Nonscarring Alopecia in Adults Treated With GLP-1s: A Propensity Score Matched TriNetX Cohort Study.

Abstract

GLP-1 receptor agonists (GLP-1s) are widely prescribed for type 2 diabetes (T2DM) and obesity, but associated hair loss outcomes remain poorly characterized. We evaluated whether GLP-1s were associated with different subtypes of hair loss in adults with T2DM or obesity. This retrospective TriNetX cohort study included adults with established care from 2018 to 2025. GLP-1 users were grouped by indication and propensity score matched to nonusers by demographics, comorbidities, and hair loss-associated medications. Outcomes were new diagnoses of nonscarring alopecia, telogen effluvium, and alopecia areata as a negative control. Hair loss outcomes were assessed at 1, 3, and 5 years after semaglutide initiation and 1, 1.5, and 2 years after tirzepatide initiation. Secondary analyses compared semaglutide and tirzepatide with other GLP-1s and evaluated differences in follow-up BMI between patients with and without hair loss outcomes. Semaglutide and tirzepatide were associated with higher odds of other nonscarring alopecia across T2DM and BMI cohorts. Telogen effluvium odds were elevated with semaglutide use at 3 and 5 years and with tirzepatide at all follow-up periods. Compared with other GLP-1s, both medications showed higher odds of other nonscarring alopecia; tirzepatide also showed higher odds of telogen effluvium. Follow-up BMI was lower in GLP-1 users with hair loss than without hair loss. Alopecia areata was not associated with GLP-1 use. Semaglutide and tirzepatide were associated with higher odds of nonscarring hair loss, particularly telogen effluvium. This association and follow-up BMI findings suggest that weight loss-associated physiologic stress may contribute to hair loss during GLP-1 therapy.