hair-loss

Because hair thinning on endocrine therapy follows the pattern of androgenetic alopecia, the drugs used for that pattern are sometimes added. The evidence in cancer survivors cannot separate them from minoxidil, the one guideline that addresses spironolactone says not to use it routinely, and an expert panel advised against finasteride and dutasteride in breast cancer.

When density has not come back, the options are to hide the gap or to move hair into it. Keratin fibres and scalp micropigmentation are cheap, immediate and reversible; hair transplantation and surgical reconstruction have been reported in cancer survivors only in small numbers, and no trial compares any of them.

Several drugs have been put on the scalp to stop chemotherapy hair loss before it starts: minoxidil lotion, vitamin D analogues, and others. The trials were done and they did not work. Scalp cooling remains the only method cleared by a regulator to prevent it.

Red and near-infrared light from a cap, comb or in-clinic device, sold for hair growth and tested twice in breast cancer. Adding it to scalp cooling did not improve on scalp cooling alone, and a separate caution applies to shining light at tissue where a tumour may be.

Blood is spun to concentrate platelets and injected into the scalp. It is sold widely for hair loss and is expensive. The one randomised study in people treated for cancer injected one half of the scalp and left the other half alone: both halves improved by the same amount.

A bare scalp burns in sun it has never met, loses heat fast in cold, and is more easily irritated while treatment is going on. The measures are small and free, and they are the part of hair loss a person can act on from the first week.

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.

In the first randomised trial of a modern scalp cooling system, half the women who used the Paxman device during taxane or anthracycline chemotherapy for early breast cancer kept most of their hair, compared with none of those who did not.

Biotin, marine-protein and multi-ingredient capsules are advertised directly to people whose hair has thinned after treatment. No randomised trial of any of them has been run in chemotherapy or endocrine-therapy hair loss. High-dose biotin also distorts hospital blood tests, including the one used to diagnose a heart attack.