Can GLP-1 Medications Cause Hair Loss? with Dr. Keren Zhou, MD

Podcast Transcript

John Horton:

Weight loss is the typical goal if you take Wegovy^® or some other type of GLP-1 medication. But in some cases, people report shedding more than just pounds. They also seem to be losing hair — clumps and clumps of hair, judging by online photos.

That brings up an obvious question: Is this normal?

That's what we're going to chat about today with endocrinologist Kathy Zhou. She's one of the many experts at Cleveland Clinic who visit our weekly podcast to help you better understand medicine and how it works. So with that, let's find out whether a medication-driving weight loss could also lead to you testing new hairstyles.

Welcome back to the podcast, Dr. Zhou. It's always nice to see a familiar face.

Dr. Kathy Zhou:

So nice to be here as always. So thanks for having me again.

John Horton:

You're here to talk about GLP-1 medications, and these are becoming so much more commonly used for weight loss. And it seems like we're hearing more and more about people using them, and then some side effects that kind of come about, too — and one of those is hair loss.

Now, I know hair loss isn't listed as an official side effect of GLP-1s by the FDA, but if you go search around online for a little bit, you'll see that it is an issue for folks. It's even been dubbed “Ozempic hair.” So which is it? Is it not a problem or is it something that you see?

Dr. Kathy Zhou:

It is, unfortunately, something that we see. The official name for it is “telogen effluvium.” And I'm sure my dermatology colleagues will take me to task for some of that pronunciation.

John Horton:

I understand why they call it “Ozempic hair,” though — that other one's a mouthful.

Dr. Kathy Zhou:

Yeah, we can stick with the “Ozempic hair.” Fair.

So it is a real concern and consideration that we see in the clinic. I certainly have had a fair share of individuals come back complaining that all of a sudden, they're losing hair. And what we need to know is, that weight loss in particular, can be a stress actually on the body. The body perceives it as stress because we were kind of more made for abundance and plenty, times of plenty.

And so what can happen in the months following some of this initial weight loss is you go into a period of kind of excessive hair loss. And so what happens in this condition is that … hair kind of has these three phases. We call it grow; kind of this quiet phase or stable phase; and then this loss phase. And most hair is kind of in the grow, grow, grow phase. But what happens when the body experiences a stressor is more of that hair is pushed into that quiet phase, which precedes a loss phase about a couple months later. And so you see this sudden shift of more of your hair into that sort of quiet and then loss phase a couple months down the line.

So that is certainly, again, something we see in the clinic. I will offer that some of the nutrient deficiencies that, unfortunately, we see when people are becoming malnourished or not being intentional with their eating on the GLPs can contribute — in particular, protein deficiencies. So if a person isn't hitting their protein intake on these GLPs, we can see some also excessive hair loss from a nutrient deficiency on the medication.

John Horton:

Yeah. So when your body has this stress and it affects that hair cycle, is that just your body making sure it holds onto some resources, so it's like hair is kind of maybe not the most important thing?

Dr. Kathy Zhou:

You hit the nail on the head. That's exactly right. The body's going to protect your heart, your kidneys, your liver before it's going to give you a nice head of hair. So we definitely see that shifting in some ways of resources toward the vital organs.

John Horton:

Which makes sense. I mean, while everyone loves their head of hair, I mean, the heart might be a little more important.

Dr. Kathy Zhou:

Yes. I would strongly argue that the body does a good thing in protecting the heart over the hair.

John Horton:

So we kind of have this stress as you drop some pounds. You had mentioned nutritional deficiencies, and that's a byproduct of just when you start taking this medication, you typically eat a little less, correct?

Dr. Kathy Zhou:

Correct. And sometimes, people take it to an extreme. They're eating a lot less, really not hitting enough calories to meet all of their nutrient demands for the day. And that's, again, when you're adding insult to injury. Not only are you losing a lot of weight and going into a calorie deficit — which again, the body can perceive as a stress when it comes to hair — but now, you're not even providing the resources to generate new hair. So yeah.

John Horton:

What about hormonal changes? Because I know when you're taking these GLP-1s, there's obviously some hormonal things happening. Does that play a role in it, too?

Dr. Kathy Zhou:

I would say probably to a lesser degree than the issues we just covered about nutrition, and then just, again, the stressor of weight loss itself. Certainly, I have a lot of patients on thyroid medication, and if you lose a lot of weight, it turns out that your dose of thyroid medication actually has to change. And so if it's kind of indirectly impacting other hormonal stability in that way, you could see further hair loss layered on top of the GLP use.

John Horton:

And I guess that's the thing to emphasize here. This sort of hair loss with rapid weight loss is something that happens, it could happen with this medication, but it could happen with anything where you're dropping pounds quickly.

Dr. Kathy Zhou:

That is exactly right. So it does not appear to be just something tied to the molecule itself, at least not to our knowledge at this time, but rather derived from just, again, what it does to potentially, that rapid weight loss.

John Horton:

Yeah. It's not the medication itself. It's what the medication's causing that's then leading [inaudible 00:06:29].

Dr. Kathy Zhou:

Precisely, precisely.

John Horton:

All right. Well, now the big question: Is hair loss from GLP-1s permanent or is it something where it's going to start growing back eventually?

Dr. Kathy Zhou:

So luckily, it's usually not permanent, but it can take months. I remind patients that we're talking about … hair goes in about these three-month cycles. And so after it experiences stress, a three-month lag, it sheds. You could be waiting three to six months for things to stabilize and go back into a growth cycle. And what you want to be doing during that time is promoting, having all the nutrients needed for a future growth cycle of hair. And also, you do probably want to get screened for any other causes of hair loss — iron deficiency. I did mention the thyroid already. That's one that we see that could be contributing to further hair loss.

John Horton:

And when we say “hair loss,” are we talking a little bit or can it be pretty extreme?

Dr. Kathy Zhou:

So the quote unquote Ozempic hair or the telogen effluvium is literally clumps of hair, the classic picture of someone's holding a ball of hair in their hand, where it's coming out onto their pillow with no kind of stress on the hair follicle. So it's significant. This isn't the little bit of strands that we lose in the shower every day. This is on a different level for sure.

John Horton:

So it's one of those things, it sounds like it's going to be a little noticeable maybe at the start when people experience it?

Dr. Kathy Zhou:

It certainly can be. The common refrain is, "I feel like I'm losing all my hair," even if it maybe isn't entirely accurate, but certainly people notice thinning. You can see kind of a little more of the scalp, maybe a couple areas are more noticeable, that there's been some receding of the hair line.

John Horton:

Yeah. And that can be pretty distressing, which isn't going to help with the stress response, which is adding to the hair loss.

Dr. Kathy Zhou:

Yeah, it's probably not. And it certainly is very distressing for a lot of patients of mine. But again, it's just remembering that this is temporary. And again, like everything, it's a benefit side effect risk analysis in terms of what the medication's doing otherwise.

John Horton:

Is there a way to avoid this? I know it's temporary and it'll grow back, but you'd rather not have to go through it. So are there ways to prevent it or really limit it?

Dr. Kathy Zhou:

Yeah. So we don't want you to be losing weight — again, I've talked before about this kind of cliff effect where someone's just losing weight so rapidly that just when you look at their weight graph, it looks like they kind of fell off a cliff. So you do want it to be kind of a more steady weight loss, emphasizing again, nutrient-dense foods and products. And in that way, you have your best shot at mitigating this. But to a certain extent, it may not be avoidable in certain individuals if they're losing weight.

John Horton:

I mean, do people take supplements, where if you're worried about maybe those nutritional deficiencies, maybe that will help?

Dr. Kathy Zhou:

They could, but it's only if there's pretty clear evidence that there is probably some degree of an underlying nutrition deficiency that we really start pushing different types of supplements. There's not a ton of evidence that things like biotin, for example, help in this situation, even though we sometimes might recommend it to people. There are certain treatments, minoxidil, steroids, that have sometimes been used in this situation, but they would only apply not so much as a preventive measure, but rather, kind of a treatment on the tail end, unfortunately, after it's already developed.

John Horton:

I mean, I'm sure if you go online, there are plenty of special shampoos or conditioners or things like that. Are those worth the money or will they help?

Dr. Kathy Zhou:

They might. I think success rates are somewhat attenuated in my personal experience in the clinic, but clinically, they may help. And I do often, in these cases, will involve my dermatology colleagues if things are really getting very out of hand or if it's particularly distressing to the patient, and they still want to continue on the medication, I may refer them to derm for a full care consult, so to speak.

John Horton:

And then, it sounds like there might be some options that they have when you go that route, but if it-

Dr. Kathy Zhou:

…correct.

John Horton:

...really gets into a bad, you're really seeing some extreme loss.

Dr. Kathy Zhou:

Correct. They have a few more tools in their toolkit to try and address this.

John Horton:

How likely is it that you might see hair loss if you start taking GLP-1s?

Dr. Kathy Zhou:

It's unclear to me if the data exists, like specific percentages, but it's fairly common. Just anecdotally, in my clinic, probably a fourth to a third of the patients describe some degree of hair loss just voluntarily to me without even being asked, which means, it's probably somewhat significant to them in their day-to-day.

John Horton:

So most people are pretty attached to their hair. I mean, we all spend our time in the morning getting it just so. So when you talk to your patients, and you're kind of walking them through what might happen when they start taking a GLP-1, how do you present this so they can be prepared and maybe weigh whether or not it's worth that?

Dr. Kathy Zhou:

Yeah, it sort of depends. I think I spend more of my time talking about the lifestyle adjustments that they need to be thinking about that also are going to potentially attenuate any of the hair loss. I do mention it often as a potential side effect. In particular, if a patient's already kind of concerned about hair loss at the get-go, I'll say, "This probably isn't going to help you very much in terms of preventing further hair loss. In fact, it may worsen the situation." But again, I tend to spend more of my time talking about nutrient-dense foods, trying to make sure you're well hydrated, really just fueling the body appropriately and not losing just ridiculous amounts of weight out the gate by starving, essentially, yourself.

John Horton:

Yeah. It sounds like a lot of it … there are things you can do to maybe help the cause, make sure those flowing locks stay a little bit, but it's a matter of working with your healthcare provider and just really trying to get a solid plan in there.

Dr. Kathy Zhou:

Precisely, precisely. It may not, again, like I mentioned earlier, be fully preventable, but there are things that you can do to try and turn the tide in your favor.

John Horton:

And as we've talked about before when it comes to GLP-1s, there's so many benefits to them as far as what they do for your overall health. You might just have to go a few months with your hair not looking the best, knowing that in the future, you're going to be healthier and maybe a more vibrant person.

Dr. Kathy Zhou:

And I find that that is a trade-off many people are willing to make.

John Horton:

That sounds like a perfect spot to end, and then I feel like I need to go and check my hair.

Dr. Kathy Zhou:

You and I both, right?

John Horton:

Thank you again for coming in, and it is always a pleasure talking with you.

Dr. Kathy Zhou:

So nice to be here again. Thanks so much for your time.

John Horton:

Hair loss is a possible side effect that comes with taking a GLP-1 medication. It's connected to rapid weight loss, not the medication, and can last for months. Talk to your healthcare provider about your options when it comes to keeping your head of hair intact.

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Speaker 3:

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