Abstract
Background: Glucagon-like peptide-1 (GLP-1) receptor agonists are widely prescribed for weight management and type 2 diabetes due to their effects on glucose regulation, appetite suppression, and metabolic health. However, hair shedding has been increasingly reported as a side effect.
Case Presentation: A female client on GLP-1 therapy presented with concerns of increased hair shedding and scalp sensitivity. Functional trichology evaluation identified metabolic stress, nutrient depletion, and scalp imbalance as contributing factors.
Intervention: A dual approach was implemented: internally, by optimizing nutrient status, supporting liver detoxification, and stabilizing glucose metabolism; and externally, by stimulating follicular activity and maintaining scalp health.
Results: After three months, hair shedding stabilized, new growth was observed in the frontal and crown regions, and scalp health improved.
Conclusion: GLP-1 therapy offers significant benefits for metabolic health but carries the risk of hair loss. For individuals choosing this therapy, maintaining scalp stimulation and optimizing internal health can mitigate shedding and promote regrowth.
Introduction
GLP-1 receptor agonists, originally developed for type 2 diabetes, have gained widespread use for weight loss and metabolic optimization. They act by enhancing insulin secretion, reducing gastric emptying, and suppressing appetite, making them highly effective for reducing body weight and improving glycemic control (Wilding et al., 2021).
Despite their benefits, side effects have been documented, including gastrointestinal disturbances, nutrient deficiencies, and hair loss. The mechanism behind GLP-1–associated hair shedding is not fully understood, but proposed pathways include nutrient depletion from rapid weight loss, increased systemic stress, and hormonal shifts affecting follicular cycling.
This case report demonstrates the application of functional trichology in managing a client on GLP-1 therapy, highlighting both the systemic considerations and targeted scalp interventions necessary to preserve hair health.
Case Presentation
A female client initiated GLP-1 therapy for weight management and glycemic stability. Within two months, she reported increased hair shedding, especially in the shower and during brushing, accompanied by scalp sensitivity and changes in hair texture.
The client’s history included:
Rapid weight reduction.
Nutrient-depleted diet with inconsistent protein intake.
Fatigue and mild digestive disturbances.
Functional Considerations
GLP-1 therapy contributes to appetite suppression and caloric restriction, which, without proper dietary planning, may lead to insufficient protein and micronutrient intake. Rapid weight loss itself is a known trigger for telogen effluvium, an acute shedding response linked to metabolic stress.
Functional Blood Chemistry
Analysis revealed:
Suboptimal ferritin and vitamin D levels.
Elevated inflammatory markers.
Lowered albumin, suggesting reduced protein status.
Normal thyroid hormones, ruling out thyroid dysfunction.
From a trichological perspective, the goal was to stabilize internal nutrient status and reduce inflammatory stress while maintaining continuous follicular stimulation at the scalp level.
Intervention
Internal Protocol
The internal plan aimed to protect against the nutrient depletion and metabolic stress associated with GLP-1 therapy:
Nutrient optimization: Focus on protein intake, iron, vitamin D, zinc, and B-complex support.
Glycemic stability: Education on meal sequencing (fiber and protein before carbohydrates) to prevent blood sugar fluctuations.
Detoxification support: Liver-supportive foods (bitter greens, cruciferous vegetables) to assist with metabolic clearance.
Anti-inflammatory nutrition: Emphasis on omega-3 rich foods and antioxidant intake to reduce oxidative stress.
External Protocol
The external plan supported scalp circulation and follicle activity:
Scalp detoxification and pH balancing to maintain a healthy microenvironment.
Ozone therapy and high-frequency treatments to stimulate blood flow and reduce microbial overgrowth.
Microneedling and laser therapy to reactivate dormant follicles and extend the anagen phase.
Topical hair nourishment with oil-based formulas designed to maintain hydration and reduce inflammation.
Outcomes
At three-month follow-up:
Hair shedding stabilized and was reduced compared to the initial presentation.
Early regrowth was observed at the crown and frontal hairline.
Scalp sensitivity resolved, and the scalp environment appeared balanced upon examination.
The client reported improved energy and better dietary adherence with structured protein intake.
While some shedding persisted, the rate had slowed significantly, and the trajectory was positive toward recovery.
Discussion
This case highlights the dual nature of GLP-1 therapy for individuals concerned with hair health.
Benefits of GLP-1 therapy:
Effective for weight reduction.
Improves glycemic control and reduces risk of type 2 diabetes complications.
May lower cardiovascular risk factors (Wilding et al., 2021).
Risks relevant to hair loss:
Rapid weight loss triggers telogen effluvium.
Appetite suppression may lead to protein and micronutrient deficiencies, undermining follicle function.
Increased systemic stress and oxidative imbalance may compromise follicle cycling.
From a trichological perspective, individuals on GLP-1 therapy benefit from proactive management:
Stabilizing nutrient intake to protect against deficiency-driven hair shedding.
Continuous scalp stimulation to preserve follicle activity during metabolic stress.
Supporting detoxification and immune balance to reduce systemic triggers of hair loss.
This case demonstrates that hair shedding associated with GLP-1 therapy can be mitigated when internal optimization and scalp-directed care are combined.
Conclusion
GLP-1 receptor agonists are powerful tools for managing obesity and metabolic dysfunction, but hair shedding can occur as a side effect of rapid weight loss and nutrient depletion. Functional trichology offers a structured approach to preserve hair health during therapy. By optimizing nutrient intake, supporting detoxification, and stimulating the scalp, individuals can slow shedding and enhance regrowth potential while benefiting from GLP-1 treatment.
References
Messenger, A. G., & McKillop, J. (2019). Alopecia areata variants: Ophiasis and sisaipho. Clinical and Experimental Dermatology, 44(8), 889–895. https://doi.org/10.1111/ced.14034
Ramos, P. M., Miot, H. A., & Trüeb, R. M. (2020). Role of vitamin D in hair disorders: A systematic review. Dermatology and Therapy, 10(1), 91–103. https://doi.org/10.1007/s13555-020-00347-1
Wilding, J. P., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., … & le Roux, C. W. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989–1002. https://doi.org/10.1056/NEJMoa2032183
