Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work, Emeritus

SEPTEMBER 12, 2018

An Injustice on Top of the Rest

All of us know about the dramatic hair loss that often, too often, accompanies chemotherapy. Not all chemo drugs have this side effect, but many do, and many of us have spent months being bald. For many women (and some men), baldness is the worst part of chemotherapy and cancer. It is a public declaration of something important happening in life, something that you might well prefer to keep private.

I have known a few women who looked beautiful bald and managed to rock it. They proudly added dangly earrings and maybe more makeup or bolder fashion. Personally, I thought I looked alarmingly like my older brother and found nothing attractive about the look. One patient told me that she screamed each time that she passed a mirror and spotted her bald self; it was a shock, over and over and over again. We make do with scarves or hats or wigs, and we eventually grow our hair back. (Note to patients: BIDMC's Windows of Hope shop on Shapiro 9 is a great source of hats, wigs, scarves, styling advice and kindness.)

If there were justice in this world, you would awaken the morning after the final chemo with the hair you had before it all began. It does not work that way. Instead, there is a painfully slow process of growth. Most women feel able to appear hatless in public about three months post treatment. Their hair is very short, but the scalp is covered, and it is possible to consider one’s self to be European chic.

It is usually shocking to see the hair that comes in. After several weeks or close attention to the mirror and running one’s hands over one’s head to try to feel something, there are finally little sprouts. Little sprouts that, if you are over 40, are likely to be white or gray. I tell women to be patient, that it is possible that the new hair will be their previous color (assuming, of course, that their previous color was natural and not purchased). The best explanation, and forgive me if you are not a dog person, is that the first growth is similar to some dogs’ undercoat. It may stay gray and thin while the real hair grows in over it. This real hair, is almost always very curly. For those of us who always had straight hair, it is challenging to learn how to deal with the curls. They do eventually grow out, and most of us end up with more or less the texture of hair that we used to have, but it takes a long time. It took almost three years for my curls to disappear. In the meantime, I became well acquainted with products and eventually appreciated the ease of the hairstyle.

There is a second kind of hair loss that sometimes occurs with chemotherapy or with hormonal treatments (Tamoxifen or the Aromatase Inhibitors). It is thinning, and the most difficult part is that it is impossible to know how thin one’s hair will get. We are aware that post-menopausal women usually have less thick hair than they did when they were younger, but this seems even more dramatic. There are no good suggestions about how to cope with thinning hair. Some shampoos and conditioners advertise that they increase volume, and drug stores sell products that are primarily aimed at men’s balding. They might help a little, but you have to apply them all over your scalp. Dermatologists are the physicians who know the most about this problem, but they don’t seem to have any great solutions.

I have known women who seriously considered stopping the hormonal treatments because of the hair thinning. If you are wondering about this, please talk with your doctor and make sure yu understand the risks. It is better, I think, to be healthy and alive than to have a gloriously full head of hair. In the best world, of course, you could have both!

Remember the lyrics from Hair:

Gimme head with hair

Long, beautiful hair

Streaming, flaxen, waxen

Give me down to there hair

Share your thoughts about hair loss and thinning in the BIDMC Cancer Community.

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