Does Tacrolimus Cause Your Hair to Fall Out?

October 7, 2025 •

4 min read

Studies have shown that up to 29% of patients taking the immunosuppressant tacrolimus may develop a type of hair loss known as telogen effluvium. This widespread thinning and shedding of hair, a less common but significant side effect, occurs as the medication affects the normal hair growth cycle.

Quick Summary

Tacrolimus can cause hair loss, specifically telogen effluvium, in some patients. This side effect is often reversible upon dosage reduction or discontinuation and is more frequently observed in women after specific transplants. The exact mechanism is still under investigation, but it may involve dose-dependent effects or compromised blood flow to hair follicles.

Key Points

Tacrolimus can cause hair loss: Clinical studies have shown that tacrolimus is associated with a form of temporary, non-scarring hair loss known as telogen effluvium in some patients.
Prevalence varies but is notable: The incidence of tacrolimus-induced alopecia can vary but has been reported to be as high as 29% in certain patient populations, with a higher frequency observed in women following kidney-pancreas transplants.
Hair loss is often reversible: In most cases, the hair loss caused by tacrolimus is reversible. Regrowth typically occurs after the dosage is reduced or the medication is discontinued, though it may take several months.
Potential mechanisms include vasoconstriction: While not fully understood, a leading theory suggests that tacrolimus may cause vasoconstriction, or narrowed blood vessels, which reduces blood flow to the hair follicles and prematurely pushes them into a resting phase.
Management options are available: Options for managing this side effect include discussing dose reduction with your healthcare team, switching to an alternative medication like cyclosporine, or using topical minoxidil.
Requires medical supervision: Patients should not alter their tacrolimus dosage or stop the medication on their own, as it is a critical immunosuppressant. Any changes must be made under strict medical supervision.
Not the same as topical tacrolimus: It is worth noting that topical tacrolimus (ointment) has different effects and is sometimes even used to treat certain autoimmune skin conditions that cause hair loss.

Understanding Tacrolimus and its Use

Tacrolimus, a potent immunosuppressant, plays a critical role in modern medicine by preventing organ rejection in transplant patients and treating various autoimmune diseases. It is a calcineurin inhibitor, meaning it works by suppressing the immune system's activity. By inhibiting T-cell activation, tacrolimus helps the body accept the new organ or control an overactive immune response. While its therapeutic benefits are immense, managing potential side effects is a crucial aspect of patient care. One such side effect that can significantly impact a patient's quality of life is alopecia, or hair loss.

The Link Between Tacrolimus and Hair Loss

Research has confirmed that tacrolimus can cause hair to fall out in a subset of patients, leading to a condition called telogen effluvium. This is not a scarring, permanent form of hair loss but rather a diffuse, temporary shedding. It can be an emotionally distressing cosmetic side effect that can affect patient compliance with their medication regimen. While the incidence varies depending on the patient population and dosage, some studies have noted rates as high as nearly 30% in specific groups, such as female kidney-pancreas transplant recipients. This suggests a need for a deeper understanding of the mechanism and effective management strategies.

Proposed Mechanisms of Tacrolimus-Induced Alopecia

The exact physiological pathway by which tacrolimus triggers hair loss is still not fully understood. However, researchers have several theories based on clinical observations and the drug's known effects on the body. It is important to note that, interestingly, the topical form of tacrolimus has shown some promise in treating certain forms of alopecia, but the systemic version (taken orally or intravenously) is the one linked to hair loss.

Vasoconstriction Theory: One leading hypothesis suggests that tacrolimus may cause vasoconstriction, or the narrowing of blood vessels, in the scalp. A reduced blood supply to the hair follicles would diminish the nutrients and oxygen they receive, potentially shocking the follicles and pushing them prematurely into the resting (telogen) phase.
Dose-Dependent Relationship: Some older studies indicate a potential link between higher average tacrolimus levels and an increased risk of hair loss, including more severe forms like alopecia totalis. This suggests that the severity of hair loss might be influenced by the drug's concentration in the bloodstream.
Other Contributing Factors: The hair loss may not be due to tacrolimus alone. Other variables, such as the stress of the underlying medical condition, major surgery (especially in transplant patients), or other medications in the immunosuppressant cocktail, could contribute. Distinguishing between these factors is often complex.

Managing and Reversing Tacrolimus-Induced Hair Loss

Patients experiencing this distressing side effect can explore several strategies with their healthcare team. The key is to manage the hair loss without compromising the critical immunosuppressive therapy. Treatment approaches are highly individualized and depend on the severity of the alopecia and the patient's overall health.

Comparison of Management Strategies for Tacrolimus Alopecia


Management Strategy	How it Works	Potential Effectiveness	Key Considerations
Tacrolimus Dose Reduction	Lowering the daily dose may reduce the severity of the side effect.	Often effective, especially in mild cases.	Requires careful monitoring to ensure the lower dose is sufficient to prevent organ rejection.
Switching to Cyclosporine	Another calcineurin inhibitor, cyclosporine, is less commonly associated with alopecia.	Highly effective, with resolution of hair loss reported.	Cyclosporine carries a higher risk of hirsutism (unwanted hair growth) and other side effects.
Topical Minoxidil	A vasodilator that promotes hair growth by increasing blood flow to the scalp.	Reported to be successful in treating tacrolimus-induced alopecia.	Does not address the root cause and is a complementary treatment.
Observation and Time	Hair loss caused by major surgery or stress (telogen effluvium) often resolves on its own over time.	Effective if the hair loss is not solely due to tacrolimus.	Requires patience and communication with the healthcare provider to differentiate causes.

The Reversibility of Hair Loss

For most patients, the good news is that tacrolimus-induced alopecia is generally considered reversible. When the dosage is reduced or the medication is stopped, hair regrowth typically occurs, although it may take several months to see significant improvement. The timing of resolution can vary, but reports indicate that patients who underwent changes to their medication regimen, whether by dose reduction or switching to an alternative, often experienced hair regrowth.

Seeking Professional Guidance

If you are a patient on tacrolimus and are concerned about hair loss, it is vital to speak with your healthcare provider or transplant team. They can help determine if the hair loss is related to tacrolimus or another factor, such as the stress of surgery or an underlying medical condition. They will also carefully evaluate the risks and benefits of any potential medication changes. Because tacrolimus is a life-sustaining medication for many patients, it is important not to make any dosage changes or stop taking the drug without medical supervision. Your healthcare team can work with you to develop a management plan that addresses your cosmetic concerns while maintaining your critical medical treatment.

Conclusion

While a less common side effect than hirsutism with cyclosporine, the link between systemic tacrolimus and hair loss, specifically telogen effluvium, is well-established. The condition, while concerning for patients, is typically reversible upon dosage adjustment or discontinuation. Several factors, including the drug's dose and potential vasoconstrictive effects, are believed to contribute to the hair loss. However, effective management strategies are available, including dose reduction, a switch to an alternative immunosuppressant like cyclosporine, or the use of topical minoxidil. Open communication with your medical team is the most important step to finding a solution that preserves your health and well-being.

Mayo Clinic Connect: Hair loss after transplant, probably Tacrolimus

Frequently Asked Questions

No, hair loss caused by tacrolimus is typically not permanent. It is a reversible condition, and hair regrowth usually begins after the dose is reduced or the medication is stopped, although it may take several months.

The primary type of hair loss associated with systemic tacrolimus is telogen effluvium. This is a condition that causes widespread thinning and increased shedding of hair across the scalp, rather than specific bald patches.

The onset of tacrolimus-induced hair loss can vary significantly among individuals, with some studies reporting it can begin anywhere from a few months to over a year after starting the medication.

Yes, some evidence suggests a dose-dependent relationship, particularly with more severe forms of hair loss. Lowering the tacrolimus dose under a doctor's supervision has been shown to help reverse the hair loss in some cases.

Some studies have indicated that alopecia may be more frequent in women receiving tacrolimus therapy, particularly after simultaneous kidney-pancreas transplantation.

Yes, aside from immunosuppressants, other medications and the stress of the transplant itself can contribute to hair loss. It is important for your healthcare provider to evaluate all potential causes.

This is a key distinction. While systemic tacrolimus can cause hair loss, topical tacrolimus (like the ointment Protopic) has been studied and used to treat certain autoimmune forms of alopecia, though with varying results.