such as taxanes and anthracyclines, which are commonly used to treat breast cancer among other cancers, are commonly associated with hair loss. But other chemotherapy drugs such as 5-fluorouracil, which is used for gastrointestinal and other cancers, tend not to cause hair loss.

Chemotherapy doesn’t only affect the hair on our head

“The hair loss on the head is probably the most noticeable, but hair loss can occur everywhere on the body,” Dr. Foss says.

Often, patients lose the hair in their eyebrows. Because eyebrows normally capture the moisture on our foreheads, patients with eyebrow loss can experience eye irritation as a result.

Managing hair loss from chemotherapy

While there is no dietary or lifestyle modification that can prevent hair loss from chemotherapy, there is a device that might help.

At the USC Norris Comprehensive Cancer Center, patients can wear a cold cap before and during chemotherapy treatment. A cold cap is a helmet-like device that constricts the blood vessels and reduces blood flow. This technique potentially makes the hair follicles less susceptible to the effects of chemotherapy, with the goal of trying to prevent hair loss.

Cold caps can reduce hair loss for many people, but they’re not a guaranteed intervention for everyone, Dr. Foss notes. Cold caps also come with a couple of challenges: They take time to set up for every infusion, and not all insurance carriers cover them.

In addition to cold caps, USC Norris provides other resources and supports to patients, such as wigs.

Hair grows back after treatment is over

Your hair will grow back after your chemotherapy treatment ends, though the rate and degree of growth can vary among patients.

“Patients are obviously disappointed to hear that hair loss is a potential side effect of chemotherapy, but most are reassured that it’s temporary,” Dr. Foss says.

It usually takes several weeks after the last infusion for patients to start seeing changes in hair growth, Dr. Foss notes. Some patients report that the color and texture of their hair after it grows back can seem slightly different, especially early on, which Dr. Foss explains can result from chemo-related damage to the hair follicles.

A few months after the last treatment, hair growth becomes more noticeable, and then typically returns to normal.

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Novid Parsi

Novid Parsi is a freelance writer for Keck Medicine of USC

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