Hair today Gone Tomorrow
Does GLP-1 cause hair loss, or does weight loss cause hair loss, or is it a nutritional deficiency?
It happens to about 8 percent of women. Three to four months after starting GLP-1, they start noticing hair loss. Just when as they feeling good about the weight loss.
First, a bit more hair in the shower drain. Then it comes out in clumps.
About 8 percent of women report hair loss on GLP-1 medications. For men, there is somewhat less than 1 percent.
Telogen Effluvium
It is such a great word, and is the condition that describes the most common cause of hair loss for people who lose weight. Whether weight loss is from diet, weight loss surgery, or GLP-1 use. TE is responsible for more than 90 percent of the hair loss, and occurs at the level of the hair follicle when the follicle is “stressed.” Essentially, the hair follicle stops making hair and takes a rest.
It can also happen after other major stressors, pregnancy, job change, divorce, new relationship, having a teenager.
Anatomy of a Hair Follicle and why it stops making hair
A hair follicle is a tiny, pocket-shaped tube in your skin that grows hair. a miniature hair factory.
Every hair on your body grows out of its own follicle. You are born with about 5 million of them all over your body, except on the palms of your hands and the soles of your feet. Well, some do have hair follicles on their palms, but that is a rare wolf like condition.
Hair follicles normally cycle through four phases: growth, transition, rest, and shedding. The hair on your head has a growth cycle (anagen phase) that can last from two to seven years. The shorter the growth cycle, the shorter your hair is. Those people with a nice long hair have much longer hair cycles. Once the hair cycle has completed, or is forced to stop, the follicle goes into a transition and rest phase, and the hair will shed. As people age, the growth cycle shortens.
Several things will force the hair follicle into a resting phase. One is major hormonal disruptions, like pregnancy or people who are given some exogenous hormones.
Everyone responds differently to stress, but for some, their hair follicles respond to stress by stopping growth and entering into a 3-month resting phase. People who go through a stressful event (like weight loss or childbirth, high fever) don't lose their hair immediately. The shedding hits right on cue 3 months later, once that resting phase wraps up.
If you begin a GLP-1 in January, then sometime in March or April you suddenly wonder why your bathroom looks like a golden doodle exploded in it.
Hair loss after weight surgery happens even more than people on GLP-1 medications. Up to 57% of people with weight surgery,
The Supplement Rush
Some people think they will avoid hair loss by taking lots of biotin, vitamins, and extra protein shakes. And while a lack of nutrients can cause hair loss, most of the time it is just TE.
But during the panic time, as the hair brush and sink fill, people look to the internet to buy biotin (not a good idea and rarely a reason for hair loss) or add more protein powder into their lives. Please resist this rush. Also resist those who say, “I took this supplement before I started and never lost a hair.” Anecdotes are not evidence.
Typical hair loss (or it is really shedding) during the first several months after a large weight loss or operation is classic telogen effluvium. Then three to four months after the initial shedding, the hair returns, often richer and fuller than before.
Persistent Hair Loss
If the hair doesn’t come back after a few months, that is when we think about other diagnoses.
Could GLP-1 Cause Hair Loss?
I suppose it could. But there has been no evidence that the drug itself causes this as an issue.
People on these drugs eat less, lose weight rapidly, and sometimes don’t eat well.
“I started Zepbound and my hair fell out” does not necessarily mean Zepbound attacked the hair follicle.
It may mean: Zepbound led to much less appetite and not enough nutrients. That is the logic that the salesmen of supplements and scams depend on.
Male and Female Pattern Baldness
These happen to men, and women, in their 20’s. A person could have both TE and pattern baldness. Rapid shedding can expose that you have fewer hairs providing cover (or comb over).
Most of the time it is temporary
Classic telogen effluvium is generally non-scarring and temporary.
The follicle isn’t dead. Stress has just reset the follicle. And it takes about 3 months for that new hair to show itself on the scalp.
Once the triggering physiologic stress settles, hairs can cycle back into growth. The American Academy of Dermatology notes that normal fullness typically returns over six to nine months.
That doesn’t make watching your hair come out any less disturbing.
Don’t overtake supplements. Protein powder probably won’t hurt you. If concerned, have your doctor look at your scalp, and maybe get some blood work.
What I Would Actually Do About GLP-1 Hair Loss
Here’s where we leave social media medicine and do some medicine.
First: Look at the Pattern
Diffuse shedding all over the scalp beginning a few months after substantial weight loss?
