Share
Will I lose my hair? For many people, this is one of the first questions after cancer treatment is discussed. Hair can be part of identity, privacy, faith, work and everyday confidence. Worrying about it is a valid part of preparing for treatment.
The answer depends on the exact medicines and their combination. Some treatments cause extensive shedding, others cause gradual thinning, and some cause little noticeable change. Chemotherapy, immunotherapy, targeted therapy and antibody-drug conjugates do not all affect hair in the same way. A useful conversation starts with the names of your medicines.
Why treatment can affect hair
Hair grows from follicles in the skin. Chemotherapy can affect rapidly dividing cells in actively growing follicles as well as cancer cells. Other treatments may alter growth signals or, less commonly, trigger immune-related inflammation around follicles. The result can be shedding, slower growth, breakage or changes in texture and colour.
Hair loss is called alopecia. It may involve the scalp, eyebrows, eyelashes, beard or other body hair. The pattern and timing help the team understand the cause; several treatments and health conditions can contribute in the same person.
Radiotherapy can also cause hair loss in the area being treated. This guide focuses on cancer medicines; ask your radiotherapy team about changes expected with radiation treatment.
Hair changes by treatment type
These are broad patterns, not predictions for your prescription. Antibody-drug conjugates (ADCs) are targeted treatments with an attached cell-killing medicine, so their effects on hair are discussed separately.
- Chemotherapy
- Thinning or substantial loss, sometimes including body hairThe specific drugs, doses and schedule
- Checkpoint immunotherapy
- Hair loss is uncommon when used alone; patchy or occasionally extensive loss can occurImmune-related effects and any accompanying chemotherapy
- Other targeted therapies
- Often gradual thinning, texture changes or altered growth; some drugs cause marked lossThe particular target and medicine
- Antibody-drug conjugates
- Thinning or substantial shedding, varying between productsThe complete ADC and its cell-killing payload
What should you expect with chemotherapy?
Not every chemotherapy drug causes complete hair loss. Taxanes such as paclitaxel and docetaxel, and anthracyclines such as doxorubicin, are examples that can cause substantial shedding. Risk depends on the regimen, dose, schedule and previous treatment.
When shedding occurs, it often begins about two to three weeks after treatment starts. The scalp may feel tender, and eyebrows, eyelashes or body hair may be affected at different times. Hair loss may develop over several treatments rather than happen all at once.
Ask about the entire regimen, including later treatment phases. Another person's experience on different medicines does not predict your own. Less hair loss does not mean a treatment is less effective.
Can immunotherapy cause hair loss?
Checkpoint inhibitors such as pembrolizumab and nivolumab usually cause less hair loss than many chemotherapy regimens when used alone. They can still cause immune-related alopecia, including alopecia areata, where immune effects on follicles produce patches of hair loss. More extensive loss can also occur.
The timing can differ from chemotherapy, and changes may appear months into treatment. New patchy loss deserves review, especially if there is scalp redness, scaling or discomfort. A dermatologist may help identify the pattern and advise treatment.
If immunotherapy is combined with chemotherapy, the chemotherapy can still cause substantial shedding. Ask about the combination rather than relying on the immunotherapy label. Hair loss alone cannot tell you which medicine is responsible.
What happens with targeted therapy?
Targeted medicines affect particular signals or features involved in cancer growth. Some of those pathways also matter to healthy hair follicles. Changes may develop gradually and include thinning, dryness, brittleness, a different curl pattern or altered colour.
Certain medicines targeting the epidermal growth factor receptor (EGFR) can also cause longer eyelashes or increased facial hair. Eyelashes that irritate the eye need advice; do not try to trim them yourself. Some targeted drugs can cause more noticeable hair loss, so the word targeted should not be taken as a promise that hair will be unaffected.
Hormonal treatment, which is often given alongside targeted therapy, may contribute to thinning as well. If treatment continues for months or years, hair changes can remain an ongoing concern. Tell the team early rather than waiting until the thinning becomes severe.
Why can an ADC cause hair loss despite being targeted?
An antibody-drug conjugate, or ADC, links an antibody to a potent cell-killing medicine called a payload. The antibody recognises a target on cells and helps deliver the payload. This delivery system does not completely spare healthy tissues.
Hair loss is a recognised, very common side effect in the official product information for trastuzumab deruxtecan and sacituzumab govitecan. That frequency category includes different degrees of hair loss; it does not mean every patient will become completely bald. Other ADCs have different side-effect patterns.
Ask about shedding and regrowth with the exact ADC. Similar-sounding antibody medicines can have different effects. An ADC also differs from a checkpoint immunotherapy drug, although both may appear in a treatment plan.
Scalp cooling: benefits and limits
Scalp cooling uses a closely fitting cold cap before, during and after some chemotherapy infusions. It may help some people retain hair, and European Society for Medical Oncology (ESMO) guidance supports its use in suitable chemotherapy settings. However, keeping some hair is different from preventing hair loss. Even a result counted as successful in a study may involve noticeable thinning.
Results depend on the chemotherapy regimen, cap fit and cooling procedure. Hair preservation can be uneven or incomplete, and substantial shedding can still occur. Cooling adds time, expense and possible discomfort or headaches, without protecting eyebrows, eyelashes or body hair. It is generally not recommended for blood cancers. Ask about the chance of retaining hair with your particular regimen, the cost and the extra time involved.
Scalp cooling is not established prevention for checkpoint-immunotherapy hair loss or for most other targeted-drug hair changes. For ADCs, a small 2026 study of 40 patients receiving trastuzumab deruxtecan found no significant reduction in hair loss. The study was non-randomised, so it cannot settle the question for every ADC.
Scalp cooling is an optional approach, not a guarantee that hair will be preserved. Planning for hair changes, gentle scalp care, headwear choices and emotional support remain useful whether or not you choose it.
Oils, supplements and hair medicines
No shampoo, oil or supplement can guarantee prevention of treatment-related hair loss. Gentle products may improve comfort, but that is different from protecting the follicle from a cancer medicine. Bring any hair-growth product or supplement to your team's attention before using it.
Minoxidil is not an established way to prevent chemotherapy-induced shedding. A clinician may consider it for selected people with persistent thinning or regrowth problems, depending on the cause and treatment stage. Do not start topical or oral minoxidil during cancer treatment without advice from the oncology team and, where appropriate, a dermatologist.
Correcting a documented nutritional deficiency may help overall recovery. Taking extra vitamins without an identified need is not a reliable substitute for assessment of the hair loss.
Caring for your hair and scalp
Gentle care can reduce breakage and irritation, even when it cannot prevent drug-related shedding. Use a mild shampoo, handle wet hair carefully and avoid tight hairstyles, vigorous rubbing and excessive heat. Seek advice before bleaching, chemical straightening or colouring a sensitive scalp.
Cutting hair short is a choice, not a medical requirement. If you choose to remove it, electric clippers can reduce the risk of cuts compared with a close razor shave. A soft head covering and sun protection help protect exposed skin.
Wigs, scarves, turbans, caps and going without a covering are all valid options. If matching your usual style matters, looking at wigs before shedding begins may help. Choose what feels comfortable and manageable for you.
When hair grows back
After chemotherapy, regrowth commonly becomes noticeable within about two to three months of finishing, although recovery varies. Early hair may be fine, a different colour or curlier than before. Eyebrows, eyelashes and scalp hair need not recover together, and fuller density takes longer than the first visible growth.
Most chemotherapy-related loss improves, but persistent thinning or incomplete regrowth can occur, particularly with some taxane regimens or high-dose treatment. It would be misleading to promise that everyone's hair always returns exactly as before.
Regrowth after immunotherapy, targeted therapy or an ADC can be less predictable, especially with continuing treatment. Request review for limited recovery several months later or continuing thinning. Pain or inflammation needs earlier assessment.
When to contact your team
Report unexpected patchy loss, significant itching, persistent scalp pain, redness, crusting or sores. These can need assessment rather than a change of shampoo. The team may review medicines, examine the scalp and check thyroid function or nutritional factors when clinically indicated.
Seek prompt medical advice for a rapidly worsening or painful rash, blistering or signs of infection. If you have fever or feel acutely unwell during cancer treatment, follow your oncology team's urgent-care instructions. Do not wait for a routine hair appointment.
Support with the emotional impact
Hair loss can make a private diagnosis visible and affect work, social life or intimacy. Tell your team if worries affect sleep, relationships or willingness to attend treatment. These concerns deserve attention alongside other treatment issues.
Ask about counselling, peer support or practical help with headwear. Families can help by asking what the person prefers instead of assuming they should cover their head or dismissing the loss. Support can begin before treatment, while there is time to plan.
Common questions
If I keep my hair does that mean treatment is not working?
No. Hair loss is a side effect, not a reliable personal measure of cancer control. Your team assesses benefit using the tests and clinical findings appropriate to your cancer.
Will shaving make hair grow back thicker?
No. Cutting or shaving does not change the follicle or prevent treatment-related loss. Choose a haircut or covering for comfort and preference rather than a promise of faster regrowth.
Will my eyebrows and eyelashes fall out too?
Some treatments can affect eyebrows, eyelashes and other body hair, sometimes at a different time from scalp shedding. Ask what is likely with your medicines and which products are safe around your eyes.
Should treatment be stopped because of hair loss?
Discuss its impact with the team, but do not stop treatment yourself. The options depend on the medicine, cancer, treatment goal and cause of the hair changes. Support or specialist assessment may help.
What is the most useful question before my first treatment?
With my exact combination, how likely is noticeable hair loss, when might it start, and what can we arrange beforehand? Discuss headwear, scalp care, expected regrowth and access to support.
Sources and further reading
- American Cancer Society — Hair Loss and Cancer Treatment
- Cancer Research UK — Hair Loss, Hair Thinning and Cancer Drugs
- European Academy of Dermatology and Venereology — Cancer Treatment-Related Hair Loss
- Zarbo and colleagues — Immune-Related Alopecia in Patients Receiving Checkpoint Inhibitors
- eviQ — Alopecia
- European Medicines Agency — Enhertu Product Information
- European Medicines Agency — Trodelvy Product Information
- Macmillan — Targeted Therapy and Immunotherapy for Non-Small Cell Lung Cancer
- American Cancer Society — Cold Caps and Scalp Cooling
- Salehi and colleagues — Scalp Cooling Outcomes with Trastuzumab Deruxtecan ESMO Open 2026
- National Cancer Institute — Hair Loss and Cancer Treatment
- Nangia and colleagues — The SCALP Randomized Clinical Trial JAMA 2017
- ESMO — Prevention and Management of Dermatological Toxicities Clinical Practice Guideline 2021
Medically reviewed and approved by Dr (Prof) Vijay Agarwal
Professor and Lead Consultant – Medical Oncology
