You’ve probably heard about some of the most common side effects of GLP-1s, including gastrointestinal issues such as abdominal pain, diarrhea, and constipation or even the buzzy term, “Ozempic face.” Now, a new study addresses the potential risk of hair loss while using these medications.
Doctors say some patients have noticed thinning hair after starting these drugs. “For years, we’ve heard reports of hair loss from patients on these medications,” says Gregory Barone, D.O., the medical director of Cooper Care Alliance Endocrinology. “This study is an introduction to see if there’s evidence that this is true.”
What did the new research find?
The study analyzed five years of prescription data from more than 12,000 people taking GLP-1s and roughly equal numbers of people taking SGLT2 inhibitors and DPP-4 inhibitors, two other drug classes that are used to treat diabetes. The number of people with hair loss on GLP-1s was slightly higher (about 3%) than on the other two drugs (about 2%), says Dr. Barone.
However, the study has limitations. First, it was an observational analysis, not a randomized clinical trial. This means the study looked back at the records of people who were already prescribed the medication. A clinical trial, on the other hand, would have compared people who were newly prescribed the medication versus a placebo, says Dr. Barone.
In addition, “this particular study included only adults with type 2 diabetes, so the results should not be generalized to people without diabetes,” says Christoph Buettner, M.D., Ph.D., a professor of medicine, the chief of the division of endocrinology, metabolism, and nutrition, and the vice chair of basic research at Rutgers Robert Wood Johnson Medical School. “It also examined the GLP-1 drug class rather than Ozempic alone.”
Nevertheless, clinical trials conducted for obesity treatment have shown similar results regarding hair loss. “In the adult Wegovy weight-management trials, hair loss was reported in approximately 3% of semaglutide-treated participants versus 1% receiving placebo,” says Dr. Buettner. “In Zepbound weight-reduction trials, hair loss was reported in approximately 4 to 5% of treated participants versus 1% receiving placebo.” This shows that hair loss is also reported among people taking these medications for obesity, though the frequency varies according to the drug, the population, and other factors.
This new study is simply one piece of evidence that hair loss may occur for some people on these types of drugs, though at fairly low numbers overall. “Of course, hair loss can be upsetting and it’s significant if it happens to you,” says Dr. Barone.
How does Ozempic cause hair loss?
It’s not yet clear. The most plausible explanation is telogen effluvium, a transient form of diffuse shedding caused by physiological stress or major body change such as weight loss. “Reduced calorie and protein intake may contribute, particularly when appetite suppression, nausea, or vomiting makes it difficult to maintain adequate nutrition,” says Dr. Buettner. “Deficiencies of iron or zinc—and, in selected patients, vitamin B12, vitamin D, or other nutrients—can compound the problem.”
There also are many other variables when it comes to hair loss. “We think the cause of hair loss is multifactorial and different from person to person,” says Melissa Piliang, M.D., FAAD, the chair of dermatology at Cleveland Clinic. “We do see patients who experience hair shedding when they lose weight, even on a healthy diet with calories restricted.”
It goes back to how humans evolved over millennia. “There were times of food and famine. During the times when there was a lack of food, you had to survive so the body let go of things that weren’t required for life, such as your hair,” says Dr. Piliang. “We also know that any extreme stress, such as illness, surgery, or even emotional stress, such as the death of a loved one, can lead to hair loss.”
Other causes, such as hormonal and metabolic changes, have been proposed, but there is currently no well-established link between GLP-1s and damage to the hair follicle.
Does hair loss from Ozempic come back?
It’s not possible to predict, though “If we learn you’re shedding because of a clear trigger, we can fix that trigger,” says Dr. Piliang. “Also, if your weight stabilizes and you’re now on a minimum or low dose of these medications, we would expect the shedding to improve.”
There are treatments that may be helpful for hair loss, including topical or oral minoxidil, topical or oral finasteride, or low-level light therapy. “But realize that even if you take one of these medications, you also have to ensure you’re getting the right diet, including lots of protein, because it takes a fair amount of protein to grow hair,” says Dr. Piliang. Before you try anything, consult a board-certified dermatologist, and be sure to include the doctor who is prescribing the GLP-1 for you in the loop.
What can you do to reduce hair loss while on Ozempic?
If you’re considering Ozempic or another GLP-1 medication, doctors say here’s what you should know about the hair loss risk:
Lose weight the right way.
“Maintain overall caloric intake rather than pursuing the fastest possible weight loss,” says Dr. Buettner. To ensure you’re not losing too much weight too fast and developing nutritional deficiencies, lean on high-quality medical care rather than a GLP-1 that’s available via the internet.
Don’t skimp on protein.
“The calories you choose are important for hair growth and overall health,” says Dr. Piliang. “Make sure you’re also eating plenty of vegetables and fruits, healthy fats and whole grains.”
Gradually increase your dose.
If you start having serious GI issues such as nausea, vomiting, or appetite suppression that prevents adequate eating, you can slow down dose escalation, says Dr. Buettner.
Don’t add supplements without consulting your doctor.
If you have significant hair shedding, you should be evaluated for underlying conditions such as iron deficiency or thyroid disorders. Documented deficiencies in iron, zinc, vitamin B12, vitamin D, or other nutrients should be corrected with guidance from your doctor, instead of indiscriminately taking high-dose supplements on your own, says Dr. Buettner. Also, keep in mind that some supplements, such as biotin, can skew lab tests.
Evaluate other potential hair loss triggers.
That may include severe stress such as illness, loss of a loved one, menopause, and other medications that may be the underlying cause of your hair loss, says Dr. Barone.
See your dermatologist for other options.
The best thing you can do is work one-on-one with a physician who can give you a personalized treatment plan.
The bottom line
Most patients do not experience clinically significant hair loss when taking these drugs, but a small number may develop noticeable shedding, particularly when weight loss is rapid or nutritional intake becomes inadequate, says Dr. Buettner. Hair may regrow, or you may opt for hair loss treatment, as prescribed by a dermatologist.
“Anytime you’re prescribed anything new, you need to understand the risks versus the benefits,” says Dr. Barone. “In this case, the most common and significant are the GI side effects, but you should also have a discussion about hair loss, if that’s a concern.”
