FDA discusses banning formaldehyde in hair straightening products

The Food and Drug Administration (FDA) plans to ban the use of formaldehyde as an ingredient in chemical hair straighteners, also known as relaxers.

Teresa Werner, MD, associate director of the Huntsman Cancer Institute and professor of oncology at the University of Utah, and Crystal Lumpkins, PhD, MS, an investigator at the Huntsman Cancer Institute and associate professor at the University of Utah, discuss some key points.

“I think this is an important step based on scientific research and data showing increased health risks, including cancer,” Werner says. “This ban highlights that we are constantly learning about the risks and must be adaptive in using the information to improve the health and safety of our patients.”

What is formaldehyde?

Formaldehyde is a colorless, flammable, and strong-smelling chemical best known for its use as an embalming fluid. The National Toxicology Program officially listed it as a known human carcinogen in 2011. According to the American Cancer Society, exposure to formaldehyde has been linked to cancer in both laboratory animals and humans.

But formaldehyde remained a common ingredient in relaxers. This is the first time the FDA has moved to ban the chemical from hair straighteners, though it has been under regulatory scrutiny for some time. The agency began warning relaxer users about possible formaldehyde exposure in 2010.

The FDA warns that formaldehyde in hair relaxers can be released into the air as a gas that can cause health problems if inhaled or comes into contact with the skin. Recent studies have also found possible long-term effects of chemical relaxers, particularly in the case of uterine cancer.

In 2022, the National Institutes of Health found that women who used chemical relaxers had higher rates of uterine cancer than those who did not. Researchers found that 1.64% of women who never used hair straighteners would develop uterine cancer by age 70. For women who frequently used relaxers, that rate increased to 4.05%.

"That's more than double, right? You might say, 'Oh my gosh, that's more than a 100% increase in risk.' But again, you have to consider that the risk of uterine cancer in general is very low, and there were fewer than 400 cases in the study," Werner says. "So looking at the absolute numbers, it's not that big of an increase, but we're always looking for factors that could potentially increase the risk."

Women, Relaxers and Uterine Cancer

Uterine cancer accounts for just 3% of all new cancer cases. But experts say the rate is rising, especially among black women, who have twice the death rate from uterine cancer compared to other racial groups.

“We know that there are big health disparities based on race and ethnicity in cancer, and many black Americans use chemical relaxers,” Werner says. “It may not just be genetics, it may be that there are other environmental factors for black women as they use these relaxers that may increase their cancer risk.”

Chemical relaxers are marketed to black women to straighten their natural hair. According to a 2014 article in the Journal of Clinical and Aesthetic Dermatology, 60% of black women choose to have their hair chemically straightened. The practice typically begins at a young age — 46% of respondents reported having their hair chemically straightened for the first time between the ages of four and eight. Women can chemically straighten their hair for decades, visiting a stylist several times a year.

"It makes sense that these environmental exposures would take a long time to actually cause cancer," Werner says. "These women are older, and they live longer. And the incidence of uterine cancer increases with age."

This may be one reason why another long-term study, the Black Women's Health Study, also found statistically higher rates of uterine cancer among postmenopausal women.

Werner notes that the scalp is a highly vascularized area, with vessels that carry blood and lymph throughout the body. “For some reason, uterine cells are more sensitive to substances that may be carcinogenic,” Werner says.

NIH researchers have identified formaldehyde as one ingredient that may contribute to increased cancer risk.

Hair and Culture

For black women, the decision to use chemical relaxers is culturally sensitive, especially for older generations.

"There was an expectation that this was the way it was supposed to be, that you straightened your hair to look like other ethnic groups," Lumpkins says. "Straightened hair was seen as a sign of professionalism and beauty."

Lampkins notes that this social pressure complicates public health communications on the topic.

"There are people who have had their scalps burned by straighteners, but they'll come back and do it again," says Lumpkins. "Their hair will fall out, but they'll say, 'I'll come back when my hair grows back and straighten it again.' That's not healthy."

If the FDA decides to ban formaldehyde in relaxers, consumers will still have to consider other chemical risks when deciding whether to straighten their hair. For Lumpkins, that means continuing the conversation among black women, especially doctors and salon owners.

“It’s important how to engage stakeholders in risk assessments that are culturally sensitive and appropriate. How can we be pragmatic and scientific about how to communicate information that is relevant and that helps inform decisions?” says Lumpkins.

"If there are products that don't use formaldehyde, if there is a safe alternative, then maybe these relaxers are safe for women."

Ultimately, people who use chemical hair straighteners will have to make the best decision for their hair care and health needs.

“Black women’s hair is an important part of who they are,” Lumpkins says. “And it really impacts a significant part of their lives, their health and their well-being.”