Frequently Asked Questions

What? Not lose your hair during chemotherapy?

Hold onto your hats!

You may not need to use them!

Who is Penguin Cold Caps?

Penguin Cold Caps is a family owned British company located in London, England (see: Frank Fronda is the scientist and company founder behind the invention of the caps who for over the last 25 years has researched and built the Penguin Cold Cap Therapy System. Used in over 150 hospitals or clinics in Europe,  patients have used Penguin Cold Caps in the United States with an approximate 90% success rate. There are clinical trials going on in the U.S. in New York, Michigan, Oregon, and California.

Who is Cold Cap Therapy Midwest?

Cold Cap Therapy Midwest, LLC is a consulting & service company in St. Paul, Minnesota that opened it's doors in 2009. Cold Cap Therapy Midwest comes alongside the client and assists with capping, training a team of helpers, and gives helpful advice before, during, and after chemotherapy. Cold Cap Therapy Midwest is a separate company from Penguin Cold Caps. Caps are rented from Penguin Cold Caps and Cold Cap Therapy Midwest offers services, answers questions, supports, and faithfully follows the clients and their chemo schedules.

How does scalp cooling work?
Every hair on the body grows out of a hair follicle. Small blood vessels in the scalp supply the cells of the hair follicles with food and oxygen, and carry away waste products. Any chemotherapy drugs in the bloodstream will also be carried to the hair follicles. When blood vessels in the scalp are cooled they become smaller, so less blood flows through them. Cooling the scalp during chemotherapy means that less of the chemotherapy drug reaches the hair follicles, so the hair is less likely to fall out. Cold Cap Therapy is a method of scalp cooling. Penguin Cold Caps has a specially designed crylon gel filled cap that can be placed and fitted snugly on the head. Every 30 minutes the cap is exchanged for a new colder cap. Colder meaning the caps always begin at about  -30 degrees Celsius. The caps are worn before chemo begins for an hour, during chemo, and usually 4 hours after chemo. This ensures that most of the chemo drugs have gone through the liver which is extremely important if the cap & the cold is to work properly. Most people will use approximately 14 caps if they are using a biomedical freezer. If a client is using dry ice, 8 caps are used and then refrozen until treatment is done for the day.

How effective are Penguin Cold Caps?

Scalp cooling with Penguin Cold Caps can be very effective in preventing or reducing the loss of your hair, but you won't know how well it will work for you until you try it. Despite scalp cooling, you will find that your hair may thin. This process is called shedding. Shedding happens to almost everyone but every person is different so the amount of hair that you shed will be different. Some of the things that will affect how much your hair sheds are: metabolism, digestive shock (probably due to stress which delays the liver from cleaning the chemo drugs from the body), how healthy your diet is, other drugs you may be taking besides chemotherapy, surgeries you've had in the last year, stress in its own right, how healthy your hair is before you begin chemotherapy, how much water you drink before, during and after chemotherapy, whether or not you have closely followed the protocol for Penguin Cold Caps, and of course how well you are versed in the capping process itself. If the caps are applied correctly, there will not be patches of hair or bald spots, but merely an overall thinning. Although the client may see and feel her hair has become thinner during treatment, most people around her/him  will not be able to tell the hair is thinner. My company has a 98% success rate meaning that 98% of the clients I have worked closely with chose not to go to a wig even though there was some shedding.

Who can use Cold Cap Therapy?

Many chemotherapy patients can use Cold Cap Therapy. The specific drug treatment plans and various health factors will need to be considered. Check-out the tab "Drug Compatibility" to see if the drugs you may be using make you a good candidate for using Penguin Cold Caps .

Why do the caps need to be cold?

Studies have shown that wearing a very cold cap slows down the metabolic rate at which hair cells absorb nutrients or anything else in the blood, like chemotherapy drugs. As a result, when the chemo is in the blood stream the hair follicles absorption rate is minimal. Most hair can withstand this level of attack although some thinning (shedding) will occur.

Are the cold caps uncomfortable?

For about the first five minutes after each cap is placed on the head, the sensation is quite cold. Warm blankets are helpful, and most clients prefer an electric, lap sized blanket to stay extra cozy and warm.The discomfort dissipates after that, and the remaining 25 minutes of wear are comfortable to the point that one can hold a normal conversation, read a magazine, or watch a movie to pass the time.   Note: even if a client had chemotherapy without Cold Cap Therapy, her body would feel cold because the saline being infused into the blood circulatory system is at ambient (room) temperature, not body temperature. This is why chemo clinics will always supply warm blankets and you are often told to dress warm.

Is it difficult to learn to use the caps?

Practice makes perfect. We recommend either our Friends & Family Training service for helpers to learn with hands-on the ins and outs of this delicate process, or full service help where the client doesn't need to worry about the process, and the capping consultant is fully in charge bringing all the tools needed with her. If the client chooses a team effort of friends and family, a minimum of one person assisting the client is essential, and two is helpful, but not critical. The helper(s) keep track of the time, keep the client drinking water throughout the process, check the temperature of the new cap going on, swaps out the old warm cap for the new cold cap, straps on the cap, and helps keep the client warm and comfortable. Each complete cap change can to occur in less than 6 minutes, and the actual scalp exposure time between caps must be only a few seconds. To be successful, everyone must do their job efficiently and know their job well. Again, practice makes perfect and good training is essential.

Is Cold Cap Therapy only for women?

Not at all. Cold Cap Therapy can be used by men. Professional men...doctors, dentists, consultants, any man who wants his privacy around cancer, will benefit from Cold Cap Therapy.

What kind of training does Cold Cap Therapy Midwest provide for their staff?
Cold Cap Therapy Midwest has an extensive training program that provides their staff with several attendance's at Friends & Family orientation trainings, hands-on experience with each other, observation in the clinical setting, and a full internship that runs several months. After training and interning, the consulting staff never goes out into the field alone until they feel confident and completely ready to assist their clients. Susan, the owner of Cold Cap Therapy Midwest must be convinced that each consultant is ready. You can meet the staff at Cold Cap Therapy Midwest under the tab “About Us.”

What is the response from actual clients who have used Cold Cap Therapy?
Over the past 9 years, 98% of the clients in Minnesota who have used Penguin Cold Caps would use them again and do Cold Cap Therapy. Almost all of our clients have been  happy with the results of the caps that they want to "give back" and are willing to talk with potential clients about Cold Cap Therapy. Feel free to ask for names and phone numbers of past or current clients so that you can talk with these clients first hand.

I'm about to undergo chemotherapy and my doctor hasn't mentioned Cold Cap Therapy. Is it not widely available?
Cold Cap Therapy is still in clinical trials in the U.S. and will probably be so for a little while longer, so awareness is at a minimum and hospitals or clinics do not carry them in-house yet.  However, with the approval of the client's physician, individuals can rent their own caps directly from Penguin Cold Caps. The Rapunzel Project is trying to facilitate the use of Cold Cap Therapy by giving clinics a free biomedical freezer so that Cold Cap Therapy is more financially manageable for patients. Without a biomedical freezer available, a client needs to use dry ice and a cooler provided by Penguin Cold Caps. This is part of our assistance program, so we will help you organize and provide most of the tools you will need.

What does Cold Cap Therapy cost using Penguin Cold Caps?
Rental costs will vary depending on the number of months the caps will be in use. Penguin has a fixed monthly basic rental charge of $495.00. A one time security deposit for the caps is required and then fully refunded when the caps are returned in good condition. Remember that 
Cold Cap Therapy Midwest is a separate business from Penguin Cold Caps and our services are over and above the costs of renting the caps. You can find more information about that here: Services under the tab, "About me."

Is Cold Cap Therapy covered by medical insurance?
Probably not, but you can check with your individual carrier. Note that even if Cold Cap Therapy is not covered at this time, plans and benefits evolve. As the cost of Cold Cap Therapy is likely to be comparable to the cost of a human hair (not synthetic) medically prescribed wig, insurance acceptance of Cold Cap therapy is likely to grow. In fact, either Cold Cap Therapy or a medically prescribed wig should be treated as a cranial hair prosthesis. Some insurance plans do cover this, so it is worth checking out. Cold Cap Therapy Midwest has had some clients that were able to collect insurance. When the time comes, we will help you go about the process with written documentation for your insurance company.

Should I decide to do Cold Cap Therapy, what do I do next?

1)   Study the Penguin Cold Caps website at:

2)  Call or email Susan any questions you might have concerning the Cold Cap Therapy process at 651.690.2223 or

3)  Once your questions are answered and you are ready to commit to the Cold Cap Therapy process, fill out and submit the  “Ordering the Caps” Application Form at:

4)    Call your credit card company and tell them an international transaction from Medical Specialties of California will be coming through. Without this call your credit card company will most likely think the european transaction is fraud and will decline the payment. If this happens, it may hold up the process of beginning Cold Cap Therapy on time.

5)   Once there is approval from Penguin's London Office, the caps will be available in the Twin City area from Cold Cap Therapy Midwest. Susan will inform you on how to receive the caps.

6)   Finally, make a decision on how much help you would like before, during, and after your chemo treatments. Training, consulting, and hands-on help are available through Cold Cap Therapy Midwest to make things less stressful, safer, and more successful for you. You may schedule services through Susan at 651.690.2223 or email: Susan will be excited to meet you.