Breast Cancer Basics: Cold Cap Therapy Helps Maintain Hair During Chemo

If you want to try to keep your hair during chemotherapy read this article. I wish more oncologists would tell their patients about this incredibly simple hair saving technique, but unfortunately many are either unaware of how effective it is or are uniformed believing it might cause you harm.

Hair loss is a distressing and common side effect of chemotherapy that can be reduced by scalp cooling. For over 40 years (mainly, in Europe), patients have been using scalp “cold cap therapy” (CCT or scalp cooling) to keep their hair from falling out during chemotherapy. Recent studies have indicated that cold cap therapy can prevent hair loss in 10-100% of those using it during chemotherapy (most studies clustering around 50% effectiveness).

CCT was first approved by the U.S. FDA, in 2015, for breast cancer patients receiving chemotherapy. This indication has since been expanded to include all solid tumors.

I was skeptical that this could even work…until I saw it with my own eyes.

About 5 years ago, I watched my step sister go through a course of chemotherapy for breast cancer. She did her own research on CCT and her medical oncologist was very supportive of this, so she decided to give it a try. The outcome was impressive. She kept most of her hair (take a look at the photos).

She also used Latisse to help her maintain her eyelashes and eyebrows, which has been reported to be effective in numerous clinical trials.

Since then, I have had many of my own patients use different CCT devices with varying degrees of success.

How does CCT work?

Cold cap therapy (CCT) involves the use of special caps, frozen to a very cold temperature, and worn for a period of time before, during and after each intravenous chemotherapy session. Studies have shown that scalp cooling reduces the blood flow to the scalp and the metabolism of chemotherapy in the hair follicles. This results in less hair loss from chemotherapy.

There are two categories of CCT devices:

These need to be kept in a special freezer before they’re worn. Patients rent the caps and the freezer/cooler. Some oncology practices have special freezers, on site.

Dry ice blocks are often used to keep the caps frozen, and these need to be purchased locally. Ideally, the office will have a special freezer on site for CCT. These keep the CCT devices at a uniform temperature, which may not be easily reproducible with coolers and dry ice blocks.

Ask your oncologist for their approval to use CCT during your chemotherapy. The machine cap cooling systems are still not available in most oncology offices, but you can rent the manual frozen gel cap devices from the manufacturers (see links, above).

Timing Before, During and After Chemotherapy

Typically, the CCT devices are worn 20-30 minutes before the start of each chemotherapy session and up to 90 minutes after the session (the amount of time depends on the type of chemotherapy given).

When using the manual frozen gel cap CCT devices, every 30 minutes, throughout the chemotherapy infusion, a new frozen cap is placed on the head.

The machine CCT systems only require the cap to be placed once during each chemotherapy session, without any additional cap changes needed.

Effectiveness Varies Based On Multiple Factors:

  • The chemotherapy drugs used
  • The timing and compliance of using the CCT device
  • Proper technique in applying the CCT device

If you are using the manual CCT devices, make sure to practice applying the caps before the 1st actual chemotherapy session. It’s also recommended to bring a helper with you to the infusion sessions, as they will assist you in keeping track of the cold cap temperatures, timing, cap exchanges, etc.

It’s recommended to be very gentle on your hair during your chemotherapy if you are using CCT (from

  • no blow drying, hot rollers, or straightening irons
  • shampoo only every third day with cool water and a gentle shampoo
  • no coloring until 3 months after chemotherapy is done
  • gentle combing and brushing

Why Don’t We Hear More About This In The U.S.?

The early studies on CCT showed that the technology at the time was not very effective. The older CCT caps did not work as well, for technical reasons (i.e. not as well-fitting, not cold enough, etc.) Additionally, the regimens were not as rigorous (i.e. not worn long enough during the infusion, etc.) The less than optimal results biased the potential early adopters from using CCT in their patients.

Furthermore, the use of CCT concerns some oncologists as it relates to safety. There is a theoretical concern that by reducing blood flow (and chemotherapy) to the scalp and skull, CCT might increase the risk of cancer cells growing into tumors (scalp and skull metastases.) This is of particular concern among patients who have cancers of the blood (leukemia) and lymph (lymphoma), both of which may hide in the scalp and skull tissues.

This risk is often overestimated both oncologists. For solid tumors, the risk of scalp and skull metastases is VERY LOW (approximately 0.04%-1%, incidence.)


The most common complaints of patients who use CCT, include:

  • Headache
  • Cold sensation
  • “It was burdensome”
  • “It was heavy”
  • Dizziness

Only 3-13% of patients discontinue CCT due to tolerability issues.

How Much Does CCT Cost?

Your costs will vary depending on the CCT system, the number of chemotherapy session and the number of months the caps will be in use.

  • The total cost for the Penguin Cold Cap system is around $1500 (approximately $400 per month for a 3 month chemotherapy course) for the cap rental and buying dry ice (a back-up freezing method, as mentioned above.)
  • Paxman: $500 for the cap, cost per chemotherapy infusion $100-200. Maximum cost capped at $2,200).

Unfortunately, most insurance companies don’t cover CCT.  It’s definitely worth asking your insurance company if they will pay for your CCT, as some may (read more here.)


It is generally recommended that CCT should not be used with the following cancers: 

  • leukemia, multiple myeloma, non-Hodgkins and other lymphomas, and melanoma

Additionally, patients with the following conditions may not tolerate CCT well:

  • cold sensitivity, cold agglutinin disease, cryoglobulinemia, cryofibrinogenemia and cold traumatic dystrophy

Cold Gloves and Booties Also Protect Skin & Nails From Chemotherapy Side Effects:

Cold gloves and booties can also be worn during chemotherapy infusion sessions to reduce the side effects to the skin and nails that often occur with this treatment.

Read more about it in this study and this study.


  • The Rapunzel project is a wonderful non-profit organization that was established to help chemotherapy patients maintain their hair during treatment. They have also helped to get funding for CCT freezers. Check out their useful tips for CCT users.