Hair Loss (Alopecia)
What causes it: Hair loss in prostate cancer patients is primarily caused by chemotherapy. Not all treatments for prostate cancer cause hair loss – for instance, hormone therapy might cause some thinning of body hair in the long term, but it doesn’t typically make you go bald. The chemo drugs used for advanced prostate cancer (like docetaxel or cabazitaxel) attack rapidly dividing cells, and hair follicles are among the fastest-growing cells in the body. The chemo can damage these follicles, leading to hair falling out.
Hair loss from chemotherapy usually starts a few weeks after the first treatment; you might notice more hair on your pillow or in the shower drain. It can progress to partial or complete baldness on the scalp, and sometimes body hair, beard, and eyebrows can thin out as well. The degree of hair loss depends on the specific drug and your individual sensitivity. Radiation therapy to the prostate does not cause hair loss on your head (it only causes hair loss in the treated area, which might be pubic hair if the radiation fields include that region). So, the big contributor to hair loss is chemo.
How it affects daily life: Losing your hair can be emotionally difficult. For many men, hair is tied to their identity and image. Sudden balding can make you feel self-conscious or “look sick,” which is hard when you’re trying to maintain a normal life. Practically, you might need to deal with a sensitive scalp as the hair falls out – some men get scalp tenderness or itchiness when hair is thinning. You’ll want to protect your head from sun and cold, since hair is a natural insulator. Without hair, you may feel colder or get sunburned on your scalp easily. Hair loss can also be a constant visible reminder of your cancer battle, which can affect your mood. On the plus side, chemo-induced hair loss is temporary – the hair almost always grows back after treatment ends. Hair may regrow with a different texture or color initially (some men’s hair comes back finer, curlier, or grayer), but these changes are usually not permanent. Knowing that the situation is temporary can be comforting, though it doesn’t necessarily make the immediate experience easier. Some men choose to shave their head when hair loss begins, to take control of the process and avoid patchy thinning. Others prefer to cut hair short and let it shed gradually. There is no right or wrong – it’s about what makes you feel comfortable.
Ways to manage or reduce it: Unfortunately, there’s no guaranteed way to prevent hair loss from chemo (aside from scalp cooling caps used in some settings – but those are more common in breast cancer treatment than prostate cancer). Scalp cooling involves wearing a cold cap during chemo infusions to constrict blood flow to the scalp; it can reduce hair loss for certain chemo drugs, though results vary and it’s not available everywhere. If you’re interested, ask your treatment center if they offer cold cap therapy. To manage hair loss, consider getting a short haircut or shaving your head at the onset of shedding – this can make the hair loss feel less messy and psychologically easier, as you won’t see clumps falling out. If you prefer to cover your head, you can wear hats, caps, or beanies. Many men opt for a simple baseball cap or a knit cap in winter.
Wigs or hairpieces are also an option. There are wig specialists and some cancer support organizations that provide free or subsidized wigs for patients (even though wigs are more commonly associated with women, there are male-style wigs too). The choice to wear a wig is personal – some men do, while others just go natural. Take care of your scalp during this time: use a mild shampoo and avoid harsh chemicals. Moisturizing your scalp can help if it becomes dry or flaky. Also, protect your head from sunburn with sunscreen or a hat when outdoors, and wear a warm cap in cold weather to stay comfortable. If you feel distressed about losing your hair, talk about it with someone – whether a loved one or a counselor. It’s a legitimate emotional issue; you’re not being “vain.” Many cancer survivors relate that once their hair started to grow back, it marked a positive turning point in recovery. During treatment, remind yourself that the hair loss is temporary and a sign that the chemotherapy is doing its job on fast-growing cells. Staying focused on the bigger picture can help you cope. And if you choose to embrace the bald look, you might find it can be low-maintenance and even empowering. Do whatever makes you feel better – there’s no wrong way to deal with hair loss.