Ethical considerations of cosmetic glucagon-like peptide-1 receptor agonist prescribing in dermatology

Glucagon-like peptide-1 receptor agonists are increasingly used beyond approved metabolic indications, including for elective weight loss and aesthetic optimization. Dermatologists may receive requests to prescribe these agents and patients may experience downstream consequences such as facial volume loss and telogen effluvium. Although prescribing these medications for hidradenitis suppurativa or psoriasis can be medically justified and helpful, elective prescribing raises ethical concerns about nonmaleficence, scope of practice, prescribing cascades, patient autonomy, justice, and stewardship of limited resources. We discuss the ethical responsibilities of dermatologists considering prescribing glucagon-like peptide-1 receptor agonists for cosmetic purposes and propose practical guardrails to balance patient preferences with professional judgment and avoid iatrogenic harm.