Should I Shave My Head Before Chemo?

Not all chemotherapy causes hair loss. It depends on which drugs you're receiving and the dosage. Ask your oncologist what to expect from your specific treatment before making any decisions. Where it does happen, it usually starts two to three weeks after treatment begins.2 Everything that happens to your hair during chemotherapy, and when, is in our chemo and hair loss guide.

For most women, hair loss from chemotherapy is temporary. Hair usually starts growing back within a few months of the last treatment.2 It may come back slightly different in texture or color at first, but for most women it comes back. For some women, particularly on certain regimens such as those containing docetaxel, hair stays thinner or does not fully return, and in a smaller number, the loss is permanent.4 Ask your oncologist about the specific drugs you will be getting and their side effects.

Most of the women we hear from recommend shaving. Their reasons come down to one word: control.

Beyond reclaiming control, there are practical reasons women give us:

• It can shorten the hardest part. Watching hair fall out over days or weeks can stretch this out into something prolonged. Shaving makes it one event, on a day you chose.
• It can be more comfortable. As hair weakens, the scalp can become tender and itchy.3 Some women describe an ache at the roots, a sore, bruised feeling like a ponytail pulled too tight, and the weight of long hair makes it worse. Women tell us the relief after shaving was immediate.
• It can become something meaningful. Some women describe shave day, done with a daughter, a sister, or a husband, as one of the most powerful moments of their experience. It doesn't feel that way for everyone, but it can.

You can wait to see how your treatment affects your hair before deciding whether to cut it. There's no need to rush a decision like this.

• You may not want to lose your hair a day sooner than you have to. Your hair is part of you right now. There's nothing wrong with wanting to hold on to that while you're adjusting to everything else that's changing.
• Hair loss may be less dramatic than expected. Some women see noticeable thinning and never lose it all. Waiting lets you see what happens before making an irreversible decision.
• Cut it down in stages. You can cut shorter in stages rather than make one big change.

• Use electric clippers, not a razor. Leave a short layer of hair rather than shaving to the skin. A blade can nick the scalp or leave ingrown hairs, and a cut matters more than usual during chemotherapy. The National Cancer Institute advises using an electric shaver rather than a blade, so you don't cut yourself.2 We suggest a #2 or #3 guard. Behind the ears is the spot most people miss. Cut long hair short with scissors before you start; clippers go through it far more easily.
• Buy a lint roller before you cut. The stubble sheds for days afterwards and catches on cotton pillowcases. A roller lifts it off your scalp and your pillow. Roll it gently over your scalp and pillow, but only on skin that is not sore, red or broken. A damp soft cloth works too, and a sleep cap keeps it off the bedding at night.
• Choose who, if anyone, you would like with you. Many hairstylists will come to your home or stay after hours for cancer patients. Some women want company and some want the bathroom door shut, and a shave party is not an obligation. Do it quietly, by yourself, if that is what you need.
• Look after the new skin. Skin that's never been exposed is tender. Use gentle, fragrance-free products; the Alra mild conditioning shampoo was made for sensitive scalps in treatment. For dryness, a light, fragrance-free moisturizer rather than a heavy oil; the Alra therapy lotion was made for skin in treatment. If the skin is red, scaly or broken, tell your care team rather than treating it yourself.
• Keep the sun off it. Protect your scalp outdoors with a brimmed hat or a broad-spectrum SPF 30+ sunscreen. Some chemotherapy drugs make skin burn faster, so ask your care team before a day outdoors.
• Donating your hair? Cut it before treatment starts, and check the charity's rules first.

You don't have to figure this all out at once.

Shopping for headwear now, while you're not exhausted or in a hurry, is a completely different experience from scrambling after the fact.

When you're ready to think practically, these are the pieces women reach for most, depending on what you expect to wear. You do not need all of them at once: if five things is too many decisions today, start with the sleep cap and one hat. The rest can wait.

In 1990 my mother Carol was wheeled out of breast cancer surgery with a surgical cap on her bald head, wishing for a pretty sleep cap. Nothing like it existed. She was a professional hairstylist, so if something better had been out there, she would have found it. She made it through on limited options and made a vow: if she survived, she would make it easier for every woman who came after her. In 1995 she and I started Headcovers together. To this day, a soft sleep cap is the first thing I tell a woman to get.

What I have learned from fitting women since then is that the feelings come before the physical part. Often a woman is unhappy with whatever she chooses until she has dealt with the hair loss itself, and for some that takes longer. So take the time you need with your hair before you worry about what goes on your head. When you get to that part, you will not be doing it alone.