If you’ve been told you’re starting TCH chemotherapy, you may feel as though everything is suddenly moving very fast. New drug names, appointment schedules, and treatment decisions can all pile up at once.

One of the most common questions patients ask early on is also one of the hardest: “Will I lose my hair?”

Hair loss doesn’t affect how well treatment works, but emotionally it can feel like a very visible loss of control at a time when life already feels uncertain. That’s why many people ask about cold capping, and whether it can help during TCH chemotherapy.

Let’s walk through this carefully, step by step, in plain language, so you can decide what feels right for you.

What is TCH chemotherapy?

TCH is a commonly used treatment for HER2-positive breast cancer. The name comes from the three medicines used together:

• Docetaxel (Taxotere) – a chemotherapy drug that stops cancer cells from dividing
• Carboplatin – another chemotherapy drug that damages cancer cell DNA
• Trastuzumab (Herceptin) – a targeted therapy that attaches specifically to HER2-positive cancer cells

TCH is usually given every three weeks, most often for 4 to 6 cycles. Trastuzumab is often continued after chemotherapy finishes.

If this feels like a lot to take in, that’s completely normal. Most people need to hear this information more than once before it settles.

What about Trastuzumab (Herceptin)?

It’s worth reassuring patients that Trastuzumab on its own does not usually cause hair loss.

Hair loss during TCH is mainly driven by the chemotherapy drugs, particularly Docetaxel, not the targeted therapy.

This is why many patients notice shedding slows or stops once chemotherapy ends, even if Trastuzumab continues.

Does TCH chemotherapy cause hair loss, and how much is typical?

Yes, hair loss is common with TCH, particularly because of Docetaxel, which is known to be tough on hair follicles.

Without scalp cooling, many patients experience:

• Significant thinning or complete hair loss
• Shedding starting around 2–3 weeks after the first treatment
• Loss of eyebrows or eyelashes

Hair loss from chemotherapy is not permanent, but knowing it’s temporary doesn’t always make it easier to face.

This is where cold capping may be an option.

How Cold Capping works (in simple terms)

Cold capping, also called scalp cooling, involves cooling the scalp before, during, and after chemotherapy.

The cooling helps by:

• Narrowing blood vessels in the scalp
• Reducing the amount of chemotherapy reaching hair follicles
• Making hair follicles less active and therefore less vulnerable

Cold caps don’t stop chemotherapy from working in the rest of your body — they only affect the scalp.

Can you use Cold Capping during TCH Chemotherapy?

Yes, many patients use cold caps during TCH chemotherapy.

You may already have seen similar guidance for other regimens. Penguin Cold Caps has detailed information on:

• TH chemotherapy and cold capping
• TC chemotherapy and scalp cooling

TCH sits somewhere between TC and TCHP in terms of intensity. That means cold capping can work, but results vary from person to person.

Cold Capping options for TCH: Manual caps vs Machine systems

If you’re considering cold capping during TCH chemotherapy, you’ll usually come across two main approaches: manual cold caps and machine-based scalp cooling systems.

Both aim to reduce hair loss by cooling the scalp, but they differ in how they work and in how effective they tend to be.

• Manual cold caps are frozen caps that are changed regularly throughout chemo treatment to keep the scalp at a consistently cold temperature. They’re typically used with the support of a partner, friend, or trained capper who manages timing and fit. Because manual caps can achieve colder temperatures, provide closer scalp contact, and allow cooling to continue after treatment ends (including at home), they are widely regarded as the most effective option for preserving hair, particularly with regimens like TCH that include Docetaxel.
• Machine-based scalp cooling systems are attached to a cooling unit that circulates cold fluid through a fitted cap. These are managed by clinic staff and don’t require cap changes, which some patients find simpler. However, cooling is limited to time spent in the clinic during treatment chair, temperatures are fixed, and fit can vary, which may affect results.

In terms of hair retention, outcomes depend on factors such as chemotherapy drugs, consistency of cooling, and cap fit. Many patients choose manual cold capping for its greater control and higher rates of hair preservation, while others value the convenience of machine systems where available.

There’s no right or wrong choice, but understanding the differences can help you decide what feels right for your treatment, support system, and priorities.

What kind of hair results can you realistically expect?

This is an important conversation to have early.

With TCH and cold capping, patients may experience:

• Thinning rather than complete hair loss
• Ongoing shedding between treatment cycles
• Enough hair retained to avoid wigs or head coverings
• Thinner areas, often around the crown or temples

Some patients keep most of their hair. Others keep enough that hair loss is less noticeable to others, even if they feel it themselves. Cold capping is best thought of as a way to dramatically reduce hair loss, not eliminate it entirely.

Preparing your hair before starting TCH

The condition of your hair going into treatment matters more than people often realise.

Before your first cycle, it helps to:

• Avoid colouring, bleaching, or chemical treatments
• Stop heat styling where possible
• Use gentle, sulfate-free shampoo
• Consider trimming very long hair to reduce weight

Think of this as protecting your hair from extra stress while it’s already being challenged.

Real hair retention results with similar chemotherapy regimens

3 months after chemo

Spotlight: Rachel — TCH chemotherapy

Regimen: TCH (6 cycles)

Hair retained: ~90%

Outcome: Maintained most of her natural hair throughout treatment, with no need for a wig or head covering

Rachel’s experience is typical of what many people using manual cold capping aim for with TCH: noticeable thinning, but strong overall preservation that allows daily life to continue without visible hair loss.

Further real-world results from Penguin Cold Caps users include:

TCHP: ~80–85% hair retention — visible thinning, but enough hair preserved to avoid wigs
TC (Taxotere & Cytoxan): ~80% hair retention — partial thinning with good overall coverage
TH: Up to 100% hair retention reported in some cases — minimal visible change

(Individual results vary depending on drugs used, fit, cooling consistency, and hair type.)

If you’d like to explore more real experiences, you can read additional patient stories here:

Tanner saved 80 – 85% of her hair on TCHP
Laura had 100% hair retention on TH
Christie saved 80% of her hair on TC
Kathy saved 80% of her hair on TH

What it’s like to Cold Cap during treatment

Cold capping requires a bit of planning, especially if manual caps are used.

You can expect:

• Cooling to begin before chemotherapy starts
• Caps to be changed regularly to maintain temperature
• Cooling to continue after treatment finishes

Some people find the first 10–15 minutes uncomfortable, then describe a numbing sensation. Others tolerate it quite easily. Everyone’s experience is different, and there is no “right” reaction.

Does Cold Capping affect cancer treatment?

This is a very common and understandable concern.

Based on current evidence, cold capping does not reduce the effectiveness of chemotherapy. The cooling is localised to the scalp and does not prevent chemotherapy from circulating through the rest of the body.

If you have specific concerns, your oncology team can talk them through with you, and they’re used to being asked.

The emotional side of hair preservation

For many patients, cold capping isn’t really about vanity.

It’s about:

• Feeling like yourself for a little longer
• Maintaining privacy around your diagnosis
• Continuing to work or socialise without questions
• Holding onto something familiar during change

Even partial hair preservation can make a meaningful emotional difference, and that matters.

Is Cold Capping worth it during TCH?

There’s no universal answer, only what feels right for you.

Some patients choose cold capping because:

• Keeping their hair feels emotionally important
• They want to try everything available
• They value having a sense of choice

Others decide it’s not for them, and that choice deserves just as much respect.

A final word

Starting TCH chemotherapy is a big step. It’s okay to ask questions, to change your mind, and to take time deciding what support you want around you.

Cold capping is one option, not a requirement, and understanding it properly can help you feel more prepared for what lies ahead.

If you’d like to speak to someone about whether cold capping is right for your treatment plan and timeline, simply complete the form below and a cold capping specialist will be in touch.