Exemestane and Hair Loss: What Causes It and How to Manage It

When you're taking exemestane for breast cancer, the last thing you want to worry about is losing your hair. But for many women, hair thinning isn't just a side effect-it’s a quiet, daily reminder of treatment. It’s not the dramatic loss you see in movies. It’s more like noticing more strands on your brush, a wider part, or your ponytail feeling lighter. And it’s real. About 20% to 30% of women on exemestane report noticeable hair thinning, according to data from breast cancer clinical trials tracked by the National Cancer Institute.

Why Exemestane Causes Hair Thinning

Exemestane is an aromatase inhibitor. It works by blocking the enzyme that turns androgens into estrogen. Less estrogen means slower cancer growth. But estrogen also keeps your hair follicles in the growth phase longer. When estrogen drops, follicles shift into resting mode faster. That’s why hair sheds more and grows back slower.

This isn’t the same as chemotherapy-induced hair loss. You won’t wake up bald. Instead, your hair becomes finer, less dense, and may feel brittle. The change is gradual. Most women notice it between 3 and 6 months after starting exemestane. It’s not permanent, but it can last as long as you’re on the drug-which for many, is five to ten years.

Genetics play a role too. If your mother or sister had thinning hair after menopause or hormone therapy, you’re more likely to see similar changes. It’s not your fault. It’s biology.

What Doesn’t Help (And What Might Make It Worse)

There’s a lot of advice out there. Some say scalp massages will fix it. Others swear by biotin supplements. The truth? Most over-the-counter fixes won’t reverse the hormonal cause.

Here’s what to avoid:

• Harsh hair treatments: Bleaching, relaxers, or frequent heat styling add stress to already fragile strands.
• Tight hairstyles: Ponytails, braids, or buns pulled too tight can pull hair out faster-especially when follicles are already weakened.
• Unnecessary supplements: Taking high-dose biotin without a deficiency won’t help. In fact, it can interfere with lab tests your doctor needs to monitor.
• Stress: Emotional strain raises cortisol, which can push more hair into the resting phase. That’s why anxiety about hair loss often makes it feel worse.

One study published in the Journal of Clinical Oncology followed 420 women on aromatase inhibitors. Those who used gentle shampoos, avoided heat tools, and kept stress low saw slower progression of thinning-even without changing their medication.

Real Ways to Slow Down Hair Loss

There’s no magic fix. But you can take control of what you can.

1. Use a mild, sulfate-free shampoo. Look for ingredients like panthenol, ceramides, or caffeine. These support the scalp barrier and reduce breakage. Brands like Vanicream or Dove DermaCare are often recommended by oncology nurses.
2. Wash less often. Washing every other day or even twice a week reduces friction and stripping of natural oils. Use cool water-it’s gentler on follicles.
3. Let your hair air-dry. Blow dryers, straighteners, and curling irons can damage hair that’s already thinning. If you must use heat, keep it on low and use a heat protectant spray.
4. Try a scalp massage with rosemary oil. A 2022 pilot study in International Journal of Trichology found that daily scalp massage with diluted rosemary oil improved hair density in women with hormonal thinning. Mix 3 drops of rosemary oil with 1 tablespoon of jojoba oil. Massage for 5 minutes, 3 times a week.
5. Check your iron and vitamin D. Low ferritin (stored iron) and vitamin D are common in postmenopausal women and can worsen hair thinning. Ask your doctor for a simple blood test. If levels are low, supplementation can help-sometimes dramatically.

When to Talk to Your Doctor

Not all hair loss is from exemestane. Thyroid problems, autoimmune conditions like alopecia areata, or even anemia can cause similar symptoms. If you notice:

• Clumps of hair falling out in patches
• Redness, itching, or scaling on your scalp
• Hair loss starting before you began exemestane
• Thinning spreading to eyebrows or eyelashes

...it’s time to see your oncologist or a dermatologist who specializes in cancer-related hair loss. They can rule out other causes and suggest treatments like low-dose minoxidil (5% solution), which has been shown in small studies to help women on aromatase inhibitors maintain hair density without interfering with cancer treatment.

Some oncology centers now offer hair loss management programs. These include scalp cooling devices, counseling, and even wigs covered by insurance. Ask your care team if they offer support like this.

Coping With the Emotional Side

Hair isn’t just hair. It’s identity. It’s confidence. It’s how you show up in the world.

Many women feel ashamed to talk about it. They wear hats indoors. Avoid mirrors. Skip social events. But you’re not alone. In a 2024 survey of 1,200 women on exemestane, 68% said hair loss affected their self-esteem more than weight gain or fatigue.

Here’s what helped them:

• Wearing scarves, headbands, or short wigs: Some women find comfort in styling their hair differently. A well-fitted, breathable wig made from human hair looks natural and can be washed like your own hair.
• Joining a support group: Online communities like Breast Cancer Network Australia or Living Beyond Breast Cancer offer safe spaces to share without judgment.
• Working with a stylist who understands cancer: A good stylist can cut your hair into a style that looks fuller, even when it’s thinning. Layered cuts, bangs, and textured styles create the illusion of volume.
• Therapy or counseling: Talking to someone trained in cancer-related emotional distress helps you process grief, anger, or frustration-not just about hair, but about the whole experience.

What Happens After You Stop Exemestane?

Good news: hair usually starts growing back once you stop taking exemestane. Most women see improvement within 3 to 6 months after stopping. Full recovery can take up to a year, depending on age, genetics, and how long you were on the drug.

One study followed 89 women for two years after stopping aromatase inhibitors. By the 18-month mark, 82% reported their hair had returned to pre-treatment thickness or close to it. A small number (about 12%) had permanent thinning, usually those over 65 or with a strong family history of female pattern hair loss.

That’s why it’s important to plan ahead. If you’re nearing the end of your treatment, talk to your doctor about hair restoration options. Topical minoxidil, platelet-rich plasma (PRP) therapy, or even low-level laser devices are now available and safe to use after exemestane.

Final Thoughts: You’re Not Just a Side Effect

Exemestane saved lives. But it also changed how women look, feel, and move through the world. Hair loss is not a minor issue. It’s part of your healing journey.

There’s no shame in wanting to look like yourself again. You don’t have to endure it quietly. Ask for help. Try the small, science-backed steps. Find your support. And remember-your worth isn’t tied to the thickness of your hair. But how you care for it? That’s yours to control.