HealthRX.com · Printable side-effect diary
Zepbound hair loss diary and questions for your prescriber
Use this sheet if you notice hair shedding while taking Zepbound (tirzepatide). Fill in the timeline, track changes over weeks, and bring it to your prescriber or pharmacist to discuss what you have noticed.
Your hair loss timeline
Write what you remember. Estimates are fine.
Date you first noticed more hair in the brush or drainMonth and year
Dates your Zepbound dose changedWrite each change and its date
Weight change since you startedYour own scale or clothing notes
Other big changes in the months before shedding beganIllness, surgery, stress, pregnancy, new medicines or supplements
Where you see the lossScalp, part line, temples, eyebrows or body hair
Before your visit
Gather these so the conversation is specific.
- Bring your current Zepbound pen box or pharmacy label
- Note your most recent blood test results and dates
- Write down any dietary changes, such as lower protein or meal skipping
- Bring this diary with the weekly entries filled in
- Check with your pharmacist whether any new product you started could affect hair
Weekly shedding and weight log
Write one row each week. Describe what you see, such as more hair in the drain or on a pillow.
| Week starting | Hair change seen | Weight | Other notes |
|---|---|---|---|
Questions for your prescriber or pharmacist
- Has anyone else on Zepbound reported this kind of hair loss to you?
- Could my shedding be linked to how fast I have lost weight?
- Would blood tests help check for a deficiency in my case?
- How long do you usually see this kind of shedding last?
- Should I keep my current dose or change it at this stage?
- Which supplements, if any, are safe to ask about before I start them?
- What signs would make you want to see me sooner?
- Is there a way to report this side effect for my records?
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.