‘I don’t want to be told that losing my hair will give me extra time in bed in the morning when I’d otherwise have been blow-drying, or that buying a range of wigs will give me the chance to try out different personalities in the bedroom…’
(The C word – Lisa Lynch, 2010)
My blog this week focuses on treatment induced hair loss and hair thinning. It’s a big topic, and I’m covering key points, but will add some useful links when I’ve finished, so you can find out more.
I’m aware how emotive the thought of losing our hair is, on many levels. In the midst of everything else, cancer wise, that is going on - this side effect often has the most impact.
People often apologise for their worries about seeming vain or superficial when faced with treatment related hair loss – but it’s neither of those things – our hair is part of who we are. Lisa Lynch, a 28 year blogger with breast cancer in her book, 'The ‘C’ Word' (2010), found the cheery upbeat information sheets didn’t cover how rubbish it all feels. She may have had a point.
It makes sense, as our hair often defines our visual identity, and self-image. Culturally and in society generally, our hair is seen as a sign of health, and a symbol of our uniqueness too – the money that is spent on hair products and grooming every year remains high up on most people’s shopping lists. Obviously, hair loss/baldness through choice is different – but to have it imposed on you can lead to feelings of vulnerability.
Whilst the media focuses on the impact hair loss has on women, during cancer treatment – I’d like to add that men can also be affected, and sometimes this isn’t acknowledged. It's been shown that men with cancer, tend not to seek advice or help about their treatment induced hair loss. I do wonder if there's an assumption that hair loss is naturally more devastating for women? In fact, men, particularly younger men, are often devastated about the loss of hair and change to their body image.
I’ll talk you through the stages of hair loss, and what to expect, with helpful tips to get you through this difficult period.
Which treatments cause hair loss/thinning?
Cancer treatments such as some chemotherapy, radiotherapy, hormonal treatments and targeted treatments have the potential to thin the hair. In chemotherapy, particularly, some drugs cause complete hair loss, whilst others may cause some hair thinning.
This hair loss is usually temporary, and after treatment should grow back. According to Breastcancer.org ‘Hair loss occurs because chemotherapy targets all rapidly dividing cells—healthy cells as well as cancer cells. Hair follicles, the structures in the skin filled with tiny blood vessels that make hair, are some of the fastest-growing cells in the body.’ (The aim of the treatment is that the cancer cells will weaken and fail to reproduce – whilst our healthy cells will recover.)
Radiotherapy can cause hair loss in the area it is targeted – so not on the head, unless the radiotherapy is treating this area. It doesn’t always happen – it depends on the type, dosage and length of treatment.
Some hormone therapies cause hair thinning, as do some targeted therapies. Again this is usually temporary, and regrows when treatment has finished. Do ask if this is a known side effect – to be forewarned is to be forearmed, as there are measures you can take to treat your hair gently.
When does it happen?
It’s usually a few weeks into treatment that hair loss occurs. With chemotherapy, it generally happens about 2-3weeks after the first cycle of chemotherapy. It also can affect eyelashes, eyebrows and other bodily hair.
Many people are on three weekly treatments, and find that it’s around the time of their second treatment/cycle, that the hair starts to fall out. It may fall out quickly or be more gradual, and some people don’t lose all their hair. You may find clumps of it on your pillow, in the shower, and in your hairbrush. I find this may be the point where the hair loss may feel the most distressing, no matter how mentally you are prepared for it.
A few days before you lose your hair, you may feel your scalp feels tender. If you haven’t had your hair cut beforehand, the weight of long hair may feel painful.
Preparing for hair loss/thinning
Even as I’m typing this, I’m thinking how hard it is to be clinical about the impact of your hair loss or thinning. So – whilst these suggestions are practically based, I’m aware that it is a hugely significant time for you. People tell me that this is the point, where they feel the world sees them as a cancer patient, and that can be hard to handle.
- Prepare your family and friends that you’re going to have treatment, and may lose your hair. Children in the family, in particular, can be encouraged to help you chose hats and headgear - if they feel involved in the process, they will be less daunted.
- Source some hats/headgear – having a collection ready, and experiment with ways of wearing them…it can take a bit of practice.
- Sorting out a wig before your lose your hair is a good idea. The hairdresser/wig fitter will be able to colour match your hair better, and see the style you favour. You may decide that a wig isn’t for you, and opt for headgear/hats/scarves or no head gear. Your hospital team will explain the process for getting an NHS wig, and the costs involved.
- Many people choose to cut their hair before their treatment begins. It can help practically – as the hair loss may not feel quite so dramatic, and more comfortable as the scalp can be quite tender during chemotherapy, particularly when the hair prepares to shed.
- If you’re going to shave your head, it’s important not to nick or scratch the scalp, as it could be a source of infection.
- Some websites suggest wearing a hair net in bed, near the time your hair may start to thin, so as to help catch some of the falling hair overnight.
- It can all feel very isolating, but you’re not alone. It can feel better taking control by finding out about managing hair loss. Maggie’s Centres ‘Managing hair loss’ workshops provides practical and emotional support to give you confidence. Simply drop in or contact your local Maggie's Centre for further details. (There is also a range of advice on the internet about managing hair loss, which I’ll add at the end of the blog). You’ll also get the chance to talk with others facing the same prospect, and meet others in the centre who have been through the experience and may have some useful survival strategies.
- Think about how you might manage the temporary loss of eyebrows and eyelashes – practical make up advice is free in many areas from Look Good, Feel Better workshops. You can find out more about what is available in your area here. You will see that many ‘Look Good, Feel Better’ workshops are held in Maggie’s Centres, so if you’re dropping by, do ask.
You may have heard of scalp cooling/cold cap, which can be a way of retaining your hair during treatment. This can be defined as ‘cooling the scalp with ice packs or cooling caps (cold caps) for a period of time before, during, and after each chemotherapy (chemo) treatment to try to prevent or reduce hair loss’ (American Cancer Society).
When scalp cooling first came out, the results weren’t particularly good, but the newer computer controlled scalp cooling systems are having better results. You can ask at your oncology clinic about having scalp cooling, as they’ll be able to advise if it’s suitable or not with your particular treatment.
People do report needing longer time at the chemotherapy administration appointment, and find it can cause some discomfort. There is a chance there may still be some hair thinning and patchy hair loss, despite the scalp cooling.
There is a useful downloadable brochure from the Cancer Hair Charity, ‘Scalp cooling’ which explains the process in much more detail. (all links mentioned available at bottom of page)
Your scalp will need some tender loving care, whilst it adjusts to hair loss. It will need washing regularly, maybe twice a day, using an organic, unscented shampoo or soap. A gentle oil, like almond oil – or even olive oil, can then be applied and help developing a dry scalp.
You may feel the cold – so a soft head covering can help retain some body heat.
It sounds logical, but sunscreen on your head, when you’re out – with an SPF30 or more.
Keeping your hats/headgear washed and clean.
When does it grow back?
For some people, there may be some regrowth even whilst on chemotherapy, but for the majority, it usually starts growing back a few weeks after treatment has finished. Its texture may feel different, and the first ‘sprouting’ can often look like baby hair, or fuzz.
I often see people with curly hair to start with, but this is generally only temporary. The colour may seem different too – and the grey some of us have hidden so well (the ‘sparkles’ as my hairdresser generously calls them), will be on show. Hair growth is very individual, but on average our hair grows about half an inch a month.
If you’ve had radiotherapy, it can take longer for the hair to grow back, and it may be thinner than it was before treatment. Occasionally there may be a bald spot where the radiotherapy was focused, but hairdressers are skilled at developing styles and hair pieces to cover any thin areas.
It’s worth noting that colouring and perming (and probably straightening etc) should be avoided for about 6 months after treatment is finished. This is because the new hair will be weak, and it’s quite porous. If you want to colour your hair before then, then considering an organic/non chemical hair dye is something some people try – with mixed results. It’s wise to consult a hairdresser for the first colouring, and you can find a list of hairdressers who have experience with post treatment hair (and wigs) in salon finder – on ‘My New Hair’ website.
You may find that with the different hairstyles and changes, over the time of your cancer treatment and beyond, you find your personality has a shift too. We express our personalities through how we present ourselves to the outside world – and it make take time to re-find your confidence.
If you’d like to talk through any of the issues raised in my blog, you’re very welcome to post a message in our conversation posts. Online visitors can share their own experiences and tips that have worked for them. Finally, you are always welcome to drop into one our Maggie’s Centres to talk anything through, and ask for information and support.
Original blog written by Sue Long, Cancer Support Specialist, May 2017 (updated April 2020)
Videos Cancer Hair Care
Hair loss, hair thinning and cancer drugs Cancer Research UK
Wigs Macmillan Cancer Support
Headwear, wig and eyelash suppliers Breast Cancer Now
The ‘C’ Word (2010) Lisa Lynch
Why and how hair loss happens Breast Cancer.org
Cooling caps (scalp hypothermia) to reduce hair loss American Cancer Society
Scalp cooling Cancer Hair Care
Find a salon My New Hair