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Risk of hair loss associated with glucagon-like peptide-1 receptor agonists in adults with type 2 diabetes: target

Huilin Tang1,2, Bingyu Zhang1,3, Yiwen Lu1,2

  • 1Center for Health AI and Synthesis of Evidence (CHASE), University of Pennsylvania, Philadelphia, PA, USA.

BMJ (Clinical Research Ed.)
|July 22, 2026
PubMed
Abstract

Insights

Glucagon-like peptide-1 (GLP-1) receptor agonists are linked to a higher risk of hair loss in type 2 diabetes patients. This association, particularly for non-scarring alopecia, warrants consideration in treatment decisions.

Area of Science:

  • Endocrinology
  • Dermatology
  • Pharmacology

Background:

  • Type 2 diabetes management often involves medications like GLP-1 receptor agonists, SGLT-2 inhibitors, and DPP-4 inhibitors.
  • Alopecia, or hair loss, is a potential side effect of various medications, necessitating investigation into drug-specific risks.

Purpose of the Study:

  • To investigate the association between glucagon-like peptide-1 (GLP-1) receptor agonists and incident alopecia in adults with type 2 diabetes.
  • To compare the risk of alopecia associated with GLP-1 receptor agonists versus sodium-glucose cotransporter-2 (SGLT-2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors.

Main Methods:

  • A target trial emulation study using electronic health records from Penn Medicine.
  • Analysis included adults with type 2 diabetes initiating GLP-1 receptor agonists, SGLT-2 inhibitors, or DPP-4 inhibitors between January 2019 and September 2024.
  • Stabilized inverse probability of treatment weighting and Cox proportional hazards models were employed, with sensitivity analyses conducted.

Main Results:

  • GLP-1 receptor agonist use was associated with a higher risk of alopecia compared to SGLT-2 inhibitors (HR 1.37) and DPP-4 inhibitors (HR 1.68).
  • The association was primarily with non-scarring alopecia, showing hazard ratios of 1.53 versus SGLT-2 inhibitors and 1.72 versus DPP-4 inhibitors.
  • Findings remained consistent across sensitivity and subgroup analyses, though attenuated after negative control outcome calibration.

Conclusions:

  • GLP-1 receptor agonists are associated with an increased risk of non-scarring alopecia in adults with type 2 diabetes.
  • While the absolute risk is low, clinicians and patients should be aware of this potential adverse effect when making treatment choices.

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