What You Need To Know About Hair Loss On Ozempic And Mounjaro

Recently I had a patient experience significant and sudden hair loss. She had been on Ozempic for some time, and she had just started using testosterone cream for 1-2 weeks. She was initially told by her dermatologist that the testosterone could have been the cause of the sudden hair loss. However, once this was immediately stopped, the hair loss shedding continued on and then it was concluded that perhaps the Ozempic was the cause.

Digging into the studies on testosterone replacement in women, and certainly based on years of clinical experience to back up these studies, generally less than 1% of women who use testosterone cream to improve deficient levels will potentially experience hair loss as a side effect. That doesn’t mean it’s impossible, but it is highly improbable.

When I started investigating the idea that Ozempic could be related to hair loss, what I found was that there was no evidence in the original research trials to prove that Ozempic directly caused hair loss, nor was it reported as a side effect during the Wegovy (semaglutide weight loss) trials. The data from the Wegovy clinical trials showed that about 3% of people reported more hair shedding compared to 1% of people in the placebo group. The 2% difference was not considered statistically significant, so the hair loss may be due to chance, and not the medication.

➔ What is clear, is that the GLP-1 medications along with other interventions that can lead to rapid and significant weight loss (such as bariatric surgery for example) may indirectly lead to hair loss. The link between rapid weight loss and hair loss is a known concern.

People that experience rapid weight loss can develop a condition known as telogen effluvium. Telogen effluvium refers to the situation where a significant number of hair follicles go into a rest/shedding phase at the same time. When this occurs, you will see a massive, coordinated shedding of hair which can lead to noticeable hair loss. This can occur 3-6 months after a phase of rapid weight loss and is largely considered a temporary condition. The hair follicle itself is not damaged and will typically go back to normal growth patterns after several months. Fortunately, not everyone who experiences rapid weight loss will develop telogen effluvium, but it is not a predictable issue.

How Is Telogen Effluvium Diagnosed?

A hair specialist can confirm TE during a physical examination of your scalp by conducting a “pull test,” in which they gently pull a small clump of 40 to 60 hairs between their fingers. Under typical conditions, only two to three hairs are pulled from your scalp. If you have telogen effluvium, you may see at least 10% (4-6) or more hairs from your scalp with white bulbs at the roots.

Rule out other causes of hair loss by doing comprehensive testing:

• Complete blood count (CBC): This can identify conditions like anemia that contribute to hair loss and can reveal signs of infection or inflammation in the body that can also impact hair health.
• Iron studies: Low iron levels (ferritin less than 30ng/ml) are a common cause of hair loss due to reduced oxygen carrying capacity of red blood cells.
• Thyroid function tests: Both abnormally low or high levels of thyroid hormone can lead to hair loss.
• Sex hormone tests: Abnormal testosterone levels may be related to androgenetic alopecia (female pattern androgen related hair loss). I also like to check for DHT (dihydrotestosterone), a more aggressive version of testosterone associated with hair follicle miniaturization. DHT binds to androgen receptors in the hair follicles, causing them to shrink, and stop producing hair.
• Vitamin levels: Vitamin D, folate, biotin, B12, iron, and ferritin, are linked to poor hair health and possible autoimmune causes of hair loss.
• Inflammatory markers: ESR (Erythrocyte Sedimentation Rate) and CRP (C-Reactive Protein) tests, can identify inflammation that might be contributing to hair loss.
• Blood sugar levels: Abnormal blood sugar levels can affect hair growth and cause hair loss. One study found that type 2 diabetes was associated with an increased risk of severe hair loss in African-American women.
• ANA: A screening test for autoimmune disease that may be associated with autoimmune related hair loss.
• Evaluate nutritional status: Insufficient intake or poor absorption of nutrients, such as vitamins B, C, D, E, protein or minerals such as iron, zinc, magnesium, etc.
• A scalp biopsy: Although not always necessary, a biopsy or sample of the scalp tissue can reveal the structure of the skin and hair follicles. This can more accurately diagnose most common types of hair loss, such as androgenetic alopecia, telogen effluvium or alopecia areata.

What can be done if you are diagnosed with telogen effluvium?

• Identify and STOP the stressor or stressors most likely related to the hair loss. If it is related to Ozempic or Mounjaro associated weight loss you may need to pause the medication, stabilize your weight loss and wait for the condition to reverse. This could take 3 to 6 months. Minimally, you may need to reduce your dosage of the GLP-1 agonists and space out doses to stabilize further weight loss.
• Address nutrient status and protein insufficiency. It is not unusual for patients on GLP-1 agonist medications to result in protein insufficiency. I typically recommend aiming for 25 to 30 grams of protein per meal while on these medications and consider adding supports like collagen, urolithin A and creatine.
• Use specialized hair nutrients and vitamin support such as Nutrafol – this is my favorite.
• Consider using topical hair regrowth formulations: some are over the counter (rogaine or topical minoxidil) and some are compounded prescription medications that include multiple ingredients such as minoxidil, spironolactone, finasteride, dutasteride, and/or retinoic acid.
• Consider low dose oral minoxidil that should be slowly titrated up to avoid low blood pressure side effects. Beware that stopping minoxidil suddenly will lead to excessive and profuse hair loss.
• Consider Alma-Ted, my favorite intervention. This is a procedure that uses acoustic sound waves and air pressure to drive hair signaling growth factors and nutrients about 4 mm deep into the scalp past our protective layer of skin down to the dermis.
• Hair Scalp PRP treatment: PRP refers to platelet-rich plasma. PRP is a part of your own blood that is rich in growth factors. These growth factors can help improve blood flow and delivery of nutrients to the hair follicle to promote new hair growth. Preliminary studies using PRP have been published in the journal Stem Cell Transplant Medicine showing clinical benefit for patients treated with PRP compared to the control group. The treated group showed: Increased hair thickness, increased hair count, microscopic evidence of increased blood flow to the area treated.
• Rule out autoimmune causes of hair loss or scarring.
• Consider androgen blocking systemic therapy: This includes prescription options such as finasteride, spironolactone or my preference, more natural options like saw palmetto, spearmint tea, pumpkin seed extract, green tea extract, stinging nettles and pycnogenol.
• Improve blood flow to your hair follicles: In addition to things like the Alma TED or Scalp PRP (check out our hair restoration programs) consider using nitric oxide supportive supplements. Nitric oxide can stimulate the activity of dermal papilla cells, located at the base of hair follicles. These specialized cells play a crucial role in regulating hair growth by providing signals for hair follicle regeneration and promoting the growth of new hair strands. It also acts as a vasodilator to relax blood vessels to improve oxygen and nutrient delivery to hair follicles, essential for hair growth.

➔ The Bottom Line:

There is a lot that you should do regarding hair loss. Get evaluated. Thoroughly investigate all possible root causes. Work with someone that understands your needs.

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Ready for the legal disclaimer? Information offered here is for educational purposes only and does not constitute medical advice. As with any health recommendations, please contact your doctor to be sure any changes you wish to consider are safe for you!

Mental Health Hormones Doctor Anita Sadaty Share The Health board certified gynecologist New York Functional Medicine NY Women’s Wellness