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Hair is the loss people can see, and it is one of the few effects of treatment with a device that prevents it in about half of the people who use it. This page gives the number for your own regimen rather than the headline number, says what happens and when by drug class, names the two things patients are least often warned about (hair that never fully returns after a taxane, and the slow thinning of years on endocrine therapy), and grades every regrowth treatment that is offered or sold, including the ones with nothing behind them. Then the practical part: wigs and who pays, scalp care, and what to ask at each stage.
A tightly fitted cap chilled to a few degrees above freezing, worn before, during and after each chemotherapy infusion, narrows the blood vessels of the scalp so less drug reaches the hair roots. In a randomised trial about half of women on taxane-based chemotherapy kept most of their hair, compared with none who went without.
Most hair grows back after chemotherapy, but a minority, especially after docetaxel, are left with thin hair, and tamoxifen and aromatase inhibitors cause gradual thinning. Minoxidil lotion or low-dose tablets, the same treatment used for pattern hair loss, improved regrowth in most patients in dermatology series and shortened regrowth time in an early randomised trial.
Eyelashes and eyebrows often fall out with chemotherapy and can be slow to return. Bimatoprost, a glaucoma eye drop approved for thin lashes, applied along the lash line each night increased lash length and thickness in a randomised trial that included people after chemotherapy.
A wig, scarf or cap restores privacy and confidence during hair loss. In the UK wigs come on NHS prescription, free in Scotland, Wales and Northern Ireland and in England for children, students under 19 and people on qualifying benefits; in the US a prescription for a 'cranial prosthesis' lets some insurers reimburse one, and charities give wigs free.
Two studies published in the same issue of one journal in 2017 are what the practice rests on, and they enrolled different regimens, so the figure you are quoted depends on which one it comes from. Each row below gives the result in the words and numbers of the paper, and what that row does not settle.
| Regimen studied | What was found | What it does not settle |
|---|---|---|
| Taxane without an anthracycline | In the DigniCap study, hair loss of 50 per cent or less was seen in 67 of 101 evaluable women (66.3 per cent, 95 per cent confidence interval 56.2 to 75.4) using the cap, against 0 of 16 concurrent controls. No participant in the cooling group received an anthracycline. | A prospective cohort, not a randomised trial, with 16 controls, 14 of them matched for age and regimen. Hair loss was estimated by unblinded patients from five photographs. Rugo et al., DigniCap prospective cohort with concurrent controls (JAMA 2017) |
| Taxane, anthracycline or both (the randomised trial) | In SCALP, hair preservation, defined as no loss or less than 50 per cent loss not needing a wig, was achieved by 48 of 95 women with cooling (50.5 per cent, 95 per cent confidence interval 40.7 to 60.4) against 0 of 47 without. Of the 142 evaluable women, 36 per cent had anthracycline-based and 64 per cent taxane-based chemotherapy. | Open label, and stopped early at the planned interim analysis for efficacy, which tends to overstate an effect. The headline is the average across both regimen types rather than the figure for either one, and no longer-term follow-up of this trial has been published. Nangia et al., SCALP randomised trial of scalp cooling (JAMA 2017) |
| Paclitaxel, and docetaxel, pooled across every published study | A 2024 systematic review and meta-analysis of 31 studies across 14 countries found that of 2,179 patients, 60.7 per cent had less than 50 per cent hair loss (pooled estimate 60.6 per cent, 95 per cent confidence interval 54.9 to 66.1). By drug: paclitaxel 69.9 per cent (64.1 to 75.4) and docetaxel 60.5 per cent (50.0 to 71.6). Across the comparative studies, 49.3 per cent of cooled patients had less than 50 per cent hair loss against 0 per cent of those not cooled, an odds ratio of 40.3 (10.5 to 154.8). Patient satisfaction was 78.9 per cent (69.1 to 87.4). | Pooling observational studies with different definitions of success. It is the best per-drug estimate available and it is not a randomised comparison. Lambert et al., scalp hypothermia to reduce chemotherapy-induced alopecia: systematic review and meta-analysis (Gynecologic Oncology 2024) |
| Anthracycline plus taxane together (the regimen many women are offered) | In the Dutch Scalp Cooling Registry of 1,411 patients at 28 hospitals, half of all cooled patients did not wear a head covering at their last chemotherapy session. By regimen, patients were satisfied with the result in 8 per cent of cases after TAC chemotherapy (docetaxel, doxorubicin and cyclophosphamide) and up to 95 per cent after paclitaxel. The registry's authors concluded that cooling is justified for all eligible patients except those needing TAC. | A registry, not a trial, and these are the only two regimen figures the published abstract gives. The ESMO guideline puts it in words rather than numbers: cooling has greater efficacy with taxane-based regimens and lower efficacy when anthracyclines are combined with taxanes or with cyclophosphamide. The successor registry of 7,424 patients at 68 hospitals found 53 per cent reported minimal hair loss and that outcomes were drug and dose dependent. van den Hurk et al., scalp cooling for hair preservation in 1,411 chemotherapy patients, the Dutch Scalp Cooling Registry (Acta Oncologica 2012) |
| Everyone, in routine care rather than a trial | The successor to that registry reported 7,424 patients at 68 Dutch hospitals: 4,191 (56 per cent) did not wear a head covering and 3,784 of 7,183 (53 per cent) reported minimal hair loss at the start of their final treatment. Outcomes were drug and dose dependent, and the study did not identify any patient characteristic or lifestyle factor that predicted whether cooling would work. | That last finding is the useful one and the disappointing one: nothing about you, your hair or how you live tells you in advance whether it will work. The drug does most of the predicting. Brook et al., results of the Dutch scalp cooling registry in 7,424 patients (The Oncologist 2024) |
| Antibody-drug conjugates: trastuzumab deruxtecan | In a prospective phase 2 study at Dana-Farber in which 40 evaluable women with metastatic breast cancer chose whether to use the cap, 33 (82.5 per cent) had alopecia of grade 1 or worse: 90 per cent of those who cooled and 75 per cent of those who did not, a difference that was not statistically significant. Grade 2 alopecia was 55 per cent in both groups. The authors concluded that scalp cooling did not reduce alopecia rates with this drug. | Small, and patients chose their own group rather than being randomised, so the groups may differ. It is nonetheless the only published result for cooling with an antibody-drug conjugate, and it is not encouraging. For sacituzumab govitecan there is one published case report of one patient. Salehi et al., scalp cooling outcomes in patients receiving trastuzumab deruxtecan for metastatic breast cancer (ESMO Open 2026) |
| Everything else | No trial has reported hair preservation with cooling for platinum-based regimens outside breast cancer, for paediatric chemotherapy, or for most solid-tumour regimens. Units use cooling with them and record their own results. | Absence of a trial is not evidence that cooling fails here; it means nobody can give you a number. A Cochrane review is being written and has published only its protocol, with no results, so anyone citing one is citing something that does not yet exist. Kojima et al., scalp cooling for the prevention of chemotherapy-induced hair loss in early breast cancer: Cochrane protocol, no results yet (Cochrane Database of Systematic Reviews 2025) |
Cooling the scalp narrows its blood vessels and slows the metabolism of the hair follicle while the drug is at its peak concentration in the blood, so much less of it reaches the dividing cells at the base of the hair. A machine circulates coolant through a close-fitting silicone cap under an insulating outer cap; manual gel caps, kept on dry ice and swapped every twenty to thirty minutes, do the same thing without a machine and need someone to help.
Lacouture et al., prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines (Annals of Oncology 2021)In the DigniCap study cooling began 30 minutes before each cycle, the scalp was held at 3 degrees Celsius throughout, and cooling continued for 90 to 120 minutes afterwards. Cancer Research UK gives the Paxman system as 30 to 45 minutes before, depending on hair type, the length of the infusion itself, and a minimum of 20 to 90 minutes after depending on the drugs. A short infusion can therefore become a half-day. Ask your unit for its own before-and-after times and plan the lift home around them.
Rugo et al., DigniCap prospective cohort with concurrent controls (JAMA 2017)Cold, and tight. In the DigniCap study 4 of 106 patients (3.8 per cent) reported mild headache and 3 (2.8 per cent) stopped cooling because they felt cold. In the SCALP trial 54 adverse events were reported in the cooling group, all grade 1 and 2, with no serious device events. The ESMO guideline notes that injuries from cold have been reported only after the use of frozen gel caps, not with machine cooling.
Rugo et al., DigniCap prospective cohort with concurrent controls (JAMA 2017)Lacouture et al., prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines (Annals of Oncology 2021)This was the long-standing objection and it has been measured. A systematic review and meta-analysis of ten longitudinal studies found scalp metastases in 0.61 per cent (95 per cent confidence interval 0.32 to 1.1) of 1,959 cooled patients against 0.41 per cent (0.13 to 0.94) of 1,238 who were not cooled, which was not statistically significant (P equals 0.43), with no difference in survival. Two things are worth knowing about that analysis: mean follow-up was shorter in the cooled group (43.1 against 87.4 months), and all three authors declared ties to a device manufacturer. The honest reading is that no excess has been shown, not that none could exist.
Rugo, Melin and Voigt, scalp cooling and the risk of scalp metastases: systematic review and meta-analysis (Breast Cancer Research and Treatment 2017)The ESMO guideline lists the contraindications: blood cancers, cold sensitivity, cold agglutinin disease, cryoglobulinaemia, cryofibrinogenaemia, cold post-traumatic dystrophy, and whole-brain radiotherapy after chemotherapy. Macmillan adds continuous chemotherapy through a pump over several days, and a liver that is not working as well as it should. Cancer Research UK adds scalp radiotherapy and severe headaches or migraine, and notes that cooling cannot be used with chemotherapy tablets because the cap would have to be worn all day. The United States authorisations stop at solid tumours, so cooling is outside the label in blood cancers there as well as outside practice. Beyond that list, which solid-tumour regimens a unit will cool is a local decision.
Lacouture et al., prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines (Annals of Oncology 2021)The ESMO clinical practice guideline on dermatological toxicities recommends scalp cooling to prevent chemotherapy-induced alopecia, graded II, B, and notes that seven of eight randomised trials favoured cooling with 50 to 65 per cent of patients developing only grade 1 alopecia. Neither MASCC nor ASCO has published a guideline on alopecia or scalp cooling. Two of the ESMO authors declare funding or consulting ties to scalp-cooling manufacturers, which is worth knowing and does not by itself make the recommendation wrong.
Lacouture et al., prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines (Annals of Oncology 2021)Nobody can say in advance. Macmillan's wording is the honest one: you will only know how well scalp cooling works for you by trying it, your hair is likely to get thinner even with it, and some people who use it lose a lot of hair. Cancer Research UK says the same, that cooling blocks only certain drugs and does not work for everyone. The trial percentages describe groups of women, not the person reading them.
Macmillan Cancer Support: scalp coolingMacmillan reports that research has shown hair grows back faster and stronger in the twelve weeks after treatment finishes in people who had scalp cooling, and that cooling can help reduce the risk of the permanent hair loss docetaxel can occasionally cause. Those are secondary benefits rather than the reason cooling is offered, and the second has not been tested with permanent alopecia as a trial endpoint.
Macmillan Cancer Support: scalp coolingAbout half the women in the randomised trial still lost more than half their hair. Nothing published says whether stopping after one cycle, or persisting, changes the outcome for an individual, so that decision rests on the unit's experience and on how the first cycle felt. A wig or covering fitted before the first cycle means the choice is not urgent.
Nangia et al., SCALP randomised trial of scalp cooling (JAMA 2017)No. Cancer Research UK states plainly that there is no known way to prevent or reduce hair loss from radiotherapy, hormone therapy, targeted cancer drugs or immunotherapy. For chemotherapy itself, a meta-analysis of 8 randomised and 9 controlled trials covering 1,098 participants found that scalp cooling significantly reduced the risk of alopecia, with a relative risk of 0.38 (95 per cent confidence interval 0.32 to 0.45), and that topical 2 per cent minoxidil and the other interventions tested did not. Scalp cooling is the only method cleared by the United States Food and Drug Administration to prevent chemotherapy hair loss.
Cancer Research UK: treatment for hair loss, including scalp coolingShin et al., efficacy of interventions for prevention of chemotherapy-induced alopecia: systematic review and meta-analysis (International Journal of Cancer 2015)Every device the United States Food and Drug Administration has authorised as a scalp cooling system, read from its own 510(k) and De Novo records rather than from the manufacturers. Manual gel caps (Penguin, Chemo Cold Caps, Arctic) are a separate and older route: they are swapped from dry ice every twenty to thirty minutes and need someone to help.
| Device | Maker | Authorisation | What it is authorised for |
|---|---|---|---|
| DigniCap System | Dignitana AB | De Novo DEN150010, granted 8 December 2015 | To reduce the likelihood of chemotherapy-induced alopecia in women with breast cancer. This grant created the device class. |
| Paxman Scalp Cooler | Paxman Coolers Limited | 510(k) K163484, cleared 17 April 2017 | To reduce the likelihood of chemotherapy-induced alopecia in women with breast cancer. The summary cites the SCALP trial. |
| DigniCap Scalp Cooling System | Dignitana AB | 510(k) K170871, cleared 3 July 2017 | Broadened to cancer patients with solid tumours. |
| Paxman Scalp Cooler | Paxman Coolers Limited | 510(k) K173032, cleared 7 June 2018 | Broadened to cancer patients with solid tumours; otherwise identical to the 2017 device. |
| DigniCap Delta | Dignitana, Inc. | 510(k) K191166, cleared 26 June 2019 | Cancer patients with solid tumours. |
| Portable Scalp Cooling System | Cooler Heads Care, Inc. | 510(k) K211526, cleared 21 October 2021 | A portable system, the first after the two established machines. |
| Eva Scalp Cooling System | Stemtech Medical Devices | 510(k) K252289, cleared 25 November 2025 | The most recent addition to the class. |
None of these is authorised for blood cancers: the labels stop at solid tumours. FDA 510(k) database, product code PMC (scalp cooling system). OnCo uses manufacturers only for what a device is, never for whether it works.
Typical timings from patient guidance. Your team can tell you what they see with your regimen; the order is more reliable than the dates.
Shedding starts, often suddenly, with tenderness of the scalp; many people cut hair short beforehand so the change is less abrupt.
American Cancer Society: hair lossScalp hair is absent or sparse; brows, lashes and body hair follow later. The scalp needs sun protection and a soft covering against cold.
Macmillan Cancer Support: hair lossFine, soft new growth appears. It is often a different texture or colour at first ('chemo curls'); this usually settles over the following year.
American Cancer Society: hair lossHair is generally long enough to style. Colouring and perming are best left until the new hair is a few centimetres long and the scalp is no longer sensitive, with a patch test first.
Macmillan Cancer Support: hair lossIf density has not recovered, ask for a dermatology referral: persistent chemotherapy-induced alopecia is a recognised diagnosis with published treatment series behind it, and the easily corrected causes (iron, thyroid) should be excluded.
Hair disorders in cancer survivors (J Am Acad Dermatol 2019)Loss is limited to the treated area and begins two to three weeks in; regrowth depends on the dose and may be incomplete after high doses.
NCI: hair loss (alopecia) and cancer treatmentMost to least. Percentages are the any-grade alopecia rates recorded on each drug's own record from its label or pivotal trial (10 drugs carry one); hover a drug for its summary. A combination regimen takes the risk of its strongest component.
| Class | How much | Drugs on OnCo | Pattern and what helps |
|---|---|---|---|
| Anthracyclines | Complete loss in nearly everyone | Doxorubicin90% | Doxorubicin and epirubicin, alone or in AC, EC and FEC regimens, cause complete hair loss in almost everyone, starting two to three weeks after the first dose. Pegylated liposomal doxorubicin causes much less. Helps: Scalp cooling works less well with anthracyclines than with taxanes alone; wigs and coverings; regrowth is expected. NCI: hair loss (alopecia) and cancer treatment |
| Taxanes | Complete loss in nearly everyone | Paclitaxel, docetaxel and cabazitaxel cause complete loss of scalp hair and often body hair, brows and lashes within a few weeks of starting. Lasting: Taxanes are the agents most often linked to persistent chemotherapy-induced alopecia, usually diffuse thinning rather than baldness. In a prospective cohort of 61 women whose hair was measured before chemotherapy, 42.3 per cent met the definition at three years, and taxane-based regimens were the ones most often involved; in the largest treated series, taxanes were the agent in 80 of 98 cases (82 per cent). Helps: Scalp cooling has its best results with taxane-only regimens (about half of women preserved most hair in SCALP); minoxidil for persistent thinning. Freites-Martinez et al., quality of life and treatment outcomes in persistent post-chemotherapy alopecia (JAMA Dermatology 2019) | |
| Alkylating agents | Complete or marked loss is common | Cyclophosphamide and ifosfamide cause marked loss at standard doses and complete loss at high dose; high-dose melphalan before stem cell transplant causes complete loss. Lasting: High-dose busulfan and cyclophosphamide conditioning for transplant can cause permanent thinning. Helps: Scalp cooling is not used in blood cancers; wigs and coverings; dermatology review if hair has not returned a year on. NCI: hair loss (alopecia) and cancer treatment | |
| Topoisomerase inhibitors and vinca alkaloids | Complete or marked loss is common | Etoposide, irinotecan, topotecan and eribulin commonly cause marked hair loss; vincristine, vinblastine and vinorelbine more often cause thinning. Helps: Scalp cooling can be offered for solid-tumour regimens; regrowth is expected. NCI: hair loss (alopecia) and cancer treatment | |
| Antibody-drug conjugates | Complete or marked loss is common | Conjugates carrying topoisomerase or microtubule payloads cause hair loss in a third to a half of patients in their pivotal trials (the rate beside each drug is read from its own record). Trastuzumab emtansine and brentuximab vedotin cause it uncommonly. Helps: Scalp cooling is used off-protocol with these regimens, and the one published result is negative: in 40 women on trastuzumab deruxtecan, alopecia of grade 1 or worse occurred in 90 per cent of those who cooled and 75 per cent of those who did not. Minoxidil afterwards. Salehi et al., scalp cooling outcomes in patients receiving trastuzumab deruxtecan (ESMO Open 2026) | |
| Hedgehog pathway inhibitors | Complete or marked loss is common | Vismodegib and sonidegib cause hair loss in more than half of patients, alongside muscle cramps and taste loss, because the hedgehog pathway maintains the hair cycle. Lasting: Regrowth after stopping can be slow and incomplete. Helps: Treatment breaks and minoxidil are used; discuss with the prescriber. NCI: hair loss (alopecia) and cancer treatment | |
| Radiotherapy to the head | Complete or marked loss is common | Hair is lost only where the beam enters or leaves, starting two to three weeks into treatment. Whole-brain radiotherapy affects the whole scalp; focused treatment affects a patch. Lasting: Regrowth depends on the dose the follicles received and, in the study that established the relationship, on nothing else tested. In a cohort of 71 patients treated for central nervous system tumours or head and neck sarcoma the median estimated scalp dose was 39.6 Gy, and the dose at which half were estimated to have moderate alopecia was 36.1 Gy (95 per cent confidence interval 33.7 to 39.6). The National Cancer Institute says hair often grows back three to six months after radiotherapy ends, and that after a very high dose it may grow back thinner or not at all. Helps: Scalp-sparing intensity-modulated or proton plans lower the dose to hair follicles where the tumour allows; ask the radiotherapy team what the plan does to the scalp. Of 34 patients in that cohort treated with topical minoxidil 5 per cent, 28 (82 per cent) responded. Phillips et al., persistent radiation-induced alopecia in patients with cancer (JAMA Dermatology 2020) | |
| Liposomal anthracycline | Thinning or partial loss | The liposome changes how the drug is distributed, so hair loss is usually mild or partial rather than complete, at the price of hand-foot skin reaction. Helps: Usually needs no specific measure; a shorter style disguises thinning. NCI: hair loss (alopecia) and cancer treatment | |
| Endocrine therapy | Thinning or partial loss | Tamoxifen, aromatase inhibitors and ovarian suppression cause gradual thinning in a pattern like female or male pattern hair loss over months to years, not sudden shedding. Lasting: Thinning persists while treatment continues and usually improves after it stops; stopping endocrine therapy early to protect hair raises recurrence risk and should be discussed, never done alone. Helps: Topical minoxidil produced moderate or significant improvement in 37 of 46 treated patients (80 per cent) in the series that described this pattern. Spironolactone is sometimes added, but the ESMO guideline recommends against its routine use. Endocrine therapy-induced alopecia in breast cancer (JAMA Dermatol 2018) | |
| CDK4/6 inhibitors | Thinning or partial loss | About a third of women on palbociclib with letrozole reported hair thinning in the label; ribociclib and abemaciclib are similar. It is thinning, not baldness, and continues through treatment. Helps: Minoxidil; the drugs are taken for years so cooling is not relevant. Endocrine therapy-induced alopecia in breast cancer (JAMA Dermatol 2018) | |
| Kinase inhibitors | Thinning or partial loss | Multikinase inhibitors such as sorafenib, cabozantinib, regorafenib and ripretinib, and FGFR inhibitors, commonly cause thinning; hair may also become curlier or lighter. Helps: Usually tolerable; minoxidil if distressing. Hair disorders in cancer survivors (J Am Acad Dermatol 2019) | |
| Antimetabolites and platinum drugs | Uncommon or mild | Fluorouracil, gemcitabine, methotrexate, the platinum drugs, temozolomide and bendamustine given alone cause mild thinning at most; in combination with a taxane or anthracycline the partner drug sets the risk. Helps: Usually no measure needed; check the combination. NCI: hair loss (alopecia) and cancer treatment | |
| Antibody-drug conjugates with lower rates | Uncommon or mild | Alopecia appears in the labels of trastuzumab emtansine and brentuximab vedotin at low rates. Helps: Usually no measure needed. NCI: hair loss (alopecia) and cancer treatment | |
| EGFR inhibitors | Texture, colour or brow and lash changes | Erlotinib and osimertinib rarely cause loss but make scalp hair brittle and curly, lengthen eyelashes (trichomegaly) and can inflame the scalp. Helps: Lash trimming by an optician if lashes irritate the eye; scalp care for folliculitis. Hair disorders in cancer survivors (J Am Acad Dermatol 2019) | |
| Checkpoint immunotherapy | Texture, colour or brow and lash changes | Checkpoint inhibitors do not cause typical chemotherapy hair loss; a small minority develop patchy alopecia areata, hair whitening or vitiligo-type changes as immune side effects. Helps: Dermatology referral; these changes often accompany a good tumour response. Hair disorders in cancer survivors (J Am Acad Dermatol 2019) |
Three things patients are least often warned about before treatment. Each has a record with the measured rates and what is known about treating it.
Hair that has not returned to its old density six months or more after chemotherapy ended. It is the effect patients are least often warned about beforehand, it is commonest after taxanes and after transplant conditioning, and it is usually thinning rather than baldness.
Gradual thinning at the parting and crown that builds over months on tamoxifen, an aromatase inhibitor or ovarian suppression. It is not the sudden shedding of chemotherapy, it lasts as long as the treatment does, and it is often dismissed because it is mild on a clinician's scale and not on the patient's.
Radiotherapy takes hair only where the beam passes through the scalp, and whether it returns depends on the dose the follicles received. Below a threshold it regrows in months; above it, the patch can stay thin for good.
Everything offered or sold for hair after cancer treatment, with the evidence behind it stated plainly. "Insufficient" means no reliable human evidence of benefit, not that it is known to fail; it is the honest grade for most of what is advertised, and it is here because a reader who finds nothing finds the advertisement instead.
| Approach | Evidence | What the evidence is | Guideline |
|---|---|---|---|
| Scalp cooling (cold caps: DigniCap, Paxman) | Strong evidence | Cooling the scalp during taxane-based chemotherapy preserved hair in about half of women in a randomised trial; weaker with anthracyclines. | FDA-cleared devices; not yet in ASCO guidelines |
| Wigs, cranial prostheses and head coverings | Strong evidence | NHS wigs in the UK, 'cranial prosthesis' prescriptions and free wig banks in the US. | None speaks to it. |
| Bimatoprost for eyelash and eyebrow regrowth | Some evidence | Approved lash-growth drop with a randomised trial including post-chemotherapy patients. | None speaks to it. |
| Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss | Some evidence | Regrowth in most patients with persistent or endocrine-therapy hair thinning in dermatology series; faster regrowth in an early randomised trial. | None speaks to it. |
Laboratory, animal or uncontrolled human data only, or trials too small and inconsistent to draw a conclusion. Not a reason to use it outside a trial.
Mechanism first, then what works today, then what is in progress. Only measures with a trial, a published series or a live programme are listed.
Nearly everyone treated with docetaxel, paclitaxel, doxorubicin or epirubicin loses their scalp hair within a few weeks, and many rank it among the worst parts of treatment.
Hair matrix cells divide faster than almost any other cell, so drugs that kill dividing cells stop the follicle mid-growth and the shaft breaks off. Cooling the scalp narrows its vessels while the drug is at peak concentration, so far less reaches the follicle.
In some people, most often after a taxane or after high-dose conditioning for transplant, hair regrows thin and does not recover its former density. In the one cohort that measured hair before chemotherapy and followed people for three years, 42.3 per cent met the definition at three years.
The stem cells that regenerate the follicle are usually spared, which is why hair returns; when they are damaged, follicles miniaturise and produce fine, sparse hair, resembling pattern hair loss.
Years of endocrine therapy, and the CDK4/6 inhibitors given with it, cause gradual thinning at the parting and crown that is easy to dismiss but affects adherence.
Lowering oestrogen shifts the balance toward androgen effects on the follicle, shortening the growth phase in the same pattern as female pattern hair loss; CDK4/6 inhibition slows matrix cell cycling directly.
Brows and lashes often fall out later than scalp hair and are missed more, because they frame the face and protect the eyes from dust and sweat.
Brow and lash follicles cycle more slowly than scalp hair, so they are hit later and regrow later; regrowth usually follows within a few months of the last dose.
Radiotherapy causes hair loss only where the beam passes through the scalp, but after high doses the follicles in that patch may not recover.
Ionising radiation damages the dividing matrix and, at higher cumulative doses, the follicle stem cells; below that threshold hair returns in months, above it the loss can be permanent.
Availability depends on the unit and the payer. Machines cost money and chair time; in the US patients are often charged per cycle, and in the UK provision varies between hospitals.
Cooling adds one to two hours to each chemotherapy visit and needs a machine or freezer capacity, which units must fund or find a charity to fund. In the United States the Rapunzel Project puts the cost to a patient at 1,500 to 2,000 dollars for three to four months of manual capping plus dry ice, and 2,000 to 2,500 dollars for machine cooling, and neither manufacturer publishes a price.
Hair loss makes cancer visible to everyone, including children and colleagues, before the person is ready to tell them.
Body image and control over disclosure are the components of distress that appearance programmes and psychological support target; the hair itself is not the whole problem.
Who provides what, by country. Charges and eligibility change; follow the links for the current rules.
Hospitals supply wigs on prescription and England charges for them. The NHS Business Services Authority, which administers the scheme, lists a stock modacrylic wig at 80.15 pounds, a partial human-hair wig at 212.35 pounds and a full made-to-order human-hair wig at 310.55 pounds. The same figures appear in the HC11 booklet that applies from April 2026, so they are current.
The NHS Business Services Authority lists free provision for anyone under 16, under 19 and in full-time education, holding a valid war pension exemption certificate for the accepted disability, or receiving Pension Credit Guarantee Credit; it adds that an HC2 certificate from the NHS Low Income Scheme means free, that an HC3 certificate caps what you pay at the amount written on it, and that New Style Jobseeker's Allowance, New Style Employment and Support Allowance and Pension Credit Savings Credit alone do not qualify. The NHS website adds hospital inpatients and people on income-related Employment and Support Allowance. Apply to the Low Income Scheme with form HC1, and claim a refund with form HC5(W) within three months if you paid and then found you were exempt.
The NHS Business Services Authority states that wigs and fabric supports supplied through a hospital are free in Scotland and in Wales; in Wales the free provision is within a set budget and you pay the difference if you choose a more expensive wig. In Northern Ireland everything dispensed on prescription, including wigs and surgical appliances, is free to everyone.
Macmillan says human-hair wigs cannot be prescribed on the NHS unless you are allergic to synthetic wigs or have a skin condition a synthetic wig would worsen. A synthetic wig usually lasts four to eight months and costs between 50 and several hundred pounds privately; a made-to-order human-hair wig takes at least ten weeks and costs around 2,500 pounds or more. There are special arrangements for people registered with a GP in Wales who are treated in England.
Cancer Research UK: claim a refund with the receipt and form HC5(W) within three months of buying the wig.
Cancer Research UK describes a network of wig banks around the UK selling and hiring new and donated wigs, washed and conditioned, for between 10 and 30 pounds.
Free real-hair wigs for anyone up to the age of 24 who has lost hair through cancer treatment, and where possible for other hair-loss conditions. The whole service is free, fitted by an accredited wig fitter and, where a salon visit is not possible, at hospital, at home or virtually. The charity also funds childhood cancer research: more than 36 million pounds across 158 projects since 2016.
Cancer Hair Care runs a free helpline and advice service on wigs, scarves and hair loss. Look Good Feel Better UK runs free workshops, in person and online, on skin, eyebrows, eyelashes, hair, nails and body confidence, open to anyone with a cancer diagnosis from the point of diagnosis to one year after treatment ends, with no referral needed.
A9282, the only wig code in the Healthcare Common Procedure Coding System, reads 'Wig, any type, each'. In the Centers for Medicare and Medicaid Services' own October 2026 code file it carries coverage code S, which the file's record layout defines as non-covered by Medicare statute, with the statute reference given as section 1861 of the Social Security Act. There is no code whose descriptor reads 'cranial prosthesis': that is the wording prescribers and private insurers use, not a code.
Many private insurers will consider a claim for a cranial or hair prosthesis prescribed with the diagnosis code for drug-induced alopecia, where they would refuse one for a wig. The wording on the prescription is what the claim turns on, and it costs nothing to ask for it.
New Hampshire requires group policies that cover other prostheses to cover a scalp hair prosthesis for hair loss from treatment for cancer or leukaemia, on a written statement of medical necessity from the treating doctor, up to 350 dollars a year. Rhode Island requires the same of individual and group policies issued or renewed from 1 January 2007, also capped at 350 dollars per member per year. Delaware has a scalp hair prosthesis law too, but it covers alopecia areata from autoimmune disease and not chemotherapy, so it does not apply here.
Free wigs through local programmes and low-cost wigs, hats and scarves through the TLC catalogue.
Free hairpieces for children up to 18 experiencing medical hair loss, including from chemotherapy and radiotherapy, on referral from a medical professional. The charity says each human-hair wig costs it more than 2,600 dollars to make and that it never charges a recipient.
Subsidies for people on lower incomes, usually with household income at or below 400 per cent of the federal poverty level, rising to 600 per cent for some donor-targeted funds. The maximum is usually 1,000 dollars, up to 1,500 dollars from those special funds, one subsidy per person, to be used within six months. Only people with solid tumours are eligible, because scalp cooling is not used in blood cancers.
Founded in 2009 by two breast cancer survivors, it helps infusion centres install the biomedical freezers manual cold caps need, because the caps must be held at minus 30 degrees Celsius and ordinary freezers do not reach it. Its published estimate of what people pay: 1,500 to 2,000 dollars for three to four months of manual capping plus dry ice, and 2,000 to 2,500 dollars for machine cooling, varying with the number of treatments.
Wig fitting, cap booking and photographs for colour matching are all easier while you still have hair, and the National Cancer Institute's advice is explicit: if you plan to buy a wig, get one while you still have hair so you can match the colour.
Synthetic wigs are lighter, cheaper and hold their style; human-hair wigs look most natural, cost more and need styling. A soft cotton or bamboo liner protects a tender scalp, and some people find a scarf or turban cooler and less itchy than a wig.
Free workshops on skincare, make-up, brows and head coverings for people in treatment. It began with two workshops at Memorial Sloan Kettering and Georgetown's Lombardi Cancer Center in 1989 and now runs through a global affiliate network of around 26 to 27 countries. A Canadian pilot study of 2009 found improvements in self-image and social interaction and a fall in anxiety; it is a pilot, not a randomised trial.
Macmillan says scalp cooling can be used with any type of hair, and that with Afro hair weaves and braids must be removed first because they put extra strain on the follicles, and chemical relaxing should be avoided. Some wig services and charities, the Little Princess Trust among them, now supply Afro-textured wigs.
The part of hair loss a person can act on from the first week, and the part that follows them out of the hospital.
The National Cancer Institute's advice is specific: a soft-bristled brush or wide-tooth comb, a mild shampoo, washing less often and gently, patting dry with a soft towel, and no hair dryers, irons, gels or clips that can hurt the scalp. Lotion or conditioner helps an itchy or tender scalp. Some people cut their hair short first so the change is less abrupt; if you shave, use an electric shaver rather than a blade.
National Cancer Institute: hair loss (alopecia) and cancer treatmentScalp skin that has spent a lifetime under hair burns quickly and loses heat fast. The same guidance asks for sunscreen or a hat outdoors and a comfortable covering to keep the head warm. Macmillan's hair-loss guidance makes the same point about keeping the head covered in cold weather.
National Cancer Institute: hair loss (alopecia) and cancer treatmentBe gentle again: less brushing, curling and blow-drying, and washing less often. Colouring and perming are usually left until the new hair is a few centimetres long and the scalp is comfortable, with a patch test first.
National Cancer Institute: hair loss (alopecia) and cancer treatmentThe National Cancer Institute suggests telling children and close family that you expect to lose your hair, before it happens. Hair loss is usually the moment an illness becomes visible to everyone, including people you had not decided to tell.
National Cancer Institute: hair loss (alopecia) and cancer treatmentSchedule 1 of the Equality Act 2010 says in one line that cancer is a disability, and the government's own guidance says you meet that definition from the day you are diagnosed. That means an employer who knows must consider reasonable adjustments, and the protection covers recruitment, terms and conditions, promotion and training, and dismissal. Macmillan adds that it does not end when treatment does and travels with you to a new employer. Northern Ireland is covered by the Disability Discrimination Act 1995 instead.
Equality Act 2010, Schedule 1, Part 1, paragraph 6 (legislation.gov.uk)Cancer Research UK puts it plainly: going back to work, meeting new people or going to interviews can all be difficult while you are coping with a change in how you look. There is no guidance that solves it, and the charities' workshops and helplines exist partly for this.
Cancer Research UK: coping with hair loss42 questions, each with the reason it is worth asking and the source that reason rests on. Print this section for the appointment; the answers are the ones your own team gives.
Background: CTCAE toxicity grading (grade 3-4 adverse events), De-escalation, escalation and response-adapted therapy, Immune-related adverse events (irAEs), Quality of life, Toxicity grade. Also on OnCo: Side effects by symptom · Checkpoint side effects by organ · Side effect rates across a drug class · Survivorship planner.
Related: complementary and supportive approaches · side effects, symptom first · side effects across a drug class · survivorship planner. Rates come from labels and pivotal trials and are not adjusted for differences between trial populations. OnCo is orientation, not medical advice; your team's advice about your regimen takes precedence.