Hair loss during treatment of obesity: current state of the problem and potential solutions
https://doi.org/10.14341/probl13817
Abstract
Obesity and overweight are significant medical and social problems, and current approaches to their treatment, including hypocaloric diets, bariatric interventions, and pharmacotherapy, including incretin drugs (e.g., glucagon-like peptide-1 receptor agonists), can be accompanied by the development of diffuse hair loss. This article, prepared following a discussion at an expert council, systematizes current data on the prevalence and clinical and morphological variants of alopecia associated with weight loss. The main pathogenic mechanisms are discussed, including metabolic stress, protein-energy malnutrition, and micronutrient deficiencies.
Special attention is paid to the role of biotin and vitamin D in maintaining hair follicle function, as well as to risk groups for alopecia in patients undergoing treatment for obesity. Approaches to the prevention, monitoring, and comprehensive management of such patients are presented, taking into account the need to maintain adherence to the main therapy.
This article systematizes current data on the prevalence and clinical and morphological variants of alopecia associated with weight loss. It examines the main pathogenic mechanisms, including metabolic stress, protein-energy malnutrition, and micronutrient deficiencies. Special attention is paid to the role of biotin and vitamin D in maintaining hair follicle function, as well as to risk groups for alopecia in patients undergoing treatment for obesity. Approaches to prevention, monitoring, and comprehensive management of these patients are presented, taking into account the need to maintain adherence to the primary therapy.
About the Authors
E. A. TroshinaRussian Federation
Ekaterina A. Troshina, MD, Dr. Sc. (Med.),Professor
Moscow
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
L. A. Suplotova
Russian Federation
Lyudmila A. Suplotova, MD, Dr. Sc. (Med.), Professor
Tyumen
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
F. Kh. Dzgoeva
Russian Federation
Fatima K. Dzgoeva, MD, PhD
11 Dm. Ulyanova street, 117036 Moscow
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
L. A. Ruyatkina
Russian Federation
Lyudmila A. Ruyatkina, MD, Dr. Sc. (Med.), Professor
Novosibirsk
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
A. G. Gadzhigoroeva
Russian Federation
Aida G. Gadzhigoroeva, MD, Dr. Sc. (Med.), Professor
Moscow
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
O. A. Gromova
Russian Federation
Olga A. Gromova, MD, Dr. Sc. (Med.), Professor
Moscow
Ivanovo
WoS ResearcherID: J-4946-2017
Scopus Author ID: 7003589812
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
Yu. Yu. Romanova
Russian Federation
Yulia Yu. Romanova, MD, PhD
Moscow
Competing Interests:
Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
References
1. Federal State Statistics Service (Rosstat). Healthcare in Russia 2025: statistical digest. — Moscow; 2025.
2. Clinical guidelines «Obesity» (approved by the Russian Ministry of Health). Available at: https://cr.minzdrav.gov.ru/preview-cr/28_3.
3. Torshin I.Yu., Gromova O.A. Efficiency of biotin use in the treatment of alopecia of various origins, skin and nail pathologies. // Medical Council. - 2024. - No. 14. - P. 135-144. doi: https://doi.org/10.21518/ms2024-296
4. Taghizadeh N, Salhab H, Alirezaei A, Najjari K, Yang W, Abedi- Kichi R, Esparham A, Shahabi Shahmiri S. Hair Loss and Metabolic and Bariatric Surgery: An Updated Systematic Review and Meta-analysis. Obes Surg. 2025;35(6):2370-2380. doi: https://doi.org/10.1007/s11695-025-07903-8
5. Rojas Lopez RF, Lynett Barrera D, Amaya Muñoz MC, Saavedra Diaz MP. Alopecia as an Emerging Adverse Effect Associated With Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists for Weight Loss: A Scoping Review. Cureus. 2025;17(8):e90021. doi: https://doi.org/10.7759/cureus.90021
6. Alexa RE, Haliga RE, Morărașu BC, Ceasovschih A, Sîrbu O, et al. The Nutritional Paradox of Obesity: Mechanisms and Clinical Implications of Micronutrient Deficiencies. Med Sci (Basel). 2026;14(2):160. doi: https://doi.org/10.3390/medsci14020160
7. Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015;16(4):341-9. doi: https://doi.org/10.1111/obr.12239
8. Zhang W, Fan M, Wang C, Mahawar K, Parmar C, Chen W, Yang W; Global Bariatric Research Collaborative. Hair Loss After Metabolic and Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg. 2021;31(6):2649-2659. doi: https://doi.org/10.1007/s11695-021-05311-2
9. Lanehart MH, Zinn Z, Beatty CJ. Association between GLP-1 receptor agonists and nonscarring hair loss: a population-based, propensity score matched cohort analysis. Arch Dermatol Res. 2026;318:164. doi: https://doi.org/10.1007/s00403-026-04603-w
10. Kang DH, Kwon SH, Sim WY, Lew BL. Telogen Effluvium Associated With Weight Loss: A Single Center Retrospective Study. Ann Dermatol. 2024;36(6):384-388. doi: https://doi.org/10.5021/ad.24.043
11. Moll H, Frey E, Gerber P, Geidl B, Kaufmann M, et al. GLP-1 receptor agonists for weight reduction in people living with obesity but without diabetes: a living benefit-harm modelling study. eClinicalMedicine. 2024;73:102661. doi: https://doi.org/10.1016/j.eclinm.2024.102661
12. Alharbi S, Alkhalifah A. Prevalence and Predictors of Hair Shedding among GLP-1 Receptor Agonist Users: A Cross-Sectional Study from Saudi Arabia. Skin Appendage Disord. 2026
13. Haykal D. Alopecia and Semaglutide: Connecting the Dots for Patient Safety. J Cosmet Dermatol. 2025;24(3):e70125. doi: https://doi.org/10.1111/jocd.70125
14. Piraccini BM, Vañó-Galván S, Blume-Peytavi U, Ribet V, Mengeaud V. Hair Loss in Patients on Glucagon-Like Peptide 1 Receptor Agonists: Understanding Risks and Managing Outcomes. Dermatol Ther (Heidelb). 2026;16(7):3345-3360. doi: https://doi.org/10.1007/s13555-026-01792-0
15. Vidal SI, Akiska YM, Nasseri M, Menta N, Nussbaum D, Cotton CH, Castelo-Soccio L, Friedman A. Increased risk of hair loss with GLP-1 receptor agonists: A real-world multicenter TrinetX cohort study. JAAD Int. 2026;25:133-135. doi: https://doi.org/10.1016/j.jdin.2026.01.014
16. Buontempo MG, Santos BT. Exploring the hair loss risk in glucagonlike peptide-1 agonists: emerging concerns and clinical implications. J Eur Acad Dermatol Venereol. 2025;39(2):263-264
17. Desai DD, Sikora M, Nohria A, Bordone L, Caplan AS, Shapiro J, Lo Sicco KI. GLP-1 agonists and hair loss: a call for further investigation. Int J Dermatol. 2024;63(9):1128-1130. doi: https://doi.org/10.1111/ijd.17246
18. Alsuwailem OA, Alanazi R, Almutairi HM, Asiree RH, Almutairi W, Almutairi TM, Zamandar A, Alkhames S. Hair Loss Associated With Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist Use: A Systematic Review. Cureus. 2025;17(9):e92454. doi: https://doi.org/10.7759/cureus.92454
19. Gupta AK, Teasell EM, Economopoulos V, Mirmirani P. GLP-1 therapies and hair loss: A systematic review of current evidence and implications for counseling. Sci Prog. 2026;109(2):368504261444578. doi: https://doi.org/10.1177/00368504261444578
20. Li H, Li W, Zhang J? et al. Risk factors for androgenetic alopecia: a systematic review and meta-analysis. BMC Public Health. 2026;26:1000. doi: https://doi.org/10.1186/s12889-026-26258-y
21. Báez-Saldaña A, Zendejas-Ruiz I, Revilla-Monsalve C, Islas-Andrade S, Cárdenas A, et al. Effects of biotin on pyruvate carboxylase, acetyl-CoA carboxylase, propionyl-CoA carboxylase, and markers for glucose and lipid homeostasis in type 2 diabetic patients and nondiabetic subjects. Am J Clin Nutr. 2004;79(2):238-243. doi: https://doi.org/10.1093/ajcn/79.2.238
22. Tong L. Structure and function of biotin-dependent carboxylases. Cell Mol Life Sci. 2013;70(5):863-891. doi: https://doi.org/10.1007/s00018-012-1096-0
23. Belda E, Voland L, Tremaroli V, Falony G, et al. (MetaCardis Consortium & Clément K). Impairment of gut microbial biotin metabolism and host biotin status in severe obesity: effect of biotin and prebiotic supplementation on improved metabolism. Gut. 2022;71(12):2463–2480. doi: https://doi.org/10.1136/gutjnl-2021-325753
24. Jitrapakdee S, Wallace JC. The biotin enzyme family: conserved structural motifs and domain rearrangements. Curr Protein Pept Sci. 2003;4(3):217-229. doi: https://doi.org/10.2174/1389203033487199
25. Shimizu H, Morgan BA. Wnt signaling through the betacatenin pathway is sufficient to maintain, but not restore, anagen-phase characteristics of dermal papilla cells. J Invest Dermatol. 2004;122(2):239-245. doi: https://doi.org/10.1046/j.0022-202X.2004.22224.x
26. Enshell-Seijffers D, Lindon C, Kashiwagi M, Morgan BA. betacatenin activity in the dermal papilla regulates morphogenesis and regeneration of hair. Dev Cell. 2010;18(4):633-642. doi: https://doi.org/10.1016/j.devcel.2010.01.016
27. State Register of Medicines. Registration documents for the drug «Biotinal B7.» https://grls.rosminzdrav.ru/CIPermissionMini.aspx?CIStatementGUID=75bb4e2e-c360-4a4ca886-bc348835ad52&CIPermGUID=c352d7bc-04dc-4479-8595-ad7fb5df7901.
28. Leaflet of the Pharmaceutical Drug Biotinal V7 LP-No.(002640)-(RG-RU) dated 05/23/2025.
29. He Y, et al. Impact of rapid weight reduction on risk of cholelithiasis: A 2025 update on metabolic interventions. Front Surg. 2025;12:6205466
30. Giustina A, di Filippo L, Allora A, Bikle DD, Cavestro GM, et al. Vitamin D and malabsorptive gastrointestinal conditions: A bidirectional relationship? Rev Endocr Metab Disord. 2023;24(2):121-138. doi: https://doi.org/10.1007/s11154-023-09792-7
31. Kamath BM, Alonso EM, Heubi JE, Karpen SJ, Sundaram SS, Shneider BL, Sokol RJ. Fat Soluble Vitamin Assessment and Supplementation in Cholestasis. Clin Liver Dis. 2022;26(3):537-553. doi: https://doi.org/10.1016/j.cld.2022.03.011
32. Send SR. Nutritional Management of Cholestasis. Clin Liver Dis (Hoboken). 2020;15(1):9-12. doi: https://doi.org/10.1002/cld.865
33. El-Tatawy RA, Gheida S, Soliman GAM, Ismail M. Oral Vitamin D Treatment in Patients with Telogen Effluvium: Clinical and Dermoscopic Evaluation. Int J Trichology. 2023;15(5):183-190. doi: https://doi.org/10.4103/ijt.ijt_92_22
34. Dedov I.I., Mel’nichenko G.A., Mokrysheva N.G., Pigarova E.A., Povaliaeva A.A., Rozhinskaya L.Ya., Belaya Zh.E., Dzeranova L.K., Karonova T.L., Suplotova L.A., Troshina E.А. Draft federal clinical practice guidelines for the diagnosis, treatment, and prevention of vitamin D deficiency. Osteoporosis and Bone Diseases. 2021;24(4):4-26. (In Russ.) doi: https://doi.org/10.14341/osteo12937
35. Dukhanin, A. S. Vitamin D Preparations: From Active Ingredient to Therapeutic Effects // Doctor. 2022; 9 (25): 66–71. DOI: 10.51793/OS.2022.25.9.001
36. Gromova O.A., Torshin I.Yu. Vitamin D: a paradigm shift. Edited by Gusev E.I., Zakharova I.N. - M.: Torus Press; 2015. P. 449-453.
37. Gromova O.A. et al. Pharmacological features of a water-soluble form of vitamin D based on micelles. // Farmateka. – 2015. – No. 1.
38. Grafe F, Wohlrab W, Neubert RH, Brandsch M. Transport of biotin in human keratinocytes. J Invest Dermatol. 2003;120(3):428-433
39. Duchi S, Rebollo Torregrosa P, Hajuj A, Molho D, Shkoor R, Saada NA, Fernández DG, Goldstein D, Pérez-Fernández A. The formulation and in vitro evaluation of WS Biotin, a novel encapsulated form of D-Biotin with improved water solubility for hair and skin treatment applications. Int J Cosmet Sci. 2024 Feb;46(1):119-129. Epub 2023 Nov 5. PMID: 37779197. doi: https://doi.org/10.1111/ics.12914
Review
For citations:
Troshina E.A., Suplotova L.A., Dzgoeva F.Kh., Ruyatkina L.A., Gadzhigoroeva A.G., Gromova O.A., Romanova Yu.Yu. Hair loss during treatment of obesity: current state of the problem and potential solutions. Problems of Endocrinology. 2026;72(4):4-9. (In Russ.) https://doi.org/10.14341/probl13817
JATS XML
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).



































.jpg)

