What Is Semaglutide?
Semaglutide is a GLP-1 receptor agonist—a medication that mimics a hormone your body naturally produces. It was originally developed for Type 2 diabetes but became a breakthrough weight loss treatment when clinical trials showed dramatic results.
Brand names include Wegovy (FDA-approved for weight loss) and Ozempic (approved for diabetes, used off-label for weight). Compounded semaglutide contains the same active ingredient, prepared by licensed pharmacies.
How Does It Work?
Semaglutide works through four main pathways:
1. Brain signals: It acts on your hypothalamus to reduce hunger signals and increase satiety signals. You feel genuinely satisfied with less food.
2. Slower digestion: Food stays in your stomach longer, creating a prolonged feeling of fullness after meals.
3. "Food noise" reduction: Many users report that the constant mental chatter about food—planning meals, fighting cravings—goes quiet. This is often described as the most life-changing effect.
4. Blood sugar regulation: It helps your body release insulin more effectively, keeping blood sugar stable and reducing energy crashes.
Clinical Trial Results
The STEP trials established semaglutide's effectiveness:
| Trial | Population | Result |
|---|---|---|
| STEP 1 | Adults without diabetes | 14.9% weight loss vs 2.4% placebo |
| STEP 2 | Adults with Type 2 diabetes | 9.6% weight loss vs 3.4% placebo |
| STEP 5 | 2-year follow-up | 15.2% maintained at 2 years |
| STEP TEENS | Adolescents 12-17 | 16.1% BMI reduction |
Dosing Schedule
Semaglutide follows a titration schedule—you start low and increase gradually:
- Weeks 1-4: 0.25 mg (introduction dose)
- Weeks 5-8: 0.5 mg (still building up)
- Weeks 9-12: 1.0 mg (effects start increasing)
- Weeks 13-16: 1.7 mg (near-therapeutic)
- Week 17+: 2.4 mg (full maintenance dose)
Important: The first 8 weeks are for adjustment, not results. Don't panic if you don't see dramatic changes at 0.25 or 0.5 mg—that's expected.
Side Effects
Most common (and usually temporary):
- Nausea: Affects many users, especially early on. Usually improves after a few weeks.
- Constipation: Slower digestion means slower bowel movements.
- Fatigue: Common during the first few weeks as your body adjusts.
- Injection site reactions: Minor redness or itching, resolves quickly.
Serious risks (rare): Pancreatitis, gallbladder issues, and a black-box warning about thyroid C-cell tumors (observed in rodent studies). Anyone with personal or family history of medullary thyroid cancer should not take semaglutide.
Who Should Take Semaglutide?
Good candidates:
- BMI 30+ (obesity)
- BMI 27+ with weight-related conditions
- Struggled with diet/exercise alone
- Ready for a long-term approach (this isn't a quick fix)
Not appropriate for:
- Pregnant or breastfeeding individuals
- History of medullary thyroid cancer or MEN2
- History of severe pancreatitis
- Type 1 diabetes
Semaglutide vs Tirzepatide
Tirzepatide (Zepbound/Mounjaro) is the newer option, targeting two receptors instead of one. In head-to-head trials, tirzepatide produced about 47% more weight loss. However, semaglutide is more affordable (especially compounded), has more long-term safety data, and works extremely well for most people.
Many people start with semaglutide and only consider switching if they plateau.
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