What is the treatment for hair loss caused by Zepbound (generic name not specified)?

Treatment of Zepbound-Induced Hair Loss

For hair loss caused by Zepbound (tirzepatide), the primary management is reassurance and watchful waiting, as drug-induced hair loss is typically telogen effluvium that resolves spontaneously within 3-6 months after the body adjusts to the medication, with topical minoxidil as the main adjunctive treatment option if hair loss persists beyond this timeframe. 1, 2

Understanding the Mechanism

• Zepbound-induced hair loss is most likely telogen effluvium, a temporary diffuse hair shedding pattern that occurs 1-3 months after starting medications that cause hormonal or metabolic changes 1, 3
• The mechanism involves premature shifting of hair follicles from the growth phase (anagen) into the resting/shedding phase (telogen) due to the physiologic stress of medication initiation or the rapid weight loss associated with GLP-1 receptor agonists 3, 4
• Individual sensitivity varies, and patients with pre-existing hair loss conditions may notice changes more readily 1

Initial Management Approach

Continue Zepbound with monitoring as the first-line strategy, since drug-induced telogen effluvium is self-limited and typically resolves after 3-6 months as the body adjusts 1

• Reassure the patient that this is a temporary phenomenon and does not indicate permanent hair damage 2, 4
• Set realistic expectations: hair regrowth cannot be expected within 3 months of onset, and full recovery may take 6-12 months 5, 1
• Document baseline hair loss with photography to track progression objectively 5, 2

When to Add Topical Minoxidil

If hair loss persists beyond 3-6 months or is causing significant distress, initiate topical minoxidil as adjunctive therapy 1, 2

• Minoxidil is the first-line pharmacologic treatment for diffuse hair loss and can accelerate recovery from telogen effluvium 5, 2
• Apply 5% minoxidil solution (for men) or 2-5% minoxidil (for women) twice daily to affected areas 2
• Counsel patients that minoxidil requires 3-4 months of consistent use before visible improvement and must be continued long-term to maintain benefits 5

Discontinuation Considerations

Stopping Zepbound should be reserved for severe, persistent hair loss that significantly impacts quality of life and does not respond to conservative management 4

• Drug discontinuation almost always leads to complete hair regrowth, though this may take 6-12 months 6, 4
• Weigh the metabolic benefits of continued Zepbound therapy (weight loss, glycemic control) against the psychological impact of hair loss 2
• If discontinuation is chosen, hair shedding may paradoxically worsen temporarily before improvement begins 3

Nutritional Assessment

Screen for nutritional deficiencies that may be exacerbating hair loss, particularly in patients experiencing rapid weight loss on Zepbound 2

• Check iron studies (ferritin, iron, TIBC), vitamin D, zinc, and thyroid function (TSH, free T4) 2
• Protein malnutrition from inadequate intake during aggressive weight loss can worsen telogen effluvium 2, 3
• Supplement deficiencies as identified, though evidence for mineral supplementation in drug-induced alopecia remains unclear 6

Key Pitfalls to Avoid

• Do not immediately discontinue Zepbound at the first sign of hair loss, as this deprives the patient of therapeutic benefit for a self-limited condition 1, 4
• Avoid prescribing oral finasteride, as it is only effective for androgenetic alopecia (male pattern baldness), not telogen effluvium 2
• Do not use intralesional corticosteroids or contact immunotherapy, as these are indicated for alopecia areata (an autoimmune focal hair loss), not drug-induced diffuse shedding 5
• Recognize that hair loss may be multifactorial: the stress of lifestyle changes, rapid weight loss, and caloric restriction can all contribute independently of the medication itself 3