Carol Saffran began taking Ozempic a 12 months in the past to manage her blood sugar after different medicines had been ineffective. She was prediabetic, a situation during which blood sugar ranges are larger than regular, and her physician prescribed Ozempic to assist her keep away from growing diabetes. She’s now near her perfect physique weight and has an appointment quickly to examine her progress in reducing her blood sugar – however after shifting as much as the very best dose of Ozempic, she began noticing one thing else.
“I would brush my hair and look at my hairbrush, and there was just a little bit more [hair] than normal,” stated Saffran, 71, of the higher Boston space. “It’s not coming out in clumps or anything like that, but it’s definitely not as dense as it used to be. It just feels thinner. My hair is not as full as it used to be.”
A hair loss specialist at Tufts Medical Center, Dr. Farah Moustafa, director of laser and cosmetics, identified Saffran with telogen effluvium: hair loss because of stress on the physique. In Saffran’s case, that stress was the numerous weight reduction she skilled since being on Ozempic, Moustafa stated.
The medicines have surged in recognition in recent times. A ballot launched Friday by KFF discovered that about 1 in 8 adults say they’re at the moment taking a GLP-1 drug to deal with a persistent illness, for weight reduction or each — a rise of 6% since May 2024.
Still, uncomfortable side effects stay a key cause why some people resolve to cease taking them. Hair loss is much less widespread than well-known uncomfortable side effects resembling nausea, vomiting or constipation, however it’s typically mentioned in on-line weight reduction teams and amongst buddies.
There are 4 phases of hair progress. The first is the anagen or progress section. It’s adopted by the catagen or transitional section, the telogen or resting section after which the exogen or shedding section. Normally, anagen is the longest section.
Telogen effluvium is a situation that pushes an irregular quantity of hair follicles into the telogen section, resulting in extra shedding than regular.
Dr. Anthony Rossi, a dermatologist at Memorial Sloan Kettering Cancer Center, stated telogen effluvium typically seems after a interval of stress, resembling childbirth, anesthesia or crash weight-reduction plan.
“Any time people lose a significant amount of weight, typically in a short period of time, it is well-known that that can trigger an event called telogen effluvium, which basically is an alteration of the hair cycle in which an abnormal percentage of hair follicles enter into the shedding phase,” stated Dr. Aron Nusbaum, a dermatologist and hair restoration surgeon on the Miami Hair Institute.
Telogen effluvium can occur three to 6 months after “an enticing event,” he stated, “whether it be a physical or emotional stress, hormonal imbalance, a massive weight loss, a new medication, things like that.”
When the physique is harassed, he stated, giant numbers of hair follicles within the anagen, or progress, section prematurely enter the telogen, or resting, section.
“It has to shift priority from nonessential things to more essential things. So hair is a nonessential appendage,” Rossi stated.
Profound weight reduction, fairly than medicine itself, seems to be the foremost mechanism for hair loss in people who’ve this explicit GLP-1 aspect impact, stated Nusbaum.
Dr. Brian Wojeck, an weight problems medication specialist on the Yale School of Medicine, likened it to what occurs after bariatric surgical procedure, during which sufferers typically expertise momentary shedding because of stress and fast metabolic change.
Wojeck suspects that sudden shifts in diet or vitamin ranges may contribute. Some people think about taking multivitamins whereas on GLP-1 medicines to mitigate the impact, he stated, though “there isn’t great data saying that taking a multivitamin is going to prevent hair loss.”
Rossi says some sufferers “are in a chronic malnourished state” whereas taking GLP-1s as a result of the medicine suppresses urge for food.
“If you’re not getting enough of these micronutrients, your body is not going to be prioritizing anagen hair growth,” he stated. “So it’s a mix of metabolic stress and then this relative caloric protein deficiency that happens.”
Rossi stated the issue is turning into extra widespread because the medicines are more and more utilized by people looking for beauty weight reduction and who will not be getting satisfactory diet.
“The kicker in all this is that they’re being used so willy-nilly, in med spas, in direct-to-consumer compounding pharmacies. People are using them inappropriately,” he stated.
“Many people we see using [the medication] are not obese, and they’re just using it for weight maintenance or weight optimization. People are starting at doses that they probably should not be starting at,” he stated. “It’s causing them to not only not eat, but they’re getting less absorption of iron, zinc, vitamin D, B, B-12, all these essential amino acids that are in foods that you normally would be taking in.”
As a end result, people typically fail to satisfy the nutrient ranges wanted for hair progress. Each individual wants 1 gram of protein per kilogram of physique weight each day for keratin renewal and satisfactory ferritin, zinc, and nutritional vitamins B, D and B-12 for wholesome hair, Rossi says.
He warned that GLP-1 medicines can even have extra severe results, and sufferers mustn’t use them flippantly. “These are real medications that have real side effects. Hair loss, while it’s more cosmetic, can be devastating. But things like pancreatitis, nausea, vomiting, those are real.”
There may be different contributing components to people’s hair loss, says Spencer Kobren, founding father of the American Hair Loss Association.
Although “much of the hair loss being reported after starting GLP-1 medications could be temporary telogen effluvium related to rapid weight loss or nutritional stress,” he believes “it is entirely plausible that in those genetically predisposed to androgenetic alopecia, [GLP-1s] may be triggering its early onset.”
Nusbaum, of the Miami Hair Institute, stated he has began to “see several patients with underlying androgenetic alopecia, which is male- or female-pattern hair loss, where that underlying condition is being exacerbated by the use of these medications.”
Androgenetic alopecia has a definite sample. For ladies, it primarily impacts the frontal hairline, the place hair meets the brow. In males, it primarily impacts the bitemporal and vertex areas: the edges of the scalp close to the temples and the crown of the top, respectively. In distinction, telogen effluvium seems like diffuse hair shedding and thinning throughout all areas of the scalp.
Nusbaum factors to a study within the Journal of the American Academy of Dermatology that examined a doable affiliation between androgenetic alopecia and GLP-1 use, though the findings had been inconclusive.
“In the literature, I don’t think that there is a strong association as of yet, but clinically we are definitely seeing a lot of patients in practice either with telogen effluvium or androgenetic alopecia, which we do believe is somehow being caused by the use of these medications,” Nusbaum stated.
Other specialists are skeptical of this rationalization.
“From what I can tell, the best described mechanism for hair loss related to these novel weight loss agents is a telogen effluvium mechanism. Other mechanisms are under investigation, however, remain speculative at this time,” Wojeck stated.
Rossi added, “Androgenetic alopecia is a pattern. We call it a patterned hair loss. It’s a gradual one.”
A Novo Nordisk spokesperson instructed NCS that hair loss is an recognized threat with semaglutide and is listed as a aspect impact.
“For example, in clinical trials of Wegovy, hair loss was reported in 2.5% of Wegovy-treated adult patients vs 1.0% of placebo-treated adult patients. Hair loss was reported more frequently in patients with a greater weight loss (≥20%) suggesting that the events of hair loss were potentially related to the magnitude of weight loss. Alopecia is also included in the post-marketing experience sections of the Prescribing Information for Ozempic and Rybelsus,” the spokesperson stated.
A spokesperson from Eli Lilly additionally stated that “hair loss has been observed with weight loss interventions” and that the aspect impact is listed on Zepbound labels however not Mounjaro, as it’s “an adjunct to diet and exercise to help improve glycemic control in adults with type 2 diabetes; it is not approved for weight loss.”
“It is addressed in the Zepbound label because it is may be an adverse reaction potentially related to weight reduction,” the spokesperson stated. The label notes, “In Zepbound clinical trials, hair loss was reported more frequently in female than male patients in the Zepbound (7.1% female versus 0.5% male) and placebo (1.3% female versus 0% male) treatment groups.”
Experts say telogen effluvium with GLP-1 use is usually momentary, however people who develop hair loss ought to search medical analysis. Some can go right into a persistent telogen effluvium state, during which shedding continues for greater than six months, Rossi says.
Since telogen effluvium’s hair loss happens with stress on the physique, Moustafa defined, as soon as that stressor is eliminated, sufferers ought to make a full restoration.
“Oral minoxidil is a really great medication that is given via a prescription. There are several ways we can intervene pharmacologically on behalf of our patients to try and get them [to recover their hair] faster,” she stated, such because the hair-loss medicine minoxidil.
This is widespread for sufferers who want to remain on a medicine that’s inflicting telogen effluvium, resembling those that could must hold utilizing the very best dose of Ozempic, Moustafa stated. Saffran, who needs to remain on Ozempic due to its different advantages, shall be reducing her dosage in addition to beginning minoxidil.
However, Nusbaum factors out that “without having the correct diagnosis, you won’t receive the proper treatment.”
That begins with ruling out any underlying causes.
“We look at several lab values, look for vitamin and mineral deficiencies, look for hormonal imbalances, and typically, if it’s telogen effluvium, correcting the underlying cause will lead to a more rapid resolution of the hair shedding and eventual regrowth,” he stated. “There are some treatments that can help speed up the cessation of shedding and push the hair cycle back into the regrowth. In androgenetic alopecia, we’re looking at more long-term therapies.”
For Saffran, Moustafa first dominated out different causes as properly.
“When I did her exam, she has an amazing hair density at baseline, so she started out with really thick, beautiful hair,” Moustafa stated, and there was not any proof of female-pattern hair loss associated to age. “So I think it really is a pure telogen effluvium that she’s experiencing.”
Moustafa advises people utilizing GLP-1s who’re involved about hair loss to “keep an eye on the rate of your hair shedding and the degree of your weight loss,” in addition to “being your own advocate in many ways, discussing these things with your prescribing doctor and asking for the referral so that you can get the support to mitigate it.”