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Hester Hill Schnipper Photo courtesy of Beth Israel Deaconess Medical Center​​​​

For many women and men, hair loss is one of the most difficult side effects of chemotherapy. The drugs can cause two kinds of hair loss: One is gradual thinning, which is nerve-wracking because you don’t know how much hair will eventually disappear. The other is near-total hair loss, known as alopecia, which often happens 14 to 21 days after the first treatment.

Your doctor can tell you which to anticipate. If your medications put you in the first group, you may wish to get a layered haircut and to have on hand a few hats or scarves, or even a wig, so you are prepared if you decide to cover your head. If you are in the second group, you may suddenly experience intense scalp tenderness for a day or two. If this happens, recognize it as a 48-hour warning; the tenderness will stop when hair starts to fall out. Hair will not come out all at once. Instead, it will come out in handfuls or patches when you touch, comb or wash it, and it will shed continuously. Losing all of your hair may take less than a day, or it may take several weeks or longer. It is worth remembering that hair loss will occur everywhere on your body, not just on your head.

If you are facing hair thinning or total hair loss, here are a number of other suggestions that may help:

1) If you wish to get your head shaved or buzzed before hair loss begins, schedule an appointment for 10 to 12 days after chemo starts. Some people prefer to quickly buzz it after hair begins to fall.

2) If you want to hold on to as much hair as you can for as long as possible, sleep in a hairnet or soft cap and refrain from touching your hair or washing it.

3) If your hair is long, consider donating ponytails of at least 10 inches to Locks of Love, which makes free and discounted wigs for children.

4) You can also give hair to our feathered friends. Leave strands of hair in bushes and trees so birds can use them to make warm, soft nests.

5) Consider wigs that are both similar to your own hairstyle and different from it.

6) Most wigs contain too much hair and will benefit from a trim.

7) Human hair wigs are expensive. Try synthetic wigs or blends of human and synthetic hair. Most insurance companies chip in; you will need a prescription.

8) In summer, wigs are hot. Keep baby wipes in the freezer. Use a cold one between your head and the wig.

9) In winter, a bald head is a cold head. Consider wearing a soft cap to bed.

10) Pick hats that sit low enough over your ears and forehead to camouflage baldness. Beware of baseball caps with a large hole in the back. Scarves, headbands and jewelry can add interest to hats.

11) Cotton or rayon scarves stay on a bald head. Silk ones don’t but can be used as a second layer. You can buy a yard of inexpensive fabric and make your own. Look for beautiful ways to tie scarves online, especially in videos on YouTube​.

Finally, remember: Hair does grow back after treatment. Most women feel able to go uncovered about three months after their final chemo. Your new hair may be gray, likely will be curly and may have a new texture. Manage it by trying new hair products, and know that you will probably never again complain of a bad hair day. 

Hester Hill Schnipper, a licensed independent clinical social worker, is a breast cancer survivor and the manager of oncology social work at Beth Israel Deaconess Medical Center in Boston. She also writes a blog, Living With Breast Cancer, for the hospital's website.