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Cold Caps: Preventing Hair Loss During Chemotherapy

An annoying cowlick, frizzy hair that can’t be tamed—we’ve all had bad hair days from time to time. But for those with hair loss, particularly those experiencing hair loss due to chemotherapy, it can be disheartening.

“Finding out you have cancer can be one of the most stressful situations a person experiences in their life, then add the fact that their appearance may be different during and after treatment,” said Sandra Ortega, a nurse navigator for Banner MD Anderson Cancer Center at Banner Gateway Medical Center in Gilbert, AZ. “Hair loss, or alopecia, due to chemotherapy is one of the most upsetting side effects of chemo treatments.”

As a way to reduce and prevent hair loss from occurring, some patients are turning to cold cap therapy, or scalp cooling, an approach that’s been used in Canada and parts of Europe for years but has grown in use in the U.S. since 2015 when the Food and Drug Administration (FDA) approved scalp cooling machines.

We spoke with Ortega about what causes hair loss during cancer treatments, how cold caps and scalp cooling work to halt hair loss and costs associated with these devices.

How does chemotherapy affect your hair?

Hair loss occurs because chemotherapy treatment attacks all fast-growing cells in your body—not just cancer cells. Hair follicles are especially sensitive because those cells multiply rapidly just like cancer cells. This can cause hair loss on your scalp, eyebrows, eyelashes, underarms, legs and pubic hair area.

You may start to notice your hair falling out pretty quickly, sometimes as early as the second or third week after the first cycle of chemotherapy, although it may not happen until after the second cycle of chemotherapy.

“When hair starts falling out, it often comes out in clumps rather than an even pattern,” Ortega said. “Imagine running your fingers through your hair and having it tangle through your fingers and fall out.”

Hair loss doesn’t occur with all chemotherapies. Whether your hair remains as it is, thins or falls out can depend on the drugs and dosages.

Once your chemotherapy has stopped, your hair should begin to grow back, but the process can test your patience and affect your self-confidence. That’s where cold caps and scalp cooling can help.

What is scalp cooling and how does it work?

Scalp cooling involves wearing a tightly fitted, helmet-like hat filled with a cold liquid or gel before, during and after you receive chemotherapy.

“During each chemotherapy session, you wear the cap for 30 minutes before the infusion, during the entire infusion and for about 60 to 90 minutes post chemotherapy,” Ortega said. “The amount of time you wear the cap can vary depending on the type of chemotherapy you’re getting and the type of scalp cooling method you use.”

Cold caps and scalp cooling systems work by narrowing the blood vessels beneath the skin of the scalp. By cooling the scalp and reducing blood flow, this also reduces the amount of medicine that reaches your hair follicles. With less chemotherapy medicine in the follicles, the hair may be less likely to fall out. However, body hair, such as eyelashes, eyebrows and pubic hair may still fall out with chemotherapy.

How effective is scalp cooling?

The effectiveness of scalp cooling varies and depends on a number of variables, such as the type of chemotherapy you receive, the dose, the amount and type of hair you have to begin with and the fit of the cold cap.

“Even when scalp cooling is effective, everyone will shed at some point during their chemo regimen, and some could shed up to 40% of their hair. But they will also have new hair growth if they continue to scalp cool,” Ortega said. “In my experience, the more motivated a patient is to decrease hair loss, the better the outcome.”

Is scalp cooling painful?

Although side effects from cooling the scalp are minor, cold caps are very cold and tight, which may cause some discomfort during and after treatment. Some may experience headaches, but these can be resolved with a pain reliever to help manage those symptoms.

Who is eligible for scalp cooling?

Scalp cooling will only work on solid tumors and is not used for blood cancers like leukemia or lymphoma. In addition, scalp cooling shouldn’t be used if you have tumors in your brain or scalp.

To determine if you’re eligible for scalp cooling, talk to your cancer care team about your potential options.

How much does scalp cooling cost?

The cost of scalp cooling can range from $1,200 to $4,000 depending on the number of chemo cycles. Unfortunately, most medical insurance companies don’t cover the cost of scalp cooling at this time. “However, some patients have submitted for reimbursement from their insurance company and received a check for the full benefit amount,” Ortega noted. “It’s worth looking into with your insurance company to see if it is a covered benefit.”

You can also reach out to a nonprofit organization called “Hair to Stay” to see if financial assistance is available.


Scalp cooling or cold caps may help minimize hair loss during chemo treatments for cancer. While the use of scalp cooling systems has been shown to reduce hair loss and thinning hair, there’s no guarantee.

It’s important to talk to your cancer care team about the potential benefits and risks of using scalp cooling.

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