Glucagon-like peptide-1 receptor agonists and hair loss: Current evidence and potential mechanisms

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for type 2 diabetes mellitus and obesity, with well-established benefits in glycemic control, weight reduction, and cardiometabolic outcomes. However, emerging clinical reports, retrospective studies, and pharmacovigilance data have raised concern for a potential association between GLP-1RA therapy and hair loss, though causality remains uncertain and findings vary across agents. This literature review synthesizes current evidence and proposed mechanisms of GLP-1RA-associated hair loss, emphasizing non-scarring alopecias such as telogen effluvium and androgenetic alopecia. Proposed contributors include rapid weight loss, caloric restriction, micronutrient deficiencies from reduced intake, follicular microenvironment changes, insulin-like growth factor-1 signaling disruption, hypothalamic-pituitary-adrenal axis activation, and androgen-mediated pathways that may unmask underlying androgenetic alopecia. Reported shedding often follows a telogen effluvium pattern, emerging several months after initiation or rapid weight reduction and improving with trigger attenuation. Management may include patient counseling, nutritional optimization with adequate protein and micronutrient repletion, follicle-directed therapies such as topical or low-dose oral minoxidil, and procedural adjuncts in select cases. Prospective studies using standardized diagnostic criteria and objective hair assessments are needed to better define incidence, mechanisms, and management.