9/13/26

chemo and cancer

Scalp Cooling and Cold Caps: Does It Work, and What Is It Really Like?

What scalp cooling is, how well it works with different chemotherapy, what women who have done it say it is actually like, and what it costs. We are not going to talk you into it or out of it.

The decision has to be made before your first infusion, which is why a lot of women hear about it too late to make it at all.

So ask before your first infusion. After that, the choice has been made for you.

This page is not a recommendation. Scalp cooling works very well for some women and very badly for others, and the women it fails have often paid thousands of dollars and sat through hours of real pain to find out. You should hear that before you hear the success rates, not after.

We do not sell scalp cooling and nobody who does pays us. What we have is the phone. Women call us who capped and kept their hair, women who capped and lost it anyway, and women who had never heard of the word until somebody said it in week three of treatment. That last group is the reason this page exists.

the short version

Ask what your own regimen does to the odds.

This is the question that decides it. Taxane-based chemotherapy responds well. Anthracyclines, the ones often nicknamed the red devil, respond poorly enough that many women who capped through them lost most of their hair anyway.

Ask what it will actually cost you here.

Not just the cap. Ask about per-session facility fees, and about dry ice if you would be using manual caps, and ask your insurer in writing rather than over the phone.

Ask how long your infusion days would become.

Then decide whether you want that, on top of chemotherapy. This is the part women most often say they underestimated.

what scalp cooling actually is

cold, and nothing cleverer than that

Chemotherapy attacks fast-dividing cells, and hair follicles are among the fastest-dividing cells you have. Cooling the scalp narrows the blood vessels under the skin, so less of the drug reaches the follicles, and it slows the follicles down so that what does reach them does less damage. That is the whole mechanism. It is cold, applied carefully, for a set number of hours around each infusion.

There are two ways to do it, and the difference matters more than most people realize before they start.

Machine scalp cooling systems compared with manual cold caps
	machine systems	manual cold caps
how it works	A cap connected to a small refrigeration unit that circulates coolant and holds the temperature steady on its own.	Gel caps frozen on dry ice, swapped over by hand every twenty to thirty minutes through the whole session.
where you get it	At the infusion center, if that center has one. The three sold in the United States are DigniCap, Paxman and the portable Amma system.	Rented directly from the cap company and brought with you. Penguin and Arctic are the names you will hear.
FDA status	Cleared as medical devices, first for breast cancer and since 2017 and 2018 for solid tumors generally.	Not FDA cleared, which is why centers usually cannot supply or store them for you.
who does the work	Infusion staff fit it and monitor it.	You need a helper, often called a capper: a friend or relative who is trained and comes to every session.
insurance	Now billable, with dedicated codes since January 2026.	Much less likely to be covered, because they are not FDA cleared.

Sources: FDA, American Cancer Society, Living Beyond Breast Cancer, breastcancer.org. Last checked September 2026.

One thing scalp cooling does not do. It works on hair loss caused by chemotherapy. It does not prevent hair loss or thinning caused by immunotherapy or targeted drug therapy, so if that is your treatment, this is not the page you need.

does it work

sometimes very well, and it depends mostly on your drugs

Yes, often, and less than the marketing suggests. Almost everyone who caps sheds something. Very few women keep the hair they have now, untouched.

Before the numbers, one thing worth being clear about, because it is easy to read them the wrong way round. The percentages below are the share of women who succeeded, not the share of hair they kept. "Success" in these studies almost always means losing less than half your hair, or keeping enough that you did not need a wig or a head covering. So 59 percent means roughly six women in ten cleared that bar. It does not mean anybody kept 59 percent of her hair.

The single biggest factor in whether you clear it is which chemotherapy you are on. Taxane-based regimens do well. Anthracyclines do much less well. Combinations sit in between.

Reported hair preservation rates with scalp cooling by chemotherapy type
regimen	share of women who kept enough hair not to need a wig
taxane based	Roughly 6 to 8 in 10. The randomized SCALP trial put it at about 59 percent of women; a large Dutch registry at 78 percent. Taxane-only groups with no anthracycline have come in higher still, up toward 9 in 10 in some series.
anthracycline based	Roughly 2 to 4 in 10. The same SCALP trial reported about 16 percent; the Dutch registry about 40 percent. Still a real benefit for some women, but go in expecting less.
both, in sequence	Roughly 4 to 6 in 10. Commonly reported between 45 and 60 percent. Starting the course with the anthracycline appears to make the whole thing harder on the hair.

Sources: SCALP randomized trial, Dutch Scalp Cooling Registry, DigniCap pivotal trial, published reviews in Pathology and Oncology Research and PMC. Figures vary between studies because "success" is defined slightly differently in each: usually hair loss under 50 percent, sometimes "did not need a head covering", and some studies had patients judge it while others used photographs scored by assessors. Last checked September 2026.

Fit matters too, and so does the center. Scalp cooling works better when the cap sits tight against the whole scalp, which is why the crown is the area that most often thins anyway, and units that have been running a program for a while get better results than units that have just started.

What partial success usually looks like, and it is not thinner all over. The cold has to be in contact with the scalp to do anything, and a cap contacts the sides and the back far better than it contacts the top of the head. So the common result is hair kept around the ears and the nape and a bald patch on the crown. Women who have been through it describe that as harder to live with than a bare head, because a bare head looks like a decision and a crown patch does not. A good many of them shave at that point anyway, having paid for the capping.

If you are on AC, ask twice. Anthracycline regimens, the ones often nicknamed the red devil, have the worst numbers here by a distance, and the most common regret we have seen written down is from women who capped through AC, suffered every session, spent thousands and lost most of it regardless. Some still say they would do it again for the regrowth. Many say they would not. Go into that one with your eyes open.

what a capping day is actually like

the part the brochures leave out

Cooling starts about thirty minutes before the drugs go in, so the scalp is already down to temperature. It runs through the whole infusion. Then it keeps running afterwards, and that tail is the part people underestimate: ninety minutes is typical with a machine, and it can be three or four hours depending on the regimen. With manual caps, worn on and changed by hand, you may be capping for four to seven hours after the infusion and travelling home in the cap with a cooler in the back of the car.

So a treatment day gets considerably longer. Women who have done it commonly describe seven to ten hour infusion days, sitting in the chair long after the pumps are off and the other patients have gone home. If someone drives you, they are waiting all of that too, and if you are using manual caps that person is not waiting, they are working: standing for hours, handling dry ice, swapping a cap every twenty minutes on the clock. Partners burn out on this, and the women they are doing it for feel guilty about it, which is its own quiet cost.

how it feels, said plainly

The marketing language is "mild discomfort for the first ten minutes". That is not how most women describe it, and being told the mild version in advance seems to make the real version worse rather than better.

The first fifteen to thirty minutes are hard. Women describe a full-skull ice cream headache, aching in the jaw and the top molars, pressure behind the eyes, and shivering that is difficult to stop. Nausea is common. Some describe coming close to pulling the cap off, and some do.
It does ease. After the first stretch the scalp dulls to it and most women who get through the first session get through the rest. Tolerance does improve across cycles.
Ask about pre-medicating before your first session, not after it. Oncologists routinely prescribe something for the pain and sometimes something for the shivering and the panic. This is the single most useful question on this page and most women only think to ask it once.
You will be cold everywhere, not just on your head. Take a blanket, warm socks, sleeves, a hot drink. Women bring heated blankets. Manual caps run colder than machines and people feel them more.
The cap has to be tight to work, because the cold does nothing where it is not touching skin. Tight enough to leave a mark on the forehead is normal. Some women pad the hairline and the tops of the ears to stop the edge biting.

why women stop partway through

Plenty do, and it is worth knowing the reasons in advance rather than discovering them in the chair.

Heavy shedding anyway after the first or second cycle, at which point the remaining hair does not feel worth the rest of it.
The cold, for the women it does not ease for.
The length of the day, on top of nausea and exhaustion that are already at their limit.
The crown patch appearing and deciding a bare head is preferable.

Stopping is not failure and it is not wasted. The cycles you capped were still capped, and there is some evidence the follicle protection helps regrowth afterwards even when the hair went.

the washing rules, and the part nobody mentions

Capping protocols restrict washing, usually to once or twice a week in cool water with no heat and no styling products. Over several months that has a consequence women rarely see written down anywhere: the scalp gets greasy, and it can start to smell, and shed hair that has nowhere to go tangles into the hair that is left. Women describe dreading the shower, because the weight of wet hair pulls on roots that are already weak.

There is no way to make that sound pleasant, so we will not try. If you are weighing this up, weigh that in too, alongside the pain and the hours. It is one of the most common reasons women say the whole thing felt harder than they expected.

who it is and is not for

a question for your oncologist, not for us

Scalp cooling is used for solid tumors: breast, ovarian, uterine, prostate, lung and others. It is generally not advised for children, for anyone having radiation to the head, or for some blood cancers such as leukemia, where deliberately reducing blood flow to an area is a different proposition. Cold sensitivity conditions rule it out too.

You will also see the question of scalp metastasis raised, the theoretical worry that cooling could shelter cancer cells in the scalp along with the follicles. The FDA describes that risk as rare, and long-term data is still thin. It is a real question and your oncologist is the person to put it to, not a hat company and not a forum.

The one sentence to take to your appointment. "Given my regimen and my diagnosis, is scalp cooling something you would recommend, and does this center support it?" That gets you both answers at once, and it gets them before the first infusion, which is when they are still useful.

what it costs, and who pays now

this changed in January 2026

For years scalp cooling was something you paid for yourself, and women commonly report the whole thing landing somewhere between $1,500 and $3,000 over a course of treatment. Medicare has cited roughly $1,900 to $2,400 for fitting and calibrating a machine cap. Manual caps are rented by the month on top of that.

Two costs get left out of the headline figure and both catch people. Hospitals often charge a separate per-session facility fee for running the machine, which women report in the region of $65 to $150 a session, so it compounds across a course. And dry ice for manual caps is bought fresh for every infusion, commonly $50 to $100 a time, by somebody who has to go and fetch it on the morning of your treatment.

Ask your own center for the total, in writing, including the facility fee. The headline rental price is not the number you will pay.

What has changed is who might pay it, though the old picture has not disappeared: insurers have historically denied these claims as cosmetic and not medically necessary, and many still do.

where coverage stands, September 2026

Medicare. Dedicated billing codes for mechanical scalp cooling moved to permanent status on 1 January 2026, with payment rates set in the Medicare Physician Fee Schedule. Providers can now bill for fitting and for each session.
State mandates. New York was first, effective 1 January 2026, requiring large group insurers to cover scalp cooling. Louisiana followed. West Virginia became the third with the Jessica Huffman Law. Maryland and Connecticut have both had bills before lawmakers.
Private insurance. Still the weak point. The long-standing pattern is denial on the grounds that scalp cooling is cosmetic rather than medically necessary, and women report the same policy paying in one state and refusing in another. Apply anyway, in writing, and expect to appeal.
Manual cold caps. Much harder to get covered, because they are not FDA cleared devices.
Federal. A national coverage bill, the Access to Scalp Cooling Therapy Act, has been introduced in Congress but has not passed.

Sources: CMS, American Medical Association CPT code set, New York AB 430, HairToStay, Paxman. Coverage is moving quickly, so confirm anything here with your own insurer.

If you cannot afford it. HairToStay is a national nonprofit that subsidizes scalp cooling for patients who would otherwise go without, usually up to around $1,000. Sharsheret runs a program that has covered cold capping costs for qualifying patients as well. The machine manufacturers run patient assistance programs of their own for uninsured and underinsured patients. Some hospitals have local funds through their own foundations. Almost all of this has to be applied for before treatment begins, so ask your oncology social worker in the same week you ask your oncologist.

looking after your hair while you cap

gentler than you think is necessary

There is no single proven routine that makes scalp cooling work better, and anyone who tells you otherwise is guessing. What every program agrees on is being gentle, because hair that is under chemotherapy and being frozen every three weeks breaks easily, and hair lost to breakage is lost just the same.

the usual rules

Wash less often, and cool. Most programs suggest once or twice a week in cool water with a mild, gentle shampoo. Alra's mild conditioning shampoo is the one we keep for this: it is formulated for scalps going through cancer treatment, with nothing harsh in it. Pat dry with a towel rather than rubbing.
No heat and no color. No dryers, irons, tongs, dye, bleach or perms for the duration. This is the rule women mind most and the one worth keeping.
Wide-tooth comb, not a brush. A wide-tooth comb passes through without dragging, where a brush pulls on hair you are working hard to keep. Start at the ends and work up. No tight ponytails, no clips that pull, nothing elasticated.
Expect to shed anyway. Shedding through the middle cycles is normal even when capping is working. It is not proof that it has failed.

Some capping programs also ask you to keep tight hats and closely tied scarves off during treatment, on the grounds that anything gripping or rubbing costs you hair you are working hard to keep. We sell hats for a living and we would still rather you followed your program than bought from us. Ask your capping team what they advise, and if you want something on your head, ask for something loose.

if it only half works, or does not work

Have a plan B and do not feel superstitious about it. Buying a scarf does not jinx the capping, and the women who cope best with the thin stage are the ones who had something in the drawer already.

A partial result most often means hair at the sides and the back and a bare patch on the crown, sometimes with long thin original hairs left lying over it. The things that help are the things that help anyone covering a crown: a tinted root powder to take the contrast off the scalp, a wide headband, a hair topper that clips into the hair you kept, or one loose hat. Plenty of women get through the whole of treatment on a headband and a powder.

Two other things worth knowing before they happen. Shedding carries on for several weeks after your last infusion, so the day chemotherapy ends is not the day your hair stops coming out, and a lot of women think capping has failed at exactly that point. And if you decide to shave at any stage, that is a decision and not a defeat.

If it does not work at all, our guide to chemo and hair loss picks up from there, and help, my hair is falling out covers the practical and emotional side of it.

One more thing, because it is the quiet argument in favor of capping even when it disappoints. Women who cool their scalps tend to regrow faster afterwards, and the follicle protection is why a number of women say the point was never really the hair they kept during treatment but the hair that came back afterwards. If that is the reason you are considering it, say so to your oncologist, because it is a different question from the cosmetic one and it deserves a proper answer rather than the standard one.

questions we get asked

open only the one you need

do cold caps really work?

Often, and partially. Read the percentages carefully: they are the share of women who succeeded, not the share of hair kept, and success usually means losing less than half your hair or keeping enough not to need a wig. On that measure, taxane-based regimens report roughly 6 to 8 women in 10, and anthracycline-based regimens far fewer, roughly 2 to 4 in 10. Almost everyone who caps sheds something and very few keep their hair untouched.

is cold capping worth it?

That depends almost entirely on your chemotherapy and on what you are prepared to trade, and nobody can answer it for you. What we can tell you is what the trade is. You would be adding several hours to every infusion day, sitting through a stretch of real pain at the start of each session, washing your hair once or twice a week for months, and paying somewhere in the low thousands that your insurer may refuse. In return, on a taxane regimen, roughly six to eight women in ten keep enough hair not to need a wig. On an anthracycline regimen it is closer to two to four in ten, and a lot of those women describe it as money and suffering spent for very little. Women who keep their hair are overwhelmingly glad they did it. Women who do not are often angry about it. Both groups are right about their own experience.

does cold capping work with AC chemo?

Less well than with anything else, and this is the single most important thing to know before you commit. Anthracycline-based regimens, often nicknamed the red devil, report the lowest hair preservation rates in every study, and the most common regret written down by women who have capped is from those who went through AC, paid for the whole course and lost most of their hair anyway. Some still say the faster regrowth made it worth it. Many say plainly that they would not do it again. If you are on AC or AC-T, put this question to your oncologist directly and ask for their honest expectation rather than the brochure.

why do I have a bald patch on top when the sides kept their hair?

Because cooling only works where the cap is touching the scalp, and caps contact the sides and the nape more reliably than the crown, where head shapes vary most. It is the most commonly reported disappointing outcome. Fit is the thing that reduces it, which is why capping teams cinch the cap much tighter than feels comfortable. If you are still capping, ask your nurse or your capper to check the crown contact at the next session.

when do I have to decide?

Before your first infusion. Scalp cooling is used before, during and after every treatment starting with the first one, and it cannot be picked up later once shedding has begun. If treatment is booked and nobody has mentioned it, raise it at your next appointment rather than waiting to be offered it.

does scalp cooling hurt?

For many women, yes, and more than the marketing suggests. The first fifteen to thirty minutes are the hardest: a full-skull cold headache, aching jaw and top molars, pressure behind the eyes, shivering, sometimes nausea. It does ease after that as the scalp dulls to it, and tolerance improves across cycles. Ask your oncologist about pre-medicating before your first session rather than after it, because that is what makes the difference for most women, and take a blanket, warm socks, sleeves and a hot drink.

how long does it add to a chemo day?

About thirty minutes before the infusion, then the whole infusion, then the tail afterwards. With a machine that tail is commonly around ninety minutes and can run to three or four hours depending on the regimen. With manual caps it can be four to seven hours, changed by hand every twenty to thirty minutes, often continuing at home.

what is the difference between cold caps and a scalp cooling machine?

A machine system is a cap plugged into a small refrigeration unit at the infusion center, which holds the temperature steady and is fitted by staff. Manual cold caps are gel caps you rent, freeze on dry ice, bring with you and swap over by hand every twenty to thirty minutes, which needs a trained helper. The machines are FDA cleared and now have insurance billing codes; the manual caps are neither, which is why most centers cannot store or supply them.

will insurance pay for scalp cooling?

More often than it used to. Medicare set payment rates for mechanical scalp cooling from January 2026, and New York, Louisiana and West Virginia have passed coverage mandates, with other states considering them. Private coverage is still patchy and manual cold caps are much harder to get paid for. Apply regardless, ask your oncology social worker about the nonprofit subsidies and manufacturer assistance programs, and do it before treatment starts.

can I use scalp cooling with any cancer?

No. It is used for solid tumors and is generally not advised for children, for anyone having radiation to the head, or for some blood cancers such as leukemia. Certain cold sensitivity conditions rule it out as well, and it does not help with hair loss from immunotherapy or targeted therapy. Your oncologist has to make that call for your diagnosis.

why we wrote this

specialists in hair loss since 1995

In 1990 my mother Carol lost her hair to breast cancer treatment. There was no scalp cooling on offer, and nothing she wanted to buy either, which is why she and I started Headcovers in 1995.

If cooling had existed then, she would have wanted to know about it, and she would have wanted somebody to tell her the truth rather than sell it to her either way. It is cold, it is a long day, it works well with some drugs and poorly with others, and a good number of the women who try it end up shaving anyway. It is also the one thing some women get to choose in a year when nothing else is up to them, and that counts for something too.

I am not going to tell you to do it and I am not going to tell you not to. I would just rather you had the choice, and had it early enough to make it properly. That is what my mother did not have.

Whatever happens with the capping. Soft hats, scarves and wigs made for hair loss, since 1995. And a person on the phone if you would rather ask.

hats & scarves → wigs & hair pieces

keep learning

chemo and hair lossWhat happens, and roughly when. hair growth after chemoThe first year, stage by stage. help, my hair is falling outCoping, scalp care and what to wear. should I shave my head before chemoHow to decide, and how to do it kindly. how to choose a cancer hatFabrics, coverage, and what to look for. free wigs for cancer patientsPrograms, insurance and where to ask.

written by Danielle Galland-Yates President of Headcovers. Designing and fitting wigs and headwear for women with hair loss since 1995. page last updated September 2026

This guide is for informational purposes only and is not medical advice. Headcovers does not supply scalp cooling and has no commercial relationship with any scalp cooling company. We sell headwear and wigs, which means we stand to gain if you do not use scalp cooling, and we have tried to write this page as if that were not true. Whether scalp cooling is suitable for you depends on your diagnosis, your treatment and your own health, and only your oncologist can answer that. Coverage rules and prices change; confirm anything here with your care team and your insurer.

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