Facial Aging
Stemming, in part, from a rapid loss of fat in the face, some people on a GLP-1 say their facial anatomy looks different, says Criner. Think: hollowed cheeks and temples, sagging skin along the jawline and neck, sunken or dark under-eye circles, and worsened wrinkles.
To sidestep this side effect, Criner recommends aiming for more-gradual weight loss, a protein-rich diet, and good hydration. If you still need help minimizing these facial effects, getting “cosmetic procedures like facial fillers, skin-tightening treatments, or surgical interventions can restore facial volume and manage excess skin,” she says.
Hair Loss
Another possible side effect linked to GLP-1 medications is an increased risk of hair loss. Rapid weight loss from GLP-1 medications can place physical and metabolic stress on the body, triggering telogen effluvium as hair follicles are prematurely shifted out of the growth phase and into the resting, shedding phase. One study found that people with type 2 diabetes who were treated with GLP-1 drugs developed alopecia (hair loss) more often than people who used other common diabetes medications. For those using GLP-1, the risk of alopecia was 37 percent higher than for those treated with SGLT-2 inhibitors, and 68 percent higher than for those using DPP-4 drugs.
While the relative risk of hair loss with GLP-1 drugs seems high compared with other diabetes medications, doctors note that the overall risk of all these medications causing hair loss is low.
Moreover, the majority of people taking GLP-1 medications do not experience noticeable hair loss, says Brianna Olamiju, MD, a clinical instructor in dermatology at the Icahn School of Medicine at Mount Sinai in New York City. “When it does occur, it is often temporary and most people see regrowth within three to six months,” she says.
While more research needs to be done to explain exactly how GLP-1 drugs may be linked to hair loss, doctors believe one reason is rapid weight loss, which is a well-recognized trigger that puts metabolic stress on the body — a known cause of hair loss, says Dr. Olamiju.
Other possible reasons for hair loss include nutrient deficiencies. “GLP-1 drugs suppress appetite, and if someone isn’t getting enough protein, iron, or other nutrients, they may be more likely to experience hair loss,” says Yolanda Rosi Helfrich, MD, a clinical professor of dermatology and the residency program director of the department of dermatology at the University of Michigan Medical School in Ann Arbor. “Hormonal changes associated with weight loss may also play a role.”
Fatigue and Weakness
These feelings are common the first day or two after taking a dose, but some medications are bigger culprits than others, says Ortiz-Pujols. If you’re noticing debilitating fatigue or weakness, talk to your doctor about decreasing the dose or switching to a new medication, which may help relieve these side effects.
Hypoglycemia
Some people with type 2 diabetes can also develop low blood sugar — typically defined as below 70 milligrams per deciliter (mg/dL) or 3.1 millimoles per liter (mmol/L) — while taking a GLP-1, especially if they’re also on other medications, such as insulin, that can also lower blood sugar levels.
If you’re having frequent drops in blood sugar levels, talk to your doctor, who may recommend lowering the medication dosage. If you do feel hypoglycemic, eat foods with simple sugars, such as a banana, or drink a half cup of apple juice.
Teeth Problems
Because you’re likely eating — and possibly also drinking — less while on a GLP-1, your mouth produces less saliva than usual, says Oritz-Pujols. The resulting dry environment can lead to cavities and gum disease.
Along with drinking enough water, ask your doctor if you should chew sugar-free gum or use a mouthwash designed for dry mouth.
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