Keep Your Hair With Scalp Cooling (“Cold Cap Therapy”) During Chemotherapy

Girl with red hairIf you want to try to keep your hair during chemotherapy read this article. I wish more oncologists would tell their patients about this incredibly simple hair saving technique, but unfortunately many are either unaware of how effective it is or are uniformed believing it might cause you harm. 

Hair loss is a distressing and common side effect of chemotherapy that can be reduced by scalp cooling. For over 15 years (mainly in Europe), patients have been using scalp “cold cap therapy” (CCT or scalp cooling) to keep their hair from falling out during chemotherapy. Recent studies have indicated that cold cap therapy can prevent hair loss in up to 90% of those using it during chemotherapy.

CCT is not yet approved by the U.S. FDA, but that has not deterred thousands of patients from using it in the U.S. and clinical trials are underway at hospitals across the U.S. Fortunately, you don’t need to wait for the results of this trial as many cancer centers are getting the word that they need to offer this to their patients or their patients may go elsewhere.

I was skeptical that this could even work…until I saw it with my own eyes.

My step sister recently completed an intensive course of chemotherapy for breast cancer and she lost all of her body hair, but she kept her beautiful head of hair (take a look at the pictures)! She used cold cap therapy (**she  also used Latisse to save her eyelashes and eyebrows. Read a study on Latisse use after chemotherapy here and watch a video on Latisse and cancer here.)


scalp_cooling_ENHow does it work?

Cold cap therapy (CCT) involves the use of special caps, frozen to a very cold temperature, and worn for a period of time before, during and after each intravenous chemotherapy session. Studies have shown that scalp cooling reduces the blood flow to the scalp and the metabolism of chemotherapy in the hair follicles. This results in less hair loss from chemotherapy.

Although there are many CCT systems on the market, the most commonly available cold cap system in the U.S. is called the Penguin Cold Cap. This cap is filled with gel material that is cooled down to minus 22 degrees Fahrenheit. The caps have to be changed every thirty minutes during the chemotherapy session.

Typically, the cap is worn 30-60 minutes before the start of each chemotherapy session. Then, every 30 minutes, throughout the chemotherapy infusion, a new frozen cap is placed on the head. The patient continues to reapply the frozen caps for 30 minutes (for up to 4 hours, depending on the chemotherapy regimen) after the chemotherapy infusion has completed.

How Effective Is It?

A recently study reported that 75% of patients receiving chemotherapy for breast cancer were able to prevent hair loss during and after their chemotherapy course! Based on other studies, efficacy for CCT has been estimated to be close to 80-90%.

One caveat: When anthracyclines (i.e. adriamycin) and taxanes (i.e. taxotere) are combined and given together (simultaneously) with cyclophosphamide (a schedule that is often called “TAC”; taxotere, adriamycin, cyclophosphamide), the results may not be as good.

coldcapabcWhy Don’t We Hear More About This In The U.S.?

Unfortunately, most oncologists and patients are not aware or not supporters of CCT. This is likely due to a couple of reasons.

The early studies on CCT showed that the technology at the time was not very effective. The older CCT caps did not work as well, for technical reasons (i.e. not as well-fitting, not cold enough, etc.) Additionally, the regimens were not as rigorous (i.e. not worn long enough during the infusion, etc.) The less than optimal results biased the potential early adopters from using CCT in their patients.

Furthermore, the use of CCT is controversial as it relates to potential safety. There is a theoretical concern that by reducing blood flow (and chemotherapy) to the scalp and skull, CCT might increase the risk of cancer cells growing into tumors (scalp and skull metastases.) This is of particular concern among patients who have cancers of the blood (leukemia) and lymph (lymphoma), both of which may hide in the scalp and skull tissues. 

This concern is likely overblown. For most cancers, the risk of scalp and skull metastases is VERY LOW (approximately 0.04%-1%, incidence.) A recent review of patients who received CCT during chemotherapy for breast cancer found that CCT did not increase that risk.

How Do You Get CCT In The U.S.?

You will need to ask your oncologist for their approval to use this during your chemotherapy. CCT is not available in most oncology offices and practices, but you can rent them from the manufacturers. Learn more about renting the Penguin Cold Cap system here.

coolerIf you use the Penguin CCT system, you will also need to store the cold caps in a special freezer to keep them frozen. Alternatively, you can use dry ice and a cooler as a back-up freezing method if you don’t have access to one of the these special freezers.

How Much Does CCT Cost?

Unfortunately, most insurance companies don’t cover CCT.  The total cost for the Penguin Cold Cap system is around $1500 (approximately $400 per month for a 3 month chemotherapy course) for the cap rental and buying dry ice (a back-up freezing method, as mentioned above.) 

Your costs will vary depending on the CCT system, the number of chemotherapy session and the number of months the caps will be in use.

It’s definitely worth asking your insurance company if they will pay for your CCT, as some may (read more here.)


Although we do not have data that shows any increased risk of developing scalp or skull metastases using CCT, it is generally recommended that CCT should not be used with the following cancers: 

  • leukemia, multiple myeloma, non-Hodgkins and other lymphomas, and melanoma.

Additionally, patients with the following conditions may not tolerate CCT well:

  • cold sensitivity, cold agglutinin disease, cryoglobulinemia, cryofibrinogenemia and cold traumatic dystrophy

Bottom Line:

Patients need to understand that without long-term follow-up data and further research, there could be a slightly higher risk of developing a scalp or skull metastasis by using CCT. That said, based on published studies, the current evidence does not suggest any increased risk. It is very important to discuss CCT with your oncologist before you decide to use it.

As your oncologist may not know of CCT, show them this blog article.

gloveCold Gloves and Booties Also Protect Skin & Nails From Chemotherapy Side Effects:

Many patients and oncologists never hear about this either. 

Cold gloves and booties can be worn during chemotherapy infusion sessions to reduce the side effects to the skin and nails that often occur with this treatment.

Read more about it in this study and this study.

A study is currently ongoing to find out if wearing cold gloves can prevent Taxol-induced neuropathy. Until this study is published we won’t know if this works, but I hear from many patients that it does. 

Resources and CCT Systems:

Cancer Centers That Have Cold Cap Freezers:

**Please comment below if you know of other centers that have these freezers, and we will include them in this list**

  • Beaumont Hospital, Royal Oak, MI 
  • Minnesota Oncology, Minneapolis office 
  • Minnesota Oncology, St. Paul office 
  • University of California, San Francisco Medical Center, San Francisco
  • New York-Presbyterian Hospital/Weill Cornell Medical College, New York
  • Block Center for Integrative Cancer Treatment, Skokie, Illinois
  • Santa Monica UCLA, CA (both of the infusion centers)
  • Tower Oncology, Beverly Hills, CA
  • UCLA Westwood, 100 Medical Plaza Building
  • Disney Cancer Center in Burbank, CA
  • UCLA in Santa Clarita, CA
  • The Angeles Clinic, Santa Monica, CA
  • Los Robles Hospital, Thousand Oaks, CA


Step By Step Video Instructions On How To Put On The Penguin Cold Cap:

More Cold Cap Videos:

GMA_624x351ABC’s Good Morning AmericaCold Cap Therapy May Help Women Undergoing Chemotherapy Keep Hair





Print Friendly

About Brian D. Lawenda, M.D.

I am an integrative oncologist. I trained at Massachusetts General Hospital (Harvard Medical School) in radiation oncology and through Stanford-UCLA (Helms Medical Institute) in medical acupuncture. I am the founder of IntegrativeOncology-Essentials.


  1. Erika Bell says:

    Great information, thanks for writing this blog post. I’ll be sharing this information with our clients on our blog.

  2. Charlotte Gyllenhaal says:

    The Block Center for Integrative Cancer Treatment in Skokie, Illinois, offers Cold Cap treatment

  3. Dear Dr Lewanda,
    I am the Penguin Cold Caps representative who actually helped your sister with using the PCC’s. I recognized her from the photos you posted. I am so glad this worked out so well for her! I am also a breast cancer survivor and I successfully used Penguin Cold Caps in 2011 and saved my hair. Since then I have helped 100’s of women like your sister do the same. Just to let you know there are lots of hospitals in my area that now have the Penguin freezers:
    Santa Monica UCLA, CA (both of the infusion centers there)
    Tower Oncology, Beverly Hills, CA
    UCLA Westwood, 100 Medical Plaza Building
    Disney Cancer Center in Burbank, CA
    UCLA in Santa Clarita, CA
    The Angeles Clinic, Santa Monica, CA
    Los Robles Hospital, Thousand Oaks, CA
    If you or anyone else would like to contact me directly please email me. I handle all the chemo patients in the Los Angeles area.
    Thanks, Tricia Strong

    • Hi Tricia, Thank you for helping so many patients save their hair! I’m very impressed with all the centers in L.A. that have Penguin Freezers. The Rapunzel Organization contacted me after reading this post, and they are donating a freezer to our practice (21st Century Oncology, Las Vegas.) We are very excited to be able to offer this for our patients! -Best, Brian Lawenda

  4. Maureen O'Connor says:

    Hello–Not quite a year ago,I used the Penguin Cold Caps at MedStar Harbor Hospital in Baltimore, MD. Dr. Young Lee, Chief of Oncology there has purchased a freezer for the caps and is raising money so that more women can benefit from this treatment. It worked WONDERS for me! Here are two news clips on my experience that I thought would interest you. Please spread the word! It means soooo much! Thank you, thank you!


  5. Thank you for sharing this Maureen.

  6. Kelly says:

    The Meredith and Jeannie Ray cancer center at Ivinson memorial hospital in Laramie, wy now has the medical freezer! I’m the first patient at the cancer center to us cct, and they are incredibly supportive!

  7. AKS says:

    The University of Colorado Hospital (Aurora, CO) got a freezer via the Rapunzel Project April 2014

  8. Rita says:

    Please please please get these cold caps approved by the BC Cancer Agency in Vancouver, BC, Canada! we desperatley need them!

Speak Your Mind