The Complete Guide to Cold Capping: What Every Woman Needs to Know Before Chemotherapy

By Re-Femme — created by a survivor, for survivors.

Hair is More Than Hair

For women facing chemotherapy, it’s identity, privacy, dignity, and control. Cold capping — also called scalp cooling — gives women a scientifically proven chance to keep their hair during chemo, and yet very few patients are ever told it even exists.

This guide breaks down everything you need to know: what cold capping is, how it works, what to expect, cost ranges, insurance tips, success rates, questions to ask companies, and real preparation advice from women who’ve actually done it.

What Is Cold Capping?

Cold capping (scalp cooling) is a process that protects your hair follicles from chemotherapy using extremely cold temperatures:

• You wear a cold cap before, during, and after chemo.
• The cap cools the scalp to 32–39°F.
• Blood vessels constrict, limiting chemo from reaching the hair follicles.
• Follicle metabolism slows, reducing damage.
• Many women keep 50–80%+ of their hair.

How Does It Work?

Manual Cold Capping vs. Machine-Based Cold Capping: What’s the Difference?

Cold capping is one of the most effective ways to help reduce chemotherapy-induced hair loss — but choosing the right method can feel confusing. Here’s a simple breakdown to help you understand the two main options.

Manual Cold Capping

Manual cold caps are gel-filled caps that are chilled (usually in a cooler with dry ice) and changed out every 20–30 minutes during treatment.

• Requires a “capper” — someone to swap caps, monitor timers, and ensure tight fit.
• More labor-intensive — can be tiring without a reliable helper.
• Widely accessible — multiple brands available for home use.
• Effective when done correctly — but results depend heavily on technique and timing.

Machine-Based Cold Capping

Machine systems are clinic-based units that keep a single cap cold through continuously circulating coolant.

• Hands-off experience — no swapping caps or timers.
• More comfortable — consistent temperature, no dripping ice or dry ice handling.
• Available only in participating hospitals/clinics.
• Results are very consistent due to precise temperature control.

Which One Should You Choose?

Both methods can be effective — the best choice depends on your budget, support system, and access to a participating facility. If you have a reliable helper and want to save money, manual capping may be perfect. If you prefer a streamlined experience and your clinic offers a machine system, the convenience may be worth it.

Re-Femme supports both methods and provides guidance, checklists, and recommended products for whichever route you choose.

What to Expect

• First 10 minutes: intense cold, then tolerable.
• Pre-cool 30–60 minutes before infusion.
• Post-cool 3–5 hours after infusion ends.
• Follow all “chemo hair rules.”
• Shedding is normal in weeks 3–6.

Questions to Ask Companies

• What's the effectiveness for your specific chemo regimen?
• What support and/or training is provided?
• What temperature is therapeutic and how is that monitored/controlled?
• What's the cost?
• What paperwork do I need from your company to submit to my insurance (if insured)?
• What codes should I reference for Filing Claims?
• What are the realistic results and expectations?

Cost Ranges

• Manual caps: $2,200–$3,000 + dry ice
• Machine-based cooling: Around $1,800
• Total average: $1,800–$3,500

Insurance Coverage

Some reimbursement may be possible. Best success with:

• Letter of medical necessity
• Detailed invoices
• FSA/HSA submission
• Appeals if denied

When to Start

• Caps must be ready before your first chemo.
• Best to order 7–14 days before treatment.

Preparation Checklist

Before Chemo

• Rent caps or reserve machine
• Watch training videos
• Practice achieving a snug fit
• Prepare dry ice or freezer space
• Pack your capping kit

During Chemo

• Begin pre-cooling early
• Snug cap fit — the most important factor
• Stay warm and layered

After Chemo

• Complete the full post-cooling time
• Keep hair dry
• No heat, sweating, or hot tools

Success Rates

• Taxane-only: 70–90% retention
• AC Taxol: 40–60% retention

Results depend on:

• Proper cap fit
• Chemotherapy regimen
• Hair texture & density
• Following all after-care rules

Tips No One Tells You

• Fit is EVERYTHING.
• Temples need extra securing.
• Shedding doesn’t mean failure.
• Use silk pillowcases.
• Avoid heat at all costs.
• Take weekly progress photos.

Final Thoughts

Cold capping is personal, empowering, and deeply under-discussed. Re-Femme is committed to helping women understand their options and feel supported every step of the way.