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The pharmacovigilance data shows slightly different reporting odds ratios for alopecia across GLP-1 receptor agonists: Tirzepatide: ROR of 1.73 (95% CI: 1.42-2.09) Semaglutide: ROR of 1.42 (95% CI: 1.3-1.55) Liraglutide: Lower reporting rates, but also less dramatic weight loss The pattern is telling

347 Activated TGF- binds to its transmembrane receptor (TR), subsequently inducing the phosphorylation of suppressor of mothers against decapentaplegic (SMAD) and its translocation into the nucleus, which suppresses hepatocyte proliferation by inhibiting the expression of downstream DNA synthesis-related genes

More serious adverse effects that require monitoring include: Pancreatitis (treatment should be discontinued immediately if suspected) Gallbladder disease (cholelithiasis and cholecystitis) Diabetic retinopathy complications (particularly with rapid HbA1c reduction in patients with pre-existing retinopathy) Acute kidney injury (secondary to dehydration from gastrointestinal side effects) Increased heart rate Hypoglycaemia (particularly when used with insulin or sulphonylureas) Understanding the expected side effect profile helps patients distinguish between typical medication responses and symptoms that may warrant further medical evaluation