Several chemotherapy treatment options are available for breast cancer, each with unique possible side effects.

If you’ve been diagnosed with HER2-positive breast cancer, your oncology team may recommend a regimen called TCHP — a combination of four cancer-fighting drugs. This treatment can effectively disrupt the growth of cancer cells but can also cause side effects including alopecia, commonly known as hair loss.

“I’m now about four months from my last infusion of the TCP. I was just told yesterday that my hair looks like a very short haircut rather than chemo grown-out,” one MyBCTeam member wrote.

Other members have said they lost their hair during treatment, only to regrow it after their cancer treatment ended. Here’s what they had to say about their experiences and what you might expect before undergoing TCHP.

What Is TCHP?

“TCHP” stands for the four medications that make up this breast cancer treatment:

The combined effects of the four medications in TCHP target cancer cells, disrupting their growth.

Chemotherapy Drugs in TCHP Can Cause Hair Loss

Docetaxel and carboplatin are chemotherapy drugs. They work by targeting rapidly dividing cells like cancer cells. The drugs work to stop cells from growing and making new copies in various phases of the cell cycle.

Unfortunately, they also harm noncancerous cells that also divide fast— including those found in hair follicles. This is why many people experience hair loss during chemo for breast cancer.

“It took two weeks for my hair to start to fall out.”

— A MyBCTeam member

In fact, 40 percent to 100 percent of people develop complete hair loss during breast cancer treatment with chemotherapy. Many others have hair thinning, but not a total loss of hair. In some cases, these changes are long term and may even be permanent.

Trastuzumab and pertuzumab aren’t chemotherapy drugs. They’re known as targeted therapies because they specifically block a protein that is sometimes found in breast cancer cells called HER2.

Trastuzumab and pertuzumab aren’t generally associated with the hair loss caused by the chemotherapy drugs in TCHP. Instead, common side effects can include fever, chills, and headache.

Scalp Cooling To Minimize Hair Loss With the TCHP Regimen

Because hair loss is common with the TCHP regimen, your oncologist may suggest protective measures to reduce this effect. One technique is called scalp cooling, which entails wearing a cooling cap on your scalp before, during, and after a chemo treatment.

Cold makes blood vessels narrow, limiting blood flow to the scalp. This effect, called vasoconstriction, also reduces how much chemotherapy reaches your hair follicles, which helps prevent hair loss.

🗳️ Did you use scalp cooling during TCHP chemo?

Yes, and I was satisfied with how much hair I kept.

Yes, and I am unhappy with how much hair I still lost.

No, I didn’t use scalp cooling and have no regrets.

No, I didn’t use scalp cooling, but I wish I had.

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The U.S. Food and Drug Administration (FDA) has approved several automated cooling systems to prevent or lessen hair loss from chemotherapy. These systems keep the scalp cool at a consistent temperature for the best results.

Since docetaxel commonly causes hair loss, scalp cooling can help during TCHP treatment. It’s not recommended specifically for targeted therapies, since these medications don’t lead to hair loss.

Manual scalp cooling devices like frozen cold caps or ice packs aren’t as effective as automated systems. This is because manual systems start warming up as soon as they’re applied to the scalp, meaning you don’t get consistent cooling.

How Long Until Hair Starts To Fall Out?

MyBCTeam members have shared a range of time frames between when they began TCHP therapy and when they experienced hair loss, but two weeks is commonly mentioned.

“It took two weeks for my hair to start to fall out. So I buzzed it short,” one member wrote. “Then even that was falling out, so my husband shaved my head.”

“I went short, then shaved. It was just easier than dealing with hair everywhere!”

— A MyBCTeam member

Another said, “I lost mine 15 days after my first infusion.”

Most people need several cycles of TCHP, so the total treatment time can take five to six months.

The chemo hair loss timeline is different for everyone — but most see hair loss within the first two to four weeks of starting treatment. “I was told 14 days from my first infusion, and that was right on the dot,” shared a MyBCTeam member.

You may also notice scalp pain or tenderness with treatment, so it’s important to protect your scalp from the sun and cold weather. To help reduce itchiness and the effects of exposure to the elements, you might try:

• Wearing hats, scarves, or wigs
• Using moisturizing lotion and sunscreen

Should You Cut Your Hair Before Treatment?

Because hair loss is such a common side effect of TCHP, you may wonder if you should just go ahead and cut or shave your hair before starting treatment.

There’s no right or wrong choice in getting a haircut before treatment. You can wait to see how your hair responds, or you can take the plunge in advance.

“I cut 12 inches off after my first round,” shared a MyBCTeam member. “About three to four days after the second round, I shaved my head — not to the skin, but left like a quarter inch or so. I probably could have kept my hair for a few more days, but it was starting to fall out, and that was upsetting me. Once it was gone, I wasn’t waiting on it to fall out and just felt relieved.”

Most MyBCTeam members reported cutting their hair after they noticed some loss to reduce the number of long strands that needed to be cleaned up around the house. “I went short, then shaved. It was just easier than dealing with hair everywhere!” explained one member.

Where Will You Lose Hair?

TCHP may affect hair anywhere on your body. However, everyone’s response is different, so you might be surprised by how it affects your hair.

"I never realized how hot hair was. I think I look pretty good without hair. Been rockin’ some pretty fancy hats, too!”

— A MyBCTeam member

“I cut my hair before chemo even started,” said a MyBCTeam member. “My son shaved the rest of it after the second round because it was falling out everywhere. I never lost my eyebrows, eyelashes, or armpit hair.”

How Members Feel After Hair Loss

Perhaps the biggest concern is how losing your hair may affect your self-image. If you have long hair or a signature hairstyle, it’s normal to feel disappointed, sad, or upset about your hair loss.

Because hair loss with TCHP can be a reminder of your breast cancer diagnosis, you may feel less like yourself. Nonetheless, most MyBCTeam members reported overall positive outlooks about hair loss with TCHP, especially when reflecting on the experience. Here’s what they had to say:

• “Now, a year later, I’m loving my super short hair. I used to love my long hair. Change is good!”
• “My hubby and daughter helped me shave my head, and it wasn’t as awful as I thought it would be. I got a henna crown four and a half months later, and it was truly liberating!”
• “It’s been six weeks. No new hair growth yet. I had long, curly white hair, now just stubble. I never realized how hot hair was. I think I look pretty good without hair. Been rockin’ some pretty fancy hats, too!”
• “I had my first proper haircut a month ago. My hair is now like it was before the chemo. It’s a joy to be back to normal. It took 19 months.”

Your timeline for hair regrowth may differ from that of others, but connecting with a support group of people who can relate can make all the difference on your journey with chemo.

If you’re struggling to adjust to the challenging side effects of chemotherapy drugs, follow up with your care team for resources to help you look and feel your best.