Does Zepbound cause hair loss?

If you’re starting on the weight loss drug Zepbound (tirzepatide), there’s no doubt you have many questions about how the medication will affect your body, including your hair. Does Zepbound cause hair loss? 

The bad news is people taking Zepbound do sometimes experience side effects, and hair loss can be among those. The good news? Only a small percentage of people experience that side effect, and it’s usually temporary. Keep reading to learn more about how Zepbound may cause hair loss, and what you can do to treat and help prevent hair loss on Zepbound.

Yes, Zepbound may cause hair loss in some people. In the Prescribing Information for the drug, hair loss is listed as one of the possible adverse reactions, alongside other Zepbound side effects like nausea, diarrhea, constipation, and fatigue, all of which were reported in clinical trials. But while gastrointestinal symptoms can occur in as many as 20% of people, hair loss was reported in just around 5% of cases. 

Hair loss is more commonly reported in women taking Zepbound than in men, but the people experiencing hair loss in clinical trials must not have found the effects to be intolerable. After all, even in those who reported hair loss, none stopped taking Zepbound because of this side effect. 

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Zepbound may cause hair loss for a couple of related reasons, including weight loss and nutrient deficiency.

Rapid weight loss

Zepbound is an effective medication for weight management. One study compared tirzepatide (the active ingredient in Zepbound) to semaglutide (the active ingredient in Wegovy), and found that average weight loss on the former was around 20% of body weight at week 72, compared to just under 14% on the latter. Those are great results of Zepbound if weight loss is your goal, but rapid weight loss is also associated with telogen effluvium (TE), a condition that causes temporary hair loss. 

TE generally results from a stressful event, which accelerates the hair growth cycle, causing hair to enter the telogen phase early. Remember that “stress” in this case means physiologic stress, or physical changes in the body such as rapid weight loss, pregnancy, illness, or surgery — rather than emotional or psychological stress alone. 

The result of telogen effluvium is that more follicles end up in the telogen phase. The telogen phase, also called the “resting” phase,  is the final phase of the hair growth cycle when hair shedding occurs. This is a normal part of your hair’s life. Under typical circumstances, about 10% to 15% of the hair on your body is in the telogen phase at any given time (which is why you’re always shedding some hair). However, when more hair follicles go into this phase abnormally early, you will notice excessive hair shedding and maybe even hair thinning on the scalp.

Research suggests that “massive” weight loss is linked with more severe TE compared to mild weight loss. In fact, weight loss of 15% of body weight at a rate of about 8 pounds per month is enough to qualify as rapid weight loss and thus to  trigger TE. While telogen effluvium is more prevalent in women and older adults, it can happen in anyone. 

Nutrient deficiency

Why would rapid weight loss cause TE? One potential reason is nutrient deficiencies that can occur when not eating enough (or even the right type of) calories. Like the rest of our bodily functions, the hair follicles need nutrients to do their job — produce hair — correctly. When you take in too few calories, you’re essentially starving the hair follicle cells of the nutrients they need to function. 

Research suggests that some people may unintentionally consume fewer than 800 calories per day early on in treatment with weight loss medications like Zepbound, far too few calories for any adult. Zepbound is part of a dual class of medications — GLP-1 (glucagon-like peptide-1 receptor agonist) and GIP (glucose-dependent insulinotropic polypeptide). Both of these cause substantial changes to the appetite, which is part of how they work so well for weight loss. 

Even with a decreased appetite, though, it’s essential to monitor your nutrient intake so you don’t inadvertently cause problems, such as hair loss. Some of the nutrients people on these medications may not consume enough of include calcium, iron, magnesium, potassium, choline, and vitamin A, C, D, and E. They frequently also don’t consume an adequate amount of protein. Many of these nutrients, like protein, iron, and vitamins A, D, and E are known to play a role in hair growth, and consuming too little of these nutrients is linked to hair loss.

If you’re concerned about starting on Zepbound due to its potential hair loss consequences, you shouldn’t automatically assume you’ll experience this side effect. In fact, the vast majority of people (about 95%) may not even experience hair loss as a side effect.

In placebo-controlled clinical trials on adults with obesity or overweight, 4% to 5% of those who received Zepbound treatment (across doses) reported hair loss, compared to 1% in the placebo group. This side effect was reported far more frequently in females than it was in males, with 7.1% of women experiencing hair loss and 0.5% of men losing hair. However, no one who received Zepbound injections reported that they stopped treatment because of hair loss in the clinical trials.

There are several steps you can take to try to prevent hair loss when taking Zepbound:

Eat a balanced diet

Zepbound reduces your appetite, which can decrease how much you eat. It’s especially important, then, to make sure you’re consuming the nutrients your body needs. Be sure to eat enough protein (research recommends around 25 to 30 grams of protein per meal during weight loss, though this amount may vary based on your overall body weight, caloric intake, and activity level). As for micronutrients, following a balanced, healthy diet is key. Consider working with a registered dietitian — many now specialize in treating clients who take medications like Zepbound and can create a customized Zepbound diet plan for you.

Control side effects

One of the reasons someone may be consuming inadequate calories, protein, or nutrients while taking tirzepatide is due to common GI side effects. These side effects, like nausea, can be better controlled with diet strategies such as eating smaller meals (four or more meals per day), reducing intake of overtly fatty foods, and avoiding overeating, according to Eli Lilly, the maker of Zepbound. 

Review your dose with your provider

If you are concerned about potential side effects of Zepbound, including hair loss, talk to your healthcare provider about the right dose of this weight loss medication for you. Since faster, more dramatic weight loss is linked to TE than more moderate weight loss, you may want to consider a lower dose for more gradual weight loss. Of course, you cannot entirely control how quickly your weight loss happens on the medication, but you can have a thorough conversation with your healthcare professional to ensure you’re on a dose that is effective and comes with tolerable side effects. Feeling good while taking Zepbound can help you maintain healthy habits, including adequate nutrition.

Your body is going through many changes on Zepbound, but hair loss may not be a welcome one. Here are a few treatment options to help manage hair loss if you experience this side effect of Zepbound:

Consider nutrient supplementation

Talk to your provider about possible testing for nutrient deficiencies, such as a blood test for iron deficiency anemia. If a deficiency is found, supplementation of that nutrient, such as iron or vitamin D, may help resolve hair loss. However, in the absence of a deficiency, it does not appear that taking extra nutrients will help with hair growth. Working with a registered dietitian can help you address gaps in your diet through your food and possible supplements.

Wait it out

This is not to make light of hair loss on Zepbound. However, if TE is the only cause of your hair loss, you can most likely feel reassured about the overall state of your hair health. Fortunately, TE is not permanent, it usually resolves without treatment, and hair tends to grow back fully. This period may not be easy, and may require patience, as hair growth can take six months to restart. You can wash and style your hair during this period as you normally would. 

Ask about hair loss medications 

If you are concerned about TE, connect with a dermatologist. For people who have a combination of TE and patterned hair loss (a hereditary progressive thinning of hair on the front, top, and sides of the scalp), using topical or oral minoxidil or finasteride can help improve hair density if your healthcare provider thinks these medications may help.

Consider an alternate medication

If Zepbound hair loss is bothersome and affecting your quality of life, you might seek medical advice from your prescriber about stopping Zepbound and trying an alternate medication. Although all GLP-1 receptor agonists could cause hair loss as a side effect, clinical research suggests tirzepatide and semaglutide are the most likely to do so. Liraglutide appears less likely to cause hair loss, though all medications come with their own risks and benefits. Be sure to weigh the pros and cons of these medications with your prescriber to find the one that’s best for you.

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Hair loss is a possible side effect of Zepbound, but likely not one that should scare you away from taking this medication if it’s right for you. 

• About 5% of people in clinical trials for Zepbound reported hair loss, but no one reported they stopped taking the medication for this reason. 

• The type of hair loss associated with Zepbound is telogen effluvium (TE), which is usually temporary. 

• Hair loss on Zepbound may be due to the strain your body experiences when you lose weight quickly. Your hair should grow back once your body adjusts to the medication, though it can take six months to notice this regrowth and timing may vary depending on the individual. 

• You may also want to connect with a registered dietitian to review your current diet and make changes to your caloric intake to ensure you’re getting adequate nutrients to help prevent and treat hair loss.

Talk to your prescriber if side effects like hair loss are bothersome or negatively affect your quality of life.