Semaglutide (Wegovy) Treatment for Trichotillomania

Inclusion Criteria: 1. Men and women age 18-75; 2. Diagnosis of current trichotillomania based on DSM-5 criteria and confirmed using the clinician-administered MIDI (13); 3. Hair pulling daily with urges to pull as the trigger in \>50% of the episodes of pulling; 4. Women of childbearing age are required to have a negative result on a beta-human chorionic gonadotropin pregnancy test; 5. Women of childbearing potential utilizing a medically accepted form of contraception defined as double barrier, oral contraceptive, injectable contraceptive, implantable contraceptive devices, and abstinence Exclusion Criteria: 1. Infrequent pulling (i.e. less than daily) or automatic pulling (i.e. no urges to pull); 2. Unstable medical illness or clinically significant abnormalities on laboratory tests, EKG, or physical examination at screen as determined by the investigator; 3. History of seizures; 4. Myocardial infarction within 6 months; 5. Current pregnancy or lactation, or inadequate contraception in women of childbearing potential; 6. A need for medication other than semaglutide with possible psychotropic effects or unfavorable interactions as determined by the investigator; 7. Clinically significant suicidality (defined by the Columbia Suicide-Severity Rating Scale); 8. Lifetime history of bipolar disorder type I or II, schizophrenia, or any psychotic disorder; 9. Current skin picking disorder; 10. Initiation of psychotherapy or behavior therapy within 3 months prior to study baseline; 11. Initiation of psychotropic medications within 3 months prior to study baseline (stable doses will be allowed); 12. Previous treatment with semaglutide; 13. Use of any weight loss medications; 14. Body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) less than 23; 15. Past-year substance use disorder other than tobacco use disorder or mild cannabis use disorder; 16. Recent (30-day) use of illicit drugs except cannabis; 17. History of diabetes, and current medical or neurological illness precluding participation based on physician judgment; 18. Personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B; 19. History of pancreatitis.