Does Zepbound Cause Hair Loss? What the Label and Studies Show
Hair loss is a listed adverse reaction on the Zepbound label, reported by 4–5% of patients in trials versus 1% on placebo, mostly women, and the label ties it to weight reduction. Causality has not been established.
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Hair loss is a listed adverse reaction on the Zepbound (tirzepatide) prescribing information. It appears among the most common adverse reactions, reported in ≥5% of patients, and the patient information sheet includes hair loss in its list of most common side effects [1]. In the pivotal trials, hair loss was reported by 5% of patients at the 5 mg dose, 4% at 10 mg, and 5% at 15 mg, compared with 1% of patients taking placebo [1]. The label states that hair loss adverse reactions in Zepbound-treated patients were associated with weight reduction [1].
The reported hair loss was much more frequent in women than in men, and no Zepbound-treated patient in the pivotal trials stopped the drug because of it [1]. Researchers’ leading explanation is not the drug acting on hair directly, but the stress that rapid weight loss places on the hair growth cycle, producing a condition called telogen effluvium [6]. Causality has not been established, and the FDA has indicated it is evaluating the potential safety signal [4].
How common is hair loss on Zepbound in the clinical trials?
The numbers come from a pool of Study 1 and Study 2, which were 72-week placebo-controlled weight-reduction trials [1].
| Group | Hair loss rate |
|---|---|
| Placebo | 1% |
| Zepbound 5 mg | 5% |
| Zepbound 10 mg | 4% |
| Zepbound 15 mg | 5% |
So roughly 1 in 20 to 1 in 25 Zepbound patients reported hair loss, versus about 1 in 100 on placebo [1]. For context, the most common adverse reactions on the label, such as nausea (25–29%) and diarrhea (19–23%), were several times more frequent [1].
Do women report it more than men?
Yes, and the gap is large. In the pooled Zepbound treatment groups, hair loss was reported by 7.1% of female patients versus 0.5% of male patients. In the placebo groups, the split was 1.3% of women versus 0% of men [1]. These figures are pooled across all Zepbound doses, not tied to any single dose [1].
The same pattern shows up outside the trials. In an analysis of alopecia reports for GLP-1 drugs in the FDA Adverse Event Reporting System (FAERS), 79.29% of the reports involved female patients [5].
Does a higher Zepbound dose mean more hair loss?
The trial data do not show a dose effect. The rates were 5% at 5 mg, 4% at 10 mg, and 5% at 15 mg, so the top dose was not higher than the lower doses [1]. Dose decisions belong to the prescriber.
Does Mounjaro cause hair loss too?
Mounjaro contains the same molecule as Zepbound — tirzepatide [1] [2]. The Mounjaro label handles hair loss differently: alopecia appears under postmarketing experience, in the skin and subcutaneous tissue category [2]. The label notes that postmarketing reports are voluntary and come from a population of uncertain size, so it is not always possible to reliably estimate their frequency or establish a causal relationship to the drug [2].
Why might hair loss occur with Zepbound?
The main hypothesis is stress from rapid weight loss leading to telogen effluvium [6]. Rapid and substantial weight loss from low calorie intake can act as a stressor on the body, affecting the growth cycle of hair follicles [6]. Weight loss and nutritional change are established risk factors for telogen effluvium, a typically transient, non-scarring form of hair loss [4] [6].
Reduced food intake may also play a role. With GLP-1 drugs, levels of iron, calcium, and some vitamins may be reduced through altered and decreased food intake, and micronutrient deficiencies have been associated with hair loss [6]. Other proposed mechanisms include changes in insulin and insulin-like growth factor 1 signaling, androgen changes, and direct effects on hair follicles [7].
The size of the weight change gives context for that stress. In a SURMOUNT-1 substudy of 160 participants tracked with DXA scans over 72 weeks, body weight fell 21.3% with tirzepatide versus 5.3% with placebo. About 75% of the weight lost was fat mass and about 25% was lean mass in both groups [8].
When does hair shedding usually start?
Two data points point to the same window. Acute telogen effluvium typically shows up as diffuse shedding about 3 months after a drug is started [6]. In the BMJ cohort study of GLP-1 users, alopecia events were concentrated in the first year after treatment initiation, peaking just before 12 months [4].
What do the large real-world studies show?
Two large studies found more hair loss among GLP-1 users, but neither result can be attributed to Zepbound specifically. The BMJ study pooled six GLP-1 drugs, including tirzepatide [4]. The TriNetX study examined GLP-1 receptor agonists as a group, without naming individual drugs [7].
A target trial emulation published July 22, 2026, used Penn Medicine electronic health records for adults with type 2 diabetes who started a GLP-1, SGLT-2, or DPP-4 drug between January 2019 and September 2024. It compared 12,004 GLP-1 initiators with 15,221 SGLT-2 initiators, and 11,964 GLP-1 initiators with 11,238 DPP-4 initiators. After adjustment, GLP-1 use was associated with a higher rate of alopecia than SGLT-2 inhibitors (hazard ratio 1.37, 95% CI 1.08 to 1.73) and DPP-4 inhibitors (1.68, 95% CI 1.28 to 2.20). Adjusted incidence was 6.91 versus 5.04 per 1,000 person-years in the SGLT-2 comparison. The association was specific to non-scarring alopecia [4].
A TriNetX study of 547,993 matched adults across 67 US healthcare organizations, covering 2014 to 2024, found higher 12-month odds for telogen effluvium (adjusted odds ratio 1.76), androgenetic alopecia (1.64), and non-scarring hair loss overall (1.40) among GLP-1 users. There was no significant association for alopecia areata, the autoimmune form of hair loss [7]. A separate TriNetX analysis found that the increased telogen effluvium risk with GLP-1 weight-loss treatment, compared with other weight-loss drugs, was driven mainly by tirzepatide [6].
Why do the reporting databases disagree?
In FAERS, a reporting odds ratio measures how often alopecia is reported for a drug compared with all other drugs — it describes reporting patterns, not incidence or risk [5].
A FAERS analysis covering 2022–2023 found increased reporting odds for alopecia with semaglutide (ROR 2.46) and tirzepatide (ROR 1.73) [6]. But a later adjusted FAERS analysis covering Q2 2022 through Q2 2025 found disproportionate reporting for semaglutide (aROR 1.23) and, in the other direction, lower reporting odds for tirzepatide (aROR 0.78, 95% CI 0.72 to 0.85) [5]. A VigiBase analysis found only semaglutide significantly associated with hair loss [6].
Alopecia reporting rose sharply in 2024, which accounted for 40.05% of reports in the study period, and the rise was driven largely by semaglutide and tirzepatide [5]. These conflicting signals are one reason causality remains unsettled.
Is the hair loss permanent?
The evidence on reversibility comes from drug-induced telogen effluvium in general, not from studies of Zepbound users specifically. Acute telogen effluvium is the most common cause of reversible drug-induced hair loss [6]. In most cases of drug-induced telogen or anagen effluvium, hair regrowth occurs after the drug is stopped — though not in every case [6].
One caveat from the review: effluvium can make existing androgenetic alopecia (male-pattern or female-pattern hair loss) more visible, even though the pattern loss itself is not caused by the drugs [6].
How strong is the evidence overall?
Causality has not been established, though the evidence suggesting an increased risk of hair loss is strongest for semaglutide and tirzepatide among the GLP-1 drugs [6]. No prospective, controlled studies have specifically evaluated GLP-1 hair loss [6], and randomized trials have not routinely captured alopecia as an adverse event [4]. The FDA has indicated it is evaluating the potential safety signal [4].
What should you do if you notice hair loss on Zepbound?
The Zepbound label advises talking to your healthcare provider about any side effect that bothers you or does not go away, and you can report side effects to the FDA at 1-800-FDA-1088 [1].
A 2026 review recommends that clinicians inform patients of the potential risk and monitor for hair loss, and that patients be given advice on adequate nutrition, including maintaining adequate intake of protein and micronutrients [6]. Any decision about continuing, pausing, or changing the dose belongs with the prescriber.
Sources
- National Library of Medicine DailyMed. ZEPBOUND (tirzepatide) injection, solution.
- National Library of Medicine DailyMed. MOUNJARO (tirzepatide) injection, solution.
- New England Journal of Medicine. Tirzepatide as compared with semaglutide for the treatment of obesity.
- The BMJ. Risk of hair loss associated with glucagon-like peptide-1 receptor agonists in adults with type 2 diabetes: target trial emulation. July 22, 2026.
- Diabetes/Metabolism Research and Reviews. Not all GLP-1 receptor agonists are alike: real-world evidence of differential endocrine and dermatologic safety. 2026.
- Dermatology and Therapy. Hair loss in patients on glucagon-like peptide 1 receptor agonists: understanding risks and managing outcomes. June 5, 2026.
- PubMed Central. Increased risk of hair loss with GLP-1 receptor agonists: a real-world multicenter TrinetX cohort study.
- PubMed Central. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight.
Frequently asked questions
Does Mounjaro cause hair loss too?
Mounjaro is the same molecule as Zepbound — tirzepatide. Its label lists alopecia under postmarketing experience in the skin and subcutaneous tissue category, and notes that voluntary reports from a population of uncertain size do not allow reliable estimates of frequency or causality.
How common is hair loss on Zepbound?
In pooled 72-week placebo-controlled trials, hair loss was reported by 5% of patients on 5 mg, 4% on 10 mg, and 5% on 15 mg, versus 1% on placebo. It is listed among the most common adverse reactions on the label, and the label ties it to weight reduction.
Why do women report it more than men?
In the pooled Zepbound trial groups, hair loss occurred in 7.1% of women versus 0.5% of men; placebo rates were 1.3% and 0%. FAERS alopecia reports for GLP-1 drugs were 79.29% female.
When does Zepbound hair shedding usually start?
Acute telogen effluvium typically causes diffuse shedding about 3 months after a drug is started. In a BMJ cohort of GLP-1 users, alopecia events were concentrated in the first year after initiation, peaking just before 12 months.
Is Zepbound hair loss permanent?
The reversibility evidence comes from drug-induced telogen effluvium in general, not Zepbound studies specifically. Acute telogen effluvium is the most common cause of reversible drug-induced hair loss, and in most cases of drug-induced effluvium, regrowth occurs after the drug is stopped — though not in every case.
Does a higher Zepbound dose mean more hair loss?
The trial data do not show a dose effect: hair loss rates were 5% at 5 mg, 4% at 10 mg, and 5% at 15 mg, so the top dose was not higher than the lower doses. Dose decisions belong to the prescriber.
Is hair loss worse on tirzepatide or semaglutide?
The evidence is mixed. A 2022–2023 FAERS analysis found higher reporting odds for both semaglutide and tirzepatide, but an adjusted FAERS analysis through Q2 2025 found disproportionate reporting only for semaglutide, with lower reporting odds for tirzepatide (aROR 0.78).
What is telogen effluvium?
Telogen effluvium is a typically transient, non-scarring form of hair loss in which diffuse shedding follows a stressor such as rapid weight loss or nutritional change. It is the most common cause of reversible drug-induced hair loss, usually appearing about 3 months after drug initiation.
This article summarizes FDA labeling, published research and company information current as of September 14, 2026. It is not medical advice and does not replace a conversation with your own healthcare provider. How we research and verify.