Marlene Busko

Should people be concerned about possible hair loss when taking Wegovy, Ozempic, or Mounjaro for weight loss (where the latter two drugs are being used off label) — as was recently claimed by some people on social media and reported in news stories?

The consensus among dermatologists and endocrinologists contacted by Medscape is no.

It's up to the individual to weigh the benefits of treating obesity against the risks of the therapy, including the low risk of developing temporary hair loss, says one expert.

Wegovy, Ozempic, and Mounjaro

Of these three newer medications, only the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Wegovy) is approved by the US Food and Drug Administration (since June 2021) for weight management — specifically for people with either obesity (body mass index [BMI] ≥ 30) or overweight (BMI ≥ 27) plus at least one weight-related comorbidity such as hypertension, type 2 diabetes, and high cholesterol — with a dosage up to a 2.4-mg weekly injection.

When there was a short supply of Wegovy soon after it became available, some people turned to the same drug — semaglutide, but marketed as Ozempic for type 2 diabetes, which is titrated up to a 2-mg weekly injection. Still others opted for tirzepatide (Mounjaro), a dual GLP-1 agonist and glucose-dependent insulinotropic polypeptide (GIP) agonist. Tirzepatide is approved for type 2 diabetes in the US but is not yet approved for weight loss.

Wegovy shortages continue to be reported.

Alopecia (hair loss) was an uncommon side effect in the clinical trials of these medications; of interest, it was more common after bariatric surgery.

In clinical trials, 3% of patients receiving Wegovy (a 2.4-mg/wk injection) vs 1% of patients receiving placebo reported alopecia. Hair loss was not reported as a side effect in clinical trials of Ozempic (a 2-mg/wk injection) for type 2 diabetes. In a clinical trial of tirzepatide for weight loss in obesity, 5.7% of patients taking the highest dose (a 15-mg once-weekly injection) reported alopecia vs 1% of those who got a placebo.

In contrast, a review of 18 mostly observational studies reported that 57% of patients had hair loss after bariatric surgery.

Is It the Drug or the Rapid Weight Loss?

None of the experts consulted by Medscape had seen patients who came to them about hair loss while taking these drugs for weight loss.

"I have not seen patients complaining of hair loss from these medications, but perhaps it is just a matter of time," said Lynne J. Goldberg, MD, a professor of dermatology and pathology and laboratory medicine, at Boston University School of Medicine, and director of the hair clinic at Boston Medical Center.

"Some of my patients lose hair when they lose weight, generally as a result of the weight loss itself and not as a side effect of these medications," said Katharine H. Saunders, MD, an obesity medicine physician, co-founder of Intellihealth, and an assistant professor of Medicine at Weill Cornell Medicine in New York City.

Should people be concerned about possible hair loss when taking Wegovy, Ozempic, or Mounjaro for weight loss (where the latter two drugs are being used off label) — as was recently claimed by some people on social media and reported in news stories?

The consensus among dermatologists and endocrinologists contacted by Medscape is no.

It's up to the individual to weigh the benefits of treating obesity against the risks of the therapy, including the low risk of developing temporary hair loss, says one expert.

Wegovy, Ozempic, and Mounjaro

Of these three newer medications, only the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Wegovy) is approved by the US Food and Drug Administration (since June 2021) for weight management — specifically for people with either obesity (body mass index [BMI] ≥ 30) or overweight (BMI ≥ 27) plus at least one weight-related comorbidity such as hypertension, type 2 diabetes, and high cholesterol — with a dosage up to a 2.4-mg weekly injection.

When there was a short supply of Wegovy soon after it became available, some people turned to the same drug — semaglutide, but marketed as Ozempic for type 2 diabetes, which is titrated up to a 2-mg weekly injection. Still others opted for tirzepatide (Mounjaro), a dual GLP-1 agonist and glucose-dependent insulinotropic polypeptide (GIP) agonist. Tirzepatide is approved for type 2 diabetes in the US but is not yet approved for weight loss.

Wegovy shortages continue to be reported.

Alopecia (hair loss) was an uncommon side effect in the clinical trials of these medications; of interest, it was more common after bariatric surgery.

In clinical trials, 3% of patients receiving Wegovy (a 2.4-mg/wk injection) vs 1% of patients receiving placebo reported alopecia. Hair loss was not reported as a side effect in clinical trials of Ozempic (a 2-mg/wk injection) for type 2 diabetes. In a clinical trial of tirzepatide for weight loss in obesity, 5.7% of patients taking the highest dose (a 15-mg once-weekly injection) reported alopecia vs 1% of those who got a placebo.

In contrast, a review of 18 mostly observational studies reported that 57% of patients had hair loss after bariatric surgery.

Is It the Drug or the Rapid Weight Loss?

None of the experts consulted by Medscape had seen patients who came to them about hair loss while taking these drugs for weight loss.

"I have not seen patients complaining of hair loss from these medications, but perhaps it is just a matter of time," said Lynne J. Goldberg, MD, a professor of dermatology and pathology and laboratory medicine, at Boston University School of Medicine, and director of the hair clinic at Boston Medical Center.

"Some of my patients lose hair when they lose weight, generally as a result of the weight loss itself and not as a side effect of these medications," said Katharine H. Saunders, MD, an obesity medicine physician, co-founder of Intellihealth, and an assistant professor of Medicine at Weill Cornell Medicine in New York City.

"Some of my patients swear by biotin supplements, prenatal vitamins or 'hair, skin, and nails' vitamins," she added. If hair loss doesn't stop, a dermatologist can look for other contributors and discuss strategies for hair restoration.

Individuals who undergo bariatric surgery require lifelong vitamin supplementation and yearly (or more frequent) lab testing, she noted.

"With, for example, bariatric surgery or any type of diet change you want to make sure you still maintain a balanced diet, whether its calories, protein, iron, zinc, vitamins (vitamin D for example)," Massick echoed.

Similarly, Peters advises: "I would say to maintain a normal healthy diet even if eating less. Exercise. Do all those healthy things. Taking a daily multivitamin isn't a bad idea. Talk with a nutritionist. Use the appetite suppression of the medication to combine with healthy eating."

"If someone is having new hair loss, they should see their clinician to evaluate for all possible causes," Weintraub said. "Their provider can evaluate for underlying causes like thyroid dysfunction, iron deficiency, and vitamin D deficiency."

However, if a patient's pattern of hair loss is not diffuse but occurs in patches, this has an entirely different set of etiologies probably unrelated to antiobesity medication and should be evaluated.

Working with a nutritionist to ensure that patients have sufficient protein and micronutrient intake can lower the risk of developing hair loss and other complications, Weintraub said. "This is particularly important for certain forms of bariatric surgery such as Roux-en-Y gastric bypass, since that can lead to malabsorption of specific vitamins and minerals that need to be periodically measured and supplemented."

In individuals starting an antiobesity medication, beginning a daily multivitamin has little harm, he added, and can ensure they are getting essential minerals and vitamins. However, no studies have specifically investigated this yet.

"Ultimately, it's important to weigh the benefits of antiobesity medications against the potential risks, as we do with any medical intervention," according to Weintraub.

"The purpose of treating obesity," he stressed, "is to reduce the risk of heart disease, stroke, and multiple types of cancers. It's up to the individual to weigh these benefits against the risks of the treatment, including the low risk of developing temporary hair loss."