Paclitaxel & hair loss: Can cold capping help you keep your hair?

Paclitaxel (Taxol) is a powerful chemotherapy drug used to treat breast, ovarian, and lung cancer. While effective, it often causes side effects like hair loss, fatigue, and neuropathy. For many, losing hair is one of the hardest parts – but there’s a way to fight back.

Hair loss is one of the most distressing chemotherapy side effects – but it’s not inevitable. Cold capping can help many patients retain their hair, sometimes up to 80% or more, even during Paclitaxel (Taxol) chemotherapy.

By cooling the scalp before, during, and after treatment, cold capping reduces the amount of chemotherapy that reaches hair follicles, helping to minimize shedding and preserve your natural hair.

What is paclitaxel?

Paclitaxel is a taxane-based chemotherapy drug that works by disrupting the normal function of microtubules in cancer cells, preventing them from dividing and spreading.

Paclitaxel is the non-branded name of the drug, but you may hear it called by one of its brand names such as Taxol.

What types of cancer is paclitaxel used for?

Paclitaxel is commonly prescribed for:

• Breast cancer (early-stage and metastatic)
• Ovarian cancer
• Non-small cell lung cancer
• Pancreatic cancer

For breast cancer, paclitaxel is often given after Adriamycin and Cyclophosphamide (AC) chemotherapy in a regimen known as AC-T (Adriamycin + Cyclophosphamide, followed by Taxol).

How is paclitaxel (Taxol) administered?

Paclitaxel can be administered in two ways:

• Dose-dense paclitaxel: Given every two to three weeks in higher doses.
• Weekly paclitaxel: Given in smaller doses once a week for 12 weeks (often better tolerated).

How does paclitaxel (Taxol) work?

Paclitaxel targets rapidly dividing cancer cells, stopping them from completing cell division. However, it also affects other fast-growing cells in the body, which is why it causes side effects like hair loss, neuropathy, and low blood counts.

It is given intravenously (IV) through a:

• Vein in the hand or arm
• Peripherally inserted central catheter (PICC line)
• Skin-tunnelled catheter (Hickman line) or implanted port

Each infusion lasts between one and three hours, and most patients receive paclitaxel for 9–12 weeks.

What to expect during Paclitaxel treatment

Before Treatment

Before starting Paclitaxel, you may have:

• Blood tests to monitor white blood cell levels
• Heart function tests (such as an ECG or echocardiogram)
• Pre-medications to reduce side effects, including:
• Steroids to prevent allergic reactions
• Antihistamines (e.g., Benadryl)
• Anti-nausea medications

During Infusion

Paclitaxel is given as an IV drip. The first infusion may take longer as your care team monitors for allergic reactions.

After Infusion

Side effects can occur within hours or days of treatment. The most common include fatigue, nausea, neuropathy, and hair loss.

Common side effects of paclitaxel

Like all chemotherapy drugs, paclitaxel can cause a range of side effects. These vary from person to person but can often be managed with supportive care.

• Hair loss (often complete scalp hair loss)
• Fatigue (ranging from mild to severe)
• Neuropathy (tingling, numbness, or pain in hands and feet)
• Low white blood cell count (higher risk of infections)
• Nausea and vomiting
• Mouth sores
• Diarrhea or constipation
• Joint and muscle pain

Knowing what to expect and exploring ways to manage side effects can help you feel more prepared as you begin treatment. Some side effects, like neuropathy, may persist after treatment, while others improve once chemotherapy ends.

If you have any questions about preparing for chemotherapy, speak to your care team to learn more about how to manage side effects and maintain your quality of life during treatment.

Hair loss and cold capping

One of the most common concerns for patients receiving paclitaxel is hair loss, which typically begins two to four weeks after the first treatment.

Many patients also experience loss of eyebrows, eyelashes, and body hair.

Cold capping, also known as scalp cooling, is a technique used to reduce the amount of chemotherapy reaching hair follicles, helping to minimize hair loss.

The effectiveness of scalp cooling depends on several factors, including dosage, individual response, and adherence to the cooling protocol. But many patients save upwards of 80% of their hair. In a recent retrospective study penguin cold caps had seen 95.7% of ≥ 50% of hair retained

For more on cold capping: What is cold capping?

How does cold capping work?

Cold capping works by cooling the scalp, which restricts blood flow to the hair follicles, limiting their exposure to chemotherapy drugs.

Here’s how it works:

• Vasoconstriction: The cold temperature causes blood vessels in the scalp to constrict, reducing the amount of chemotherapy that reaches the hair follicles.
• Lower drug absorption: With reduced blood flow, fewer chemotherapy drugs penetrate the scalp, decreasing damage to the follicles.
• Hair follicle preservation: By minimizing drug exposure, cold capping helps protect hair follicles, reducing the likelihood of hair loss.

Want to learn more? Read our article: Will cold capping save my hair on chemo?

Clinical evidence supporting Penguin Cold Caps

Research has shown that cold capping can significantly reduce hair loss in patients undergoing chemotherapy, including those receiving paclitaxel (Taxol) and AC regimens.

Clinical studies, along with numerous patient success stories, highlight cold capping as an effective option for preserving hair during treatment.

For more information, visit: The evidence that cold cap therapy works

FAQs about paclitaxel

Will I lose all my hair on paclitaxel?

Without cold capping, most patients experience complete hair loss, including eyebrows, eyelashes, and body hair.

When does hair loss start with paclitaxel?

Hair shedding typically begins two to four weeks after the first treatment, with significant loss by week four.

Will my hair grow back after paclitaxel?

Yes, in most cases, hair starts growing back within a few weeks to months after treatment ends. However, some patients notice changes in texture or color, and regrowth can be slow.

Can Paclitaxel cause permanent hair loss?

While rare, some patients report persistent thinning or incomplete regrowth after chemotherapy. Cold capping may help reduce the risk of long-term hair changes.

Will I lose my eyebrows and eyelashes?

Yes, many patients lose their eyebrows and eyelashes later in the treatment cycle or after completing chemotherapy. These typically grow back a few months post-treatment.

How does cold capping work?

Cold caps work by narrowing the blood vessels in the scalp, which reduces the amount of chemotherapy that reaches hair follicles, helping to prevent hair loss.

How effective is cold capping for paclitaxel?

Studies show that cold capping can help patients retain 50–100% of their hair, depending on dosage, scalp cooling adherence, and individual response.

Does cold capping work for weekly paclitaxel?

Yes! Cold capping is particularly effective for weekly low-dose paclitaxel regimens, where patients often retain more hair than with higher-dose treatments.

Can cold capping prevent all hair loss?

While many patients keep most or all of their hair, some experience thinning, shedding, or patchiness—especially around the hairline and crown.

How long do I need to wear the cold cap?

Cold caps are worn:

• Before chemo (50 minutes)
• During infusion
• After chemo (depending on the regimen)

Penguin Cold Caps provides a customized cooling schedule based on your treatment.

Is cold capping painful?

Some patients find the cold uncomfortable for the first 10–15 minutes, but most adjust quickly. Wearing thermal layers, blankets, and heated pads helps keep the body warm.

Can I wash my hair during cold capping?

Yes, but use lukewarm water, sulfate-free shampoo, and gentle brushing. Avoid washing your hair for at least 48 hours after treatment to minimize shedding.

What hair care products should I use?

• Sulfate-free, paraben-free shampoo & conditioner
• Wide-tooth comb (no harsh brushing)
• Avoid heat styling, dyeing, or tight hairstyles