What are the management options for hair shedding associated with Ozempic (semaglutide) therapy?

Management of Hair Shedding Associated with Ozempic (Semaglutide)

For patients experiencing hair shedding with Ozempic (semaglutide), evaluation of thyroid function, vitamin D, zinc, and ferritin levels is recommended as the first step, followed by appropriate supplementation of any deficiencies before considering topical minoxidil 5% as treatment.

Diagnostic Evaluation

When a patient reports hair shedding while on semaglutide therapy, the following evaluations should be performed:

• Laboratory testing:

  • Thyroid function (TSH and free T4)
  • Iron stores (ferritin)
  • Vitamin D levels
  • Zinc levels 1

• Clinical assessment:

  • Pattern and extent of hair loss
  • Timeline in relation to semaglutide initiation
  • Pre-existing conditions that may contribute to hair loss

Treatment Algorithm

Step 1: Address Underlying Deficiencies

• Correct nutritional deficiencies if identified:
  • Iron supplementation if ferritin is low
  • Vitamin D supplementation if deficient
  • Zinc supplementation if deficient
  • Thyroid hormone replacement if hypothyroid 1

Step 2: Topical Treatments

• Topical minoxidil 5% is the first-line pharmacological treatment:

  • Apply twice daily to affected areas
  • Results may take 3-4 months to become apparent
  • Effective for stimulating hair regrowth 1, 2
  • Note: Initial shedding may occur in the first 2-12 weeks of minoxidil use, which paradoxically predicts better treatment response 3

• Biotin supplementation (2.5 mg daily) may be considered, though evidence is limited 1

Step 3: Additional Supportive Measures

• Hair care practices:

  • Use sulfate-free, hydrating shampoos and conditioners
  • Avoid excessive heat styling
  • Protect hair from environmental damage 2

• Consider specialized shampoos containing alpha-1 adrenergic receptor agonists or trace amine-associated receptor agonists, which can reduce hair shedding by contracting the arrector pili muscle 4, 5

Monitoring and Follow-up

• Take baseline photos before starting treatment
• Evaluate initial response at 3 months
• Perform comprehensive assessment at 6 months to determine treatment efficacy 2

Important Considerations

• Temporal relationship: Hair shedding with semaglutide typically represents telogen effluvium, which is usually self-limiting once the trigger is addressed 6

• Patient education: Explain that:

  • Hair shedding is often temporary
  • Complete recovery may take 6-12 months
  • Treatment aims to accelerate regrowth and prevent further loss

• Medication considerations:

  • If hair loss is severe and significantly impacts quality of life, discuss the risk-benefit ratio of continuing semaglutide therapy
  • Pre-treatment assessment of patients on semaglutide should ideally include thyroid function tests 7

• Contraindications:

  • Minoxidil should be avoided in pregnancy and breastfeeding
  • Use with caution in patients with scalp conditions that may increase absorption 2

By following this structured approach, most patients experiencing hair shedding with semaglutide can achieve improvement in their condition while continuing to receive the metabolic benefits of the medication.