A cancer diagnosis can be devastating, and for many women facing chemotherapy treatment, the possibility of hair loss, also known as alopecia, is a crushing added blow. Some women even consider forgoing chemo because they fear this upsetting side effect—as well as a variety of other unpleasant treatment-related issues.

“Most chemotherapy drugs kill cancer cells by interfering with the way they reproduce,” explains Sara Jo Grethlein, MD, a medical oncologist at IU Health Simon Cancer Center in Indianapolis. “Cancer cells, in general, reproduce more rapidly than normal cells do.” But chemo drugs also attack normal cells in our bodies “that reproduce quickly, like the cells that line our mouths and GI tract, our bone marrow cells that make blood cells and hair,” she adds.

Not all chemo drugs cause hair loss, however, so discuss your options with your oncologist. How chemotherapy affects your crowning glory can depend on the type and stage of cancer, drug protocol, administration and duration of treatment and other factors. “For example, low doses of oral cyclophosphamide (Cytoxan) are less likely to cause total alopecia,” explains Shikha Jain, MD, a medical oncologist at Northwestern Memorial Hospital in Chicago. (In addition, high or moderate doses of the intravenous form of this drug also causes hair loss.)

In general, combination chemotherapies are more likely to cause cancer patients to lose their hair than single-drug regimens. Individuals treated with a class of drugs called anthracyclines normally experience partial or complete hair loss. “Most chemotherapy drugs fall somewhere in the middle—causing hair thinning in many patients but not complete hair loss,” says Grethlein. “In most cases, the hair loss is temporary, but it has been found that docetaxel (Taxotere) can cause permanent hair loss in some patients.”

For those who opt to wear wigs, there are some made to meet medical needs. Usually, these replacements for a patient’s lost locks are covered by health insurance. “The construction is designed to be more comfortable for those with bare heads as opposed to those who wear them for fashion over their own hair,” says Jeanna Doyle, author of Wig Ed: What to Look for When Looking for a Wig. Regular nonmedical wigs may also be covered by insurance as long as you secure a prescription from your oncologist and reference it as a “cranial prosthesis” on insurance claims.

In the event that your insurance company doesn’t reimburse for this expense, you can get free or low-cost wigs by contacting cancer organizations and charities, such as Cancer Care (which has a wig clinic) and the American Cancer Society.

Because hair loss associated with chemotherapy is usually short-term, Doyle suggests buying a synthetic wig. “They are typically less expensive and easier to care for than a human hair wig,” she say. But the benefit of human hair wigs is that you can use products on them and style them the way you like for more natural-looking results.

For synthetic wigs with natural textures, check online, as these can be more difficult to find. If you have trouble locating one, you may prefer a wig made from human hair. “Look at the reviews and comments. People will typically give a descriptive review or helpful comments on the wig,” says Quanisha Bynum, a cosmetologist and esthetician at IU Health Simon Cancer Center.

Chemo can cause you to lose body hair too, including eyebrows and eyelashes. Latisse or an inexpensive nondrug solution, such as SurvivorEyes, created specifically for brow loss from cancer therapy, can remedy this problem.

Newer cancer treatments, such as targeted therapy and immunotherapy are less likely to cause hair loss than traditional chemotherapy. But there will, no doubt, be future opportunities to explore this topic.

Chemo Care Solutions

These current treatments may help preserve your hair.

According to Sara Jo Grethlein, MD, a medical oncologist at IU Health Simon Cancer Center in Indianapolis, “By putting ice or other cold substances in contact with the scalp, the blood vessels constrict, reducing the delivery of chemotherapy to the scalp.”

Doctors say this reduces hair loss by decreasing the amount of chemotherapy that reaches hair cells. (Note: Thick hair and styles that block the scalp might make the caps less effective.)

Cold caps (Penguin, Chemo Cold and Elasto-Gel) resemble soft ice pack helmets and are stored in a special freezer. These caps thaw during chemo infusions and must be replaced with a new one every 30 minutes. They are worn before, during and after treatments.

Scalp cooling systems are purchased by some cancer treatment centers and hospitals and made available to patients for a fee. These caps are attached to a refrigeration unit that circulates coolant, so the cap doesn’t need to be replaced during chemotherapy. The Food and Drug Administration has approved the Paxman and DigniCap scalp cooling systems, and some insurance companies might cover the costs to patients.

Scalp tourniquet, a mechanical device that’s inflated and placed around the hairline to reduce blood flow to the scalp, is another way to address chemo-induced hair loss.

Check with your oncologist before trying any of these devices or methods.

Editor’s Note: The print issue version of this article incorrectly stated that a high or moderate dose of intravenous cyclophosphamide does not cause hair loss. That error is corrected in this online version of the article.