How do GLP-1 medications work for weight loss?
GLP-1 receptor agonists (semaglutide, tirzepatide) slow gastric emptying, increase satiety signals in the brain, and improve insulin sensitivity. The combined effect: reduced appetite, smaller portion sizes, and slower glucose response — leading to sustained weight loss (STEP-1 trial NEJM 2021; SURMOUNT-1 trial NEJM 2022).
Semaglutide vs tirzepatide — what's the difference?
Semaglutide (Wegovy/Ozempic) activates the GLP-1 receptor alone. Tirzepatide (Zepbound/Mounjaro) is a dual GIP/GLP-1 receptor agonist — it activates both pathways. In head-to-head data, tirzepatide produces greater weight loss: 15-22% average body weight loss vs. 12-15% for semaglutide over 68-72 weeks (STEP-1 vs SURMOUNT-1 trials).
How much weight will I lose?
Average body weight loss in clinical trials: ~15% on semaglutide and ~22% on tirzepatide at maximum dose over ~68 weeks (NEJM 2021, 2022). Individual results vary based on dose, adherence, exercise, and starting body composition.
Is compounded semaglutide/tirzepatide the same as the name-brand?
Compounded versions contain the same active ingredient as Wegovy/Ozempic (semaglutide) or Zepbound/Mounjaro (tirzepatide), prepared by US-licensed compounding pharmacies. The active ingredients are individually FDA-approved; the final compounded preparation is not separately FDA-evaluated. Compounding is legal when name-brand drugs are on the FDA shortage list.
Why is compounded available now?
Both semaglutide and tirzepatide were placed on the FDA drug shortage list in 2022-2023 due to manufacturer supply issues. While a drug is in shortage, federal law (21 USC 503A and 503B) permits licensed compounding pharmacies to prepare versions to fill the gap. If/when the shortage ends, compounding access may be restricted.
What are the common side effects?
Most common (especially in weeks 1-8): nausea (44% of patients), diarrhea (30%), constipation (24%), vomiting (24%), abdominal pain (20%) — all dose-dependent and typically improve with the gradual dose titration (STEP-1, SURMOUNT-1). Less common: fatigue, headache, injection-site reactions, food aversions.
How do I manage GLP-1 side effects?
Slow dose escalation (your protocol does this automatically), eat smaller and more frequent meals, prioritize protein (1g per pound of goal body weight), stay hydrated (80+ oz/day), avoid greasy and high-fat meals during ramp-up, and message your Care Coach if symptoms are severe or persist past week 4.
Will I lose muscle on a GLP-1?
Without active muscle preservation, 25-40% of total weight lost can be muscle mass (STEP-1 DXA substudy 2022). To minimize this: hit 1g protein per pound of goal weight, lift weights 3x/week using compound movements (squat, deadlift, press), and avoid extreme calorie deficits beyond what the medication naturally creates.
What happens when I stop the medication?
Without lifestyle changes, weight regain is common. The STEP-4 trial showed patients who stopped semaglutide regained two-thirds of their lost weight within 1 year. To minimize regain: build resistance training habits, protein-forward eating patterns, and consider a maintenance dose with your clinician before complete discontinuation.
Is there a maintenance dose?
Yes. Many patients stay on a lower 'maintenance' dose (e.g., 1mg semaglutide weekly instead of 2.4mg) once they've reached their goal weight. This often preserves the metabolic benefits without continued weight loss. Discussed with your clinician at goal-weight check-in.
Can I drink alcohol on a GLP-1?
Yes, in moderation. Many patients report reduced alcohol cravings on GLP-1s — multiple studies are now investigating this for alcohol use disorder. Combining alcohol with the medication can worsen nausea, especially during dose escalation.
Do I need bloodwork to start?
Bloodwork is not strictly required, but it's strongly recommended. We screen for thyroid function, lipid panel, HbA1c (diabetes screening), CBC, comprehensive metabolic panel, hs-CRP, and vitamin D. Optional 80+ biomarker panel ($196) gives a complete metabolic baseline.
Will my insurance cover this?
Compounded medications are not typically covered by insurance. The cash-pay price ($269-450/month depending on protocol) usually ends up similar to or lower than the insurance copay for name-brand Wegovy or Zepbound, since most insurance plans require step-edits and prior authorization.
Who shouldn't take a GLP-1?
Contraindications: personal or family history of medullary thyroid carcinoma (MTC), Multiple Endocrine Neoplasia syndrome type 2 (MEN-2), severe gastroparesis, severe inflammatory bowel disease, or known hypersensitivity to GLP-1 receptor agonists. Pregnancy and breastfeeding are also contraindications.
Will it affect my pancreas?
GLP-1s carry a labeled warning for pancreatitis. The actual incidence in clinical trials was low (0.2-0.4% per year) but slightly higher than placebo. Symptoms of pancreatitis (severe abdominal pain radiating to back, persistent vomiting) require immediate medical attention. People with prior pancreatitis history are screened out at intake.
What's included in the monthly price?
Compounded medication shipped from a US-licensed pharmacy, ongoing clinician messaging through the patient portal, weekly check-ins with a Care Coach (Certified Medical Assistant), dose adjustments at no extra cost, and refills. Bloodwork is separate ($196 once).
How long does shipping take?
After clinician approval (24-48 hours from intake submission), medication ships within 3-5 business days from the partner compounding pharmacy. Each shipment contains a 4-week supply with all syringes and alcohol pads included.
Can I exercise on a GLP-1?
Yes, and you should. Resistance training preserves muscle mass during weight loss, and cardiovascular exercise supports the metabolic benefits. Start gradually since nausea/fatigue can be present in weeks 1-4. By week 5-6, most patients tolerate normal training volume.
