Hair Loss & Scalp Cooling During Chemo: What It’s Actually Like

I want to start sharing a bit more of the practical things that happen during chemo. The stuff that sits somewhere between medical reality and everyday life. Hair loss is one of those things, and there’s no point pretending it’s not a big deal.

Going into chemo, my main focus was very clear: I wanted to get through it, I wanted to be healthy, I wanted to survive this. But at the same time, hair still mattered to me. Probably more than I expected. And yes, part of that is just how much hair is tied to identity, especially as a woman. I wish I had been a bit more detached from it, but the reality is, I wasn’t.

Chemo already takes a lot from you. Physically, mentally, structurally. And there’s something about not wanting to also look as sick as you might feel. Or sometimes even worse, looking sicker than you actually feel. I remember looking in the mirror and seeing pale skin, no tan anymore, eyebrows slowly disappearing, hair thinning, and it just hits differently. Even on days where I felt relatively okay, I looked at myself and thought, this is not how I recognise myself. So for me, it was a very natural decision in the beginning to try to hold on to my hair for as long as possible, using whatever was available.

Scalp cooling: what it is and what actually happens

That’s where scalp cooling came in. I used the Paxman Scalp Cooling System during my 6 months of chemo in Melbourne. It was offered as part of my treatment and covered, so there was no real downside in trying it. No one promised me results, it was very much framed as something that might help but might not.

The way it works is relatively straightforward, but the experience of it is quite physical. Your scalp is cooled down to just a few degrees above freezing, usually around 3 to 5°C. That level of cold reduces blood flow to the scalp, which means less of the chemo drugs reach the hair follicles. At the same time, the follicles become less active, which makes them slightly less vulnerable to damage.

That’s the mechanism. Whether it works depends on a lot of factors, including the type of chemo you’re on and how your body responds.

In practical terms, it becomes part of your chemo routine. Your hair gets wet beforehand, you put conditioner in so the cap doesn’t stick, and then the cap is fitted tightly onto your head. It goes on about 30 to 60 minutes before the infusion starts, stays on during the entire chemo session, and then for about another hour afterwards.

For me, that meant chemo days of around 5-6 hours. So it’s not just a small add-on, it really shapes the day. Sometimes the nurses helped set everything up, but often my partner, my sister or friends supported me with it. It’s manageable, but you are quite involved in the process.

What it felt like

In terms of how it felt, I personally didn’t find it as bad as I had expected. The first minutes are intense, that initial cold is very noticeable, but after a while your body adjusts. I never had a moment where I felt like I had to stop because of it. But I am sure there's other people who experience this differently.

What stood out way more to me was how different it could feel each time. And I think that’s something that’s really important to keep in the back of your mind. You don’t show up to chemo the same way every week. Sometimes you come in after a really rough week, you’re tired, maybe a bit more emotional, your body already feels off. And sometimes you come in feeling really okay, you’ve slept better, you just feel a bit more like yourself.

The exact same setup can feel completely fine one day and much harder the next. Not just the scalp cooling, but everything around it. A blood draw suddenly feels more intense, an injection stings more than usual, or you just feel more sensitive overall.

It doesn’t always mean something is wrong. A lot of the time it’s just where your body and your nervous system are at that day. So if something feels harder one session than the last, I would really try not to overanalyse it. Just take it for what it is and be a bit more gentle with yourself on those days.

A few practical things that made this easier

There are also a few very practical things I wish I had known earlier. Nothing big, but the kind of small things that make everyday life a bit easier.

• After each session, your hair is usually full of conditioner. I almost always just put on a cap or a beanie to go home and dealt with it there.

• I washed my hair much less than I normally would, probably once or twice a week. Not because of strict rules, but because you do notice that more hair comes out with each wash.

• I stopped trying to make it look perfect. Caps, messy hair, just leaving it as it is took a lot of pressure off.

• On longer chemo days, I made sure I was as comfortable as possible. Layers, snacks, something to distract myself.

• And maybe the biggest one: not overanalysing every small change.

• I took Biotin (after got the approval from the oncologist), not sure if it did something, but something it's teh thought alone is enough )

  
  

None of this is a rule. Just things that made it feel more manageable for me.

Hair loss, switching chemo, and the point where I let go

Hair-wise, I didn’t really have a clear “it worked” or “it didn’t work” moment. I ended up somewhere in between. I’d say I kept maybe around 60 to 70 percent of my hair. Which, on paper, sounds like a lot. And maybe from the outside it even looked like that.

For the first few months, it felt like it was working quite well. Then my chemo changed from TC to AC, which is a stronger combination, and that’s when I noticed a shift. The shedding increased and my hair started to look more patchy.

I think from the outside, most people wouldn’t have noticed it that much. But I definitely did. And that changes how you feel about it. I started wearing caps, and technically I probably could have continued like that. But at some point, constantly thinking about how to cover it, how it looks, whether it’s noticeable, it just became exhausting.

It stopped feeling like something that supported me and more like something I had to manage all the time. That’s when I started questioning what I was actually holding on to.

That's when I decided to shave it. That moment was emotional, I cried while my sister shaved my hair, but it was also a relief. I didn’t have to negotiate with it anymore.

What actually shifted for me after shaving

After I shaved my hair, something shifted pretty quickly. Of course it was emotional in the moment. But once it was gone, there was also this really unexpected sense of relief. I didn’t have to think about it anymore. I didn’t have to hide it, manage it, or constantly check how it looked.

Even though the buzzed hair was still a bit patchy, it didn’t bother me in the same way. It actually felt… freeing. And that feeling was new to me. There was something about having short hair as a woman that made me question a lot of things I had never really questioned before. Why is this such a big deal? Why is so much of how we see ourselves tied to this one thing?

And at the same time, it didn’t just disappear overnight. I still had moments where I looked in the mirror and felt unsure. I remember asking Aaron more than once if he still found me attractive like this. If I still looked like “me”. And he would just look at me and tell me I looked cute. That it suited me and he loves me no matter what!

But it takes a moment for that to actually land. Because you’re still holding onto this internal image of yourself that suddenly doesn’t match what you see anymore. For me, that whole phase was less about the hair itself and more about letting go of what I thought I needed to look like.

Last but not least: Hands, feet and neuropathy

Depending on the chemo protocol, another thing that sometimes comes up alongside scalp cooling is cooling gloves and socks to reduce the risk of neuropathy. I was given both.

For me, cooling my feet was completely fine. I barely noticed it after a while. The gloves for my hands were a different story. My fingers were much more sensitive, and I found it hard to keep them on for hours.

I ended up doing it in a more flexible way. I would keep them on for a while, take them off to eat or use my phone, and then put them back on again. So not perfectly consistent, more like in phases throughout the session.

For me, that worked and I didn’t experience neuropathy. But I’d be careful taking that as a general recommendation. If you notice early signs like tingling or numbness, it probably makes sense to be more consistent than I was, even if it’s uncomfortable.

This is just my experience. There are people for whom this won’t even be that relevant, depending on the chemo protocol. Some treatments are shorter, or less aggressive in terms of hair loss, and I can imagine that in the first few months there’s often a higher chance of keeping most of your hair anyway.

There are also people who don’t feel as attached to their hair in the first place. Or who have already gone through that internal shift long before chemo. And others who were already wearing their hair short, where the whole process might feel very different again.

I think that’s the bigger point. Everyone goes through this in their own way, and what feels like a big thing to one person might not feel the same to someone else.

For me, it was a big thing. And I’m really glad I had the option to try scalp cooling. And I would do it again (I hope I never have to lol).

Not because it worked perfectly, but because it gave me choices. And I’m genuinely grateful that this kind of technology even exists now and is accessible in some places.