Associations Between GLP-1 Receptor Agonists and Alopecia: A Multi-Centre Retrospective Analysis and Public Interest Trends

Abstract

Background: There is a growing body of literature suggesting that GLP-1 receptor agonists (GLP-1RAs) may be associated with hair loss; however, primary literature is sparse. Additionally, it is not well-established which types of hair loss may be associated with GLP-1RA use. Objectives: This study aims to assess associations between GLP-1RAs and hair loss, specifically androgenetic alopecia (AGA), alopecia areata (AA), and telogen effluvium (TE) using a multi-centre retrospective database, to augment existing single-institution and adverse event reporting system data. Additionally, this study assesses trends in public perception of GLP-1RAs and hair loss using a publicly available data set. Methods: The All of Us Database (AoUDB) was queried for GLP-1RA prescriptions as well as alopecia diagnoses with subanalysis of AGA, AA and TE. Multivariate regression adjusted for demographics, metabolic factors, and socioeconomic factors. Google Trends data was used to track aggregate search records worldwide for hair loss and GLP-1RAs. Results: Patients with any GLP-1RA use had a significantly higher odds ratio (OR) for diagnosis of any alopecia. Subanalysis for individual GLP-1RAs revealed significant increases in OR for any alopecia and AGA but not AA for patients on liraglutide and dulaglutide. Patients on semaglutide had a significantly increased OR for AGA. Patients on exenatide had a significantly increased OR for AGA and TE. Tirzepatide revealed no significant changes across all outcomes. Analysis of Google Trends data showed a significant increase in searches for hair loss and subcutaneous semaglutide and tirzepatide over the studied period. Conclusions: The effect of GLP-1RAs on hair loss may not be universal across all types of hair loss. The underlying mechanism is not yet entirely understood and may be attributed to many factors. As public interest in this association continues to rise, clinicians should consider counselling patients on these associations when discussing the risks and benefits of GLP-1RAs.