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May 24, 2023 – If you are concerned about hair loss when taking Mounjaro, Ozempic or Wegovy for weight loss, as recently claimed by some people on social media and reported in the news?
The consensus among dermatologists and endocrinologists contacted by WebMD is no.
It is up to the individual to weigh the benefits of obesity treatment against the risks of therapy, including the low risk of developing temporary hair loss, an expert says.
Mounjaro, Ozempic and Wegovy
Of these three newer drugs, the FDA has approved only the drug semaglutide (Wegovy) for weight control — specifically for people who are obese or overweight plus at least one weight-related disorder, such as high blood pressure, type 2 diabetes, and high cholesterol — with a dose of up to a weekly injection of 2.4 milligrams.
When there was a shortage 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 given in injections of up to 2 milligrams per week, or to tirzepatide (nun). Tirzepatide is approved for type 2 diabetes in the US, but not yet approved for weight loss.
Wegovy Shortage they continue to be reported.
Hair loss was a rare side effect in clinical trials of these drugs. In fact, it was more common after bariatric surgery.
In clinical trials, 3% of patients receiving Wegovy versus 1% of placebo patients reported hair loss. Hair loss was not reported as a side effect in clinical trials of Ozempic for type 2 diabetes. in a clinical trial of tirzepatide for weight loss in obesity, 5.7% of patients taking the highest dose (one 15-milligram injection once weekly) reported hair loss compared with 1% of those receiving a placebo.
On the contrary, 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 for this story had seen patients come to them about hair loss while taking these weight-loss drugs.
“I haven’t seen patients complain of hair loss from these medications, but it may just be 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, usually as a result of the weight loss itself, and not as a side effect of these medications,” said Katharine H. Saunders, MD, obesity medicine doctor, co-founder of Intellihealth . , and assistant professor of medicine at Weill Cornell Medicine, in New York City.
“Hair loss from rapid weight loss is very common. [and] not necessarily a side effect of the drug itself, but more as a result of how quickly the weight loss occurs,” said Susan Massick, MD, an associate professor of dermatology at The Ohio State University and a dermatologist at the school’s Wexner Medical Center.
“Hair loss is complicated,” she said Dr Anne Peters, Director of Clinical Diabetes Programs at the University of Southern California. “Losing weight and/or changing your diet causes hair loss. Stress can cause hair loss. Therefore, it is difficult to separate the weight loss from the effect of the medication.”
Elimination of stress with rapid weight loss
Hair loss appears to be associated with rapid weight loss, the experts agreed.
“It’s rare, but we can see patients who have a period of diffuse hair loss, called telogen effluvium or ‘stress shedding,’ with rapid weight loss,” said Michael A. Weintraub, MD, an endocrinologist at NYU Langone Health in New York. . City.
This hair loss occurs during a stressful event that is either physical (surgery, pregnancy, illness) or emotional, said Weintraub, an assistant professor at the NYU Grossman School of Medicine.
Hair loss due to rapid weight loss could be caused by an obesity drug, but it could also occur with other obesity treatments, such as bariatric surgery or even drastic dietary changes, he said. Hair loss is usually short-lived and reversible.
About 80% to 85% of hair is in the anagen (growing) phase, about 5% is in a transition (catagen) phase, and the rest is in the telogen (resting or shedding) phase, Messick said. In Telogen effluvium, hair that is normally in the growth phase suddenly goes into the telogen phase and causes rapid hair loss.
“youTelogen effluvium can be caused by rapid weight loss, major surgery, severe COVID infection, high fever, or death in the family,” he said. “You won’t go bald with telogen effluvium, but you may lose a good volume of hair”, much more than the normal loss of up to 100 hairs a day.
“I counsel my patients about the possibility of losing their hair before having bariatric surgery,” Saunders said. “Overall, the health benefits of weight loss and maintenance outweigh the risk of temporary hair loss.”
Nutritional deficiencies and malnutrition can also contribute to hair loss, and iron deficiency is sometimes to blame, he said.
“If anyone is concerned” about hair loss associated with weight loss, “they should see their doctor,” Peters said. “If you’re taking thyroid hormone, in particular, levels should be retested after weight loss.”
“Hair loss seems more common after bariatric surgery than with anti-obesity drugs,” Weintraub said, and it’s not clear if this is because weight loss is more dramatic after surgery and therefore So it’s a major source of stress or due to a nutrient deficiency or something. something else entirely.
Iron and vitamin D deficiencies are the most common nutritional deficiencies that can cause hair loss, he said.
Slow and steady weight loss instead of fast
“I would suggest that patients try to keep weight loss slow and steady, rather than rapid,” Goldberg said, “and follow whatever vitamin/mineral supplementation plan they are given. Bariatric surgery patients are given nutritional guidance and a supplement plan.”
“Follow a well-balanced dietary strategy with plenty of protein, vegetables and some fruit,” Saunders said. Health care providers should monitor laboratory tests to check for and treat vitamin deficiencies, and registered dietitians can be crucial in ensuring a proper nutrition. She advises patients: “Find coping strategies to reduce stress and get enough sleep. If iron levels are low, start an iron supplement under the supervision of your provider.
“Some of my patients rely on biotin supplements, prenatal vitamins, or hair, skin, and nail vitamins,” she added. If hair loss doesn’t stop, a dermatologist can seek out other collaborators and discuss strategies for hair restoration.
People who undergo bariatric surgery require lifelong vitamin supplements and yearly (or more frequent) laboratory tests, he noted.
“With, for example, bariatric surgery or any type of dietary change, you want to make sure you continue to eat a balanced diet, whether it’s calories, protein, iron, zinc, vitamins (vitamin D, for example),” Massick said.
Similarly, Peters advises: “I would say stick to a normal, healthy diet even if you eat less. Exercise. Do all those healthy things. Taking a daily multivitamin isn’t a bad idea. Talk to a nutritionist. Use appetite suppression of medication to combine with a healthy diet”.
“If someone is having new hair loss, they should see their doctor to evaluate all possible causes,” Weintraub said. “Your provider can test for underlying causes, such as thyroid dysfunction, iron deficiency, and vitamin D deficiency.”
However, if the pattern of hair loss occurs in patches, this has a completely different set of causes probably unrelated to your obesity medication and should be evaluated.
Working with a nutritionist to make sure patients have enough protein and nutrients can reduce the risk of developing hair loss and other complications, Weintraub said. “This is particularly important for certain forms of bariatric surgery…as that can lead to malabsorption of specific vitamins and minerals that need to be measured and supplemented regularly.”
If you’re starting an obesity medication, there’s little harm starting with a daily multivitamin, he said, and can help ensure you’re getting essential minerals and vitamins. However, no study has specifically investigated this yet.
“Ultimately, it’s important to weigh the benefits of anti-obesity drugs against the potential risks, as we do with any medical intervention,” Weintraub said.
“The purpose of treating obesity,” he said, “is to reduce the risk of heart disease, stroke and multiple types of cancer. It is up to the individual to weigh these benefits against the risks of treatment, including the low risk of developing temporary loss hair related”.
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