TCH and hair loss: Why it doesn’t need to be inevitable
Published: July 29, 2025
If you’ve been diagnosed with HER2-positive early breast cancer and offered TCH chemotherapy, you’re likely thinking about the side-effects you might face. One of the most visible, and for many, most distressing, is hair loss.
While your body’s ability to fight the disease is always front and centre, many patients tell us that losing their hair is a deep concern too. Hair loss can feel like an outward sign that something is wrong, a change that many would prefer to keep private.
Patients often describe receiving a cancer diagnosis as if their world has been thrown into turmoil. In the midst of this uncertainty, many want to hold on to a sense of control and normality, and for many, preserving their hair plays a key role in achieving that.
This article will guide you through what to expect from your TCH treatment, the possible side effects, and how cold capping could help reduce hair loss during chemotherapy.
What is TCH?
TCH stands for a combination of three treatments:
- Docetaxel (Taxotere)
- Carboplatin
- Trastuzumab (Herceptin)
This regimen is commonly recommended for patients with early-stage breast cancer that tests positive for the HER2 protein. TCH aims to reduce the risk of the cancer returning by targeting cancer cells aggressively.
How does TCH work?
Each drug in the TCH combination plays a role:
- Docetaxel and carboplatin are chemotherapy agents that destroy fast-growing cells, including cancer cells.
- Trastuzumab (Herceptin) is a monoclonal antibody that attaches to HER2 proteins on cancer cells, blocking signals that promote their growth.
Together, these medicines improve the chance of controlling the cancer more effectively.
What to expect during treatment?
TCH is typically given every three weeks:
- You may have up to six cycles of docetaxel and carboplatin.
- Trastuzumab continues every three weeks for up to 12 months.
Treatment is delivered through a cannula (a small tube in a vein). The first dose of Herceptin is often given on a separate day, but after that, the drugs are usually given together.
Your medical team will monitor your blood counts before each cycle and check your heart function with echocardiograms because Herceptin can occasionally affect the heart.
What are the side effects of TCH?
One of the most visible and emotionally challenging side effects of TCH chemotherapy is hair loss. Most people experience significant or complete loss of hair on the scalp, as well as possible loss of eyebrows, eyelashes, and body hair.
In most cases, this hair loss is temporary. Your hair will usually start growing back after treatment finishes, although it may look or feel different at first. Increasingly numbers of people are using cold capping (scalp cooling) to help reduce this side effect, something we’ll cover shortly.
Other common side effects of TCH can include:
- Increased risk of infection – Lower white blood cell levels can make you more prone to infections.
- Bruising or bleeding – Reduced platelets can lead to nosebleeds, bleeding gums, or easy bruising.
- Anaemia (low red blood cells) – This may make you feel tired or breathless.
- Nausea and vomiting – Anti-sickness medications are usually provided, but let your team know if you’re struggling.
- Fatigue – Many people feel particularly tired in the days following treatment.
- Sore mouth and ulcers – Good oral hygiene can help, and mouthwashes may be prescribed.
- Muscle or bone pain – Often manageable with pain relief.
- Numbness or tingling (peripheral neuropathy) – This may affect your hands and feet and should be reported.
- Nail and skin changes – Nails may darken or become brittle; skin may feel dry.
- Taste changes – Food might taste different during treatment.
- Memory or concentration difficulties – Often temporary, sometimes called “chemo brain.”
Herceptin can occasionally affect heart function, so your team will monitor this carefully.
What is cold capping?
Hair loss with TCH chemotherapy is very common, as both docetaxel and carboplatin are drugs that affect rapidly dividing cells, including those in your hair follicles.
For many patients, hair loss can be one of the most upsetting aspects of treatment. It’s natural to want to explore options to help reduce or prevent this, which is where scalp cooling (cold capping) comes in.
Cold capping, or scalp cooling, involves wearing a specially designed cap filled with a cold gel or cooled liquid during chemotherapy. By lowering the temperature of the scalp, cold capping reduces blood flow to hair follicles, meaning less chemotherapy reaches them.
The goal is to reduce or prevent hair loss while allowing the chemotherapy to treat the cancer effectively.
Penguin Cold Caps is one of the leading providers of this technology, offering patients a well-established method to help protect their hair during treatment.
To find out more go to: What is cold capping?
Does cold capping work with TCH?
While success rates can vary depending on individual factors (including hair type, fit and temperature of the cap, and strict adherence to the cooling protocol), many patients using cold caps with TCH have successfully saved their hair.
For best result it’s important to:
- Start cold capping with your first chemotherapy session.
- Work closely with your oncology team and cold cap provider to get the best results.
- Follow the recommended guidelines for cap fitting and duration of cooling.
Scalp cooling isn’t right for everyone, but many patients find that preserving even some of their hair helps them feel more like themselves during treatment.
If you’ve already started chemotherapy, it’s not too late to begin cold capping. While starting scalp cooling after treatment has begun means you may still experience some hair loss, many patients find that cold capping helps encourage regrowth even during chemotherapy. This often means your hair begins to recover sooner, helping you return to feeling like yourself more quickly once treatment ends.
What does it feel like to cold cap?
We’re often asked: Is cold capping uncomfortable? Will I find it unbearably cold?
It’s natural to worry about how you’ll feel during scalp cooling. After all, the caps must be chilled to very low temperatures to help protect your hair follicles during chemotherapy.
The truth is, everyone experiences cold capping differently, what feels manageable to one person may feel more challenging to another.
So rather than tell you how you might feel, we asked real Penguin Cold Caps users to share their experiences, in their own words.
Liesl
“Yes, the caps are cold, but they’re not intolerable and any discomfort I had was minimal and absolutely worth it to save my hair.”
Christine
“On my first day of chemo, I was more nervous about the cold capping than I was about the chemo. I had heard so many different opinions – it’s painful, it’s so cold, take blankets, drink hot tea, etc. But while it wasn’t exactly pleasant, I never felt that it was painful, and I never needed to lay under blankets or drink tons of tea.”
Bernice
“Before we started, I was worried about how I’d cope with the cold and whether I’d find it too painful. But I didn’t need to worry. I only experienced a bit of discomfort from the initial cap at the start of each chemo session. But this only lasted a few minutes as my head adjusted to the cold – after that, it was fine.”
Sophie
“I was nervous about how I would cope with tolerating the cold. I’m generally a cold person and was worried I would be shivering the whole time wit
h a brain freeze. But it was absolutely nothing like that. The first cap was always the worst, but you become numb to the cold after a while, and they really are tolerable.”
Cold capping can feel challenging at first, but as these real-life experiences show, many people find the initial discomfort passes quickly, and the potential to save their hair makes it all worthwhile.
If you’re considering cold capping, speak to our team. We can help you prepare with practical tips, from bringing warm blankets to knowing what to expect on the day.
What is the evidence that is works?
Evidence shows that cold capping can significantly reduce hair loss and help patients maintain their sense of identity and confidence during cancer treatment.
The evidence that cold cap therapy works, highlights the science behind cold capping and the growing body of research supporting its use. Key findings include:
- Up to 96% of patients on docetaxel chemotherapy (part of the TCH regimen) retained significant amounts of hair using cold capping.
- Patients using Penguin Cold Caps reported not just better hair retention, but also improvements in emotional well-being and a more positive outlook during treatment.
- Studies consistently show that scalp cooling is effective across a range of chemotherapy regimens, with success rates as high as 92% in some patient groups.
Alongside the research, you can read many more patient stories from people who used Penguin cold caps to help preserve their hair and maintain a sense of normality through an otherwise challenging journey. You might also find the Penguin Cold Caps Instagram a great research resource, with many people sharing their personal stories of cold capping.
FAQs: TCH and hair loss
- Does cold capping really work to prevent hair loss during chemotherapy?
Cold capping can significantly reduce hair loss for many patients. Success rates vary depending on the chemotherapy drugs used, how early you start cold capping, and how well the cap fits and is managed during treatment. - How much hair can I expect to keep if I use cold caps during TCH chemotherapy?
Many patients using cold caps during TCH chemotherapy retain a significant amount of hair. Some studies report over 90% of patients on docetaxel-based regimens keep at least half of their hair. - Is cold capping painful?
Most people describe cold capping as cold and uncomfortable at first, especially during the first 10-15 minutes, but say it becomes tolerable as the scalp numbs. The experience varies between individuals. - When should I start cold capping for the best results?
It’s important to start cold capping from your very first chemotherapy session. This gives you the best chance of protecting hair follicles from the outset. - Can I start cold capping after chemotherapy has already started?
Yes, you can start cold capping even after treatment has begun. While it’s most effective when started at the first session, many patients find that cold capping helps with faster hair regrowth if started later. - Does cold capping work with all chemotherapy drugs?
Cold capping is most effective with certain chemotherapy regimens, such as taxane-based treatments (like docetaxel). It is generally less effective with anthracyclines, although some studies show that cold capping can be beneficial for anthracycline-based treatments, but the success rate is typically lower. - How long do I have to wear the cold cap during each chemo session?
Typically, you’ll wear the cold cap 30-50 minutes before chemotherapy starts, throughout the infusion, and for up to 90 minutes after the chemo ends. Exact times depend on the type of chemotherapy you’re receiving. - Are there any risks or side effects from using cold caps?
The main side effects are feeling cold, headaches, or discomfort from the weight of the cap. Serious risks are rare, but it’s always best to discuss cold capping with your medical team. - Will my hair grow back faster if I use cold caps?
Many patients report that even if they lose some hair during treatment, cold capping seems to encourage faster regrowth, helping them return to their normal look sooner after chemotherapy ends. - What can I do to make cold capping more comfortable?
Wearing warm clothes, using blankets or heat pads, drinking warm drinks, and bringing something to distract yourself (like music or a podcast) can all help make cold capping sessions more manageable.
Find a support network
TCH, or any type of chemotherapy, can be both physically and emotionally demanding.
Having a strong support network can make a significant difference in your treatment experience, offering encouragement, shared experiences, and practical advice.
- Support groups
Connecting with others who understand what you’re going through can be incredibly helpful. Many cancer centers offer in-person support groups, allowing you to share experiences, ask questions, and receive emotional support from people on similar treatment journeys. - Online communities
For those looking for support from the comfort of home, online forums and social
media groups provide a valuable space to connect with others undergoing chemotherapy. Groups like the Chemotherapy Support Group on Facebook or cancer-specific forums offer a platform to exchange advice, discuss side effects, and find encouragement.
Looking for inspiration? Follow our Instagram to see stories from our amazing clients who are going through their own cancer journey right now!