I’ve Helped People with their Hair for 50 Years. Now I'm Losing Mine: How to Deal with Hair Loss During Chemotherapy

There are moments in life no one can really prepare you for. Hearing the word cancer is one of them. Shock. Fear. Uncertainty. But when the emotions finally settle down, the part no one talks about comes: learning how to live this new chapter including the consequences you have to deal with, especially hair loss. What's going to happen to my hair? How should I treat my hair during chemotherapy? Will I lose all my hair?

I never imagined I'd be asking these questions myself. I've spent over 50 years helping people care for their hair. In the beginning of my career as a hairstylist, I loved watching women leave my chair with newfound confidence. Later, as the Founder & CEO of Number 4, hearing women say "I've never seen my hair so gorgeous" was one of the most amazing gifts. Hair has always been a tremendous part of my personal and professional identity. When I received my cancer diagnosis in the spring, I dreaded what was to come and realized that this Hair Loss Awareness Month was going to take on a whole new meaning for me.

Let the research begin…. Hair fall and loss of hairline. Women hair thinning and hair loss. Hair protection during chemotherapy. Hair loss medications. I wanted to understand every and all topics related to chemotherapy induced hair loss before I started treatment. I spent hours talking with my doctor, researching medical articles, and reading through endless support group chats on blogs and Facebook. I am incredibly thankful to the women who have shared their journeys, so I can better navigate mine. Now it's my turn to share. While I am still undergoing treatment, I want to share what I've found the most helpful thus far, in hopes these tips will make your hair journey easier, too. A quick disclaimer: even though these insights have worked for me, please always consult your oncologist or care team before making any decisions about your treatment or hair care.

Before Chemotherapy: How to Treat Your Hair and Cope with Hair Loss

Hair loss is inevitable; every day the average human loses 50 to 100 strands, depending on the hair's length, thickness, and frequency of washing. How does this change during chemotherapy? Chemo targets rapidly growing cells, including those in hair follicles. As a result, strands become more fragile, and hair shedding increases. It's natural to wonder about the causes of hair falling, but during chemotherapy, it's the treatment, not the cancer itself. The unpleasant truth I had to accept is that no hair routine, no matter how specific or regimented, can completely stop chemotherapy-related hair shedding. And, unfortunately, there is no magic pill that can prevent hair thinning. The good news is that you can still support your scalp during chemo and help reduce unnecessary stress on already fragile strands. This is the approach I am taking.

My doctor recommended wearing a cold cap (also called scalp cooling therapy). It is a tight-fitting headpiece worn during chemo treatment to help reduce hair loss. How it works is, the cap placed by a professional, lowers the scalp temperature, which helps stall cellular activity, minimizing the amount of chemotherapy drugs that reach hair follicles. Statistics show that it preserves 60% to 90% of hair for many patients, but results depend on the specific case and may vary. While an investment, I opted for the scalp cooling therapy to help maintain as much of my hair as possible. I also decided to keep my hair extensions as long as I could. Thankfully, my hairdresser found lightweight extensions that put less tension on my hair. I was advised to wear a cold cap for 30 to 45 minutes before chemotherapy and for 30 to 120 minutes afterwards.

I also sought out questions to various other hair concerns, such as… Is it safe to wash my hair before chemotherapy? What should I look for in hair care products to help prevent hair shedding? How often is it safe to wash my hair following treatment? The answers did not surprise me, given my familiarity with formulations, however they confirmed that it is essential to use a gentle, pH-balanced shampoo and conditioner, without parabens and sulfates. Hair experiences so much stress during chemotherapy, and harsh chemicals make it weaker, causing even more hair thinning. Thankfully, all Number4 products contain botanical ingredients and are free from sulfates, parabens, and sodium. Our shampoos deliver a luxurious lather that gently cleanses and feels amazing. I can not say enough about indulging in your routine and taking the time to do small things to pamper yourself during this time.

My hair routine didn't change dramatically before treatment, but there were a few important guidelines from my care team I followed before starting scalp cooling therapy:

• Wash your hair 2 days before treatment. It's not recommended to wash your hair earlier than 3 days after chemotherapy, so I found it helpful to start with a clean, residue-free scalp. During treatment, hair and scalp become drier and more sensitive, so a deep but scalp-friendly shampoo is a good choice for this step. N4 Daily Clarifying Shampoo gently cleanses product build-up, oils, and impurities, without stripping moisture or color. While a clean scalp is important, I also wanted to keep my hair hydrated because hair and scalp lose so much moisture during treatment. N4 Hydrating Condition leaves hair hydrated and more manageable – I found it made my hair easier to prepare for each cold cap session. Plus, Vitamin B5 properties help strengthen the hair, giving it extra support, which is especially beneficial during treatment. I followed up with N4 Reconstructing Hair Masque for an extra boost of moisture. Its rich blend of vegetable proteins nourishes and soothes hair without weighing it down.
• Skip a drastic haircut before chemotherapy. I was tempted to cut my hair very short. But hair follicles are already accustomed to the weight of hair, and a drastic haircut puts extra stress on a hair bulb, leaving strands even more fragile. If you still need to freshen your hair before chemotherapy, it's better to opt for a light trim to remove split ends. Also, make sure to let your hairstylist know about the upcoming treatment to avoid excessive tension.
• Avoid any chemical service 2 weeks before and throughout the treatments since it can significantly weaken the hair follicle.

I have long believed in hair rituals, but preparing for chemotherapy made me reconsider my routines, reminding me about something bigger. Despite all the chaos and difficult moments, hair rituals allow you to feel good about who you are. You're a woman. You're allowed to feel feminine, and hair loss can't take that from you. It is essential to support yourself through small acts of self-care. Take your beauty routine as moments to slow down, indulge your senses, and simply reconnect with yourself. While I have always loved N4 Soothing Body Wash as part of my regular routine to cleanse and shave my legs with, this product became an essential part of my self-care ritual. I look forward to this small, restorative part of my routine that is entirely mine, reviving and refreshing my skin and senses.

Nothing fully prepares you for the emotional and physical changes that come with chemotherapy. I couldn't control the outcome, only how I choose to support and care for myself.

Tips on Haircare During Chemotherapy

Scalp cooling using the cold cap was a strange sensation, and not one I will ever really get used to. At first, it felt like plunging my head into a bucket of ice, with an ice cream headache after. But over time, the sensation eased, and the intimidating time has turned into just another step in my treatment. While I believe the cold cap is helping to reduce shedding, I have noticed my hair thinning after the first few treatments. I have come to peace with the shedding, knowing I am doing everything I can to minimize the negative effects of the treatment.

Here are a few additional tips that have become part of my daily hair care habits:

• Washing hair only on the third day after treatment. The 72-hour break gives your hair and scalp time to recover and reduces unnecessary stress from washing on already fragile strands. You can imagine by 3 days, hair can look oily and ready for a wash, however the main goal of this step is to remove medication residue from your scalp, so a deep but gentle clarifying cleanse can be helpful. N4 Daily Clarifying Shampoo cleanses thoroughly but safely, without stripping moisture and color or drying the scalp.
• Washing and rinsing hair with cool or lukewarm water using a very low-pressure hose. Gentle water temperature and low pressure minimize friction that can cause hair breakage or even increase hair thinning.
• Keeping conditioner away from the scalp. Apply it to the mid-lengths and ends to avoid unnecessary residue, since your scalp becomes more sensitive during chemotherapy. I've reached for N4 Hydrating Condition to nourish the mid-length and keep my hair easier to manage, followed by N4 Reconstructing Hair Masque for extra hydration and smoothing.
• Massaging the scalp gently, without vigorous scrubbing. Also, it's important not to scrub the shampoo on the ends, as this can increase knots and may lead to matting. I use N4 Super Comb™ Prep & Protect to detangle my hair and prevent pulling – it's much easier than dealing with knots right before a cold cap session. Plus, a couple drops of Fluoro5 Elixer Restore & Repair Oil helps to surface damage and smooth strands.
• Using a wide-tooth comb to reduce tension on hair. Always start detangling with the ends, not the roots. Working from the roots can pull knots tighter, increasing the risk of tangling and breakage. N4 Detangling Comb helps glide easily through hair, separating knots and making hair smooth. Detangling hair before and after washing has helped me prevent tangling.
• Sleep on a satin or silk pillow case. Cotton pillow cases can cause tension that can lead to pulling and tugging. This tension can add to hair shedding. A satin or silk pillowcase allows for slip and is gentler on the hair follicle.

While I can't promise these tips will make every day easier, they've certainly made a difference for me. My hair is shedding, and that's an unavoidable part of my journey. But these rituals have helped me minimize hair breakage, making it feel healthier, softer, and more manageable.

They've also reminded me how important it is to care for yourself, no matter the circumstances. I'm still going through chemotherapy, but I can already see the beginning of a new chapter. In my next blog, I'll share the steps I'm taking to support hair regrowth and the hair routine after chemotherapy.

The more we share our stories, the more we can learn from each other and support each other. I look forward to updating you all on my status and providing what is hopefully a fresh perspective to women and men facing a similar journey. Stay tuned.

With love,

Toni Wells