Semaglutide Forum: Game Changer for Weight Loss

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Mark A. Moyad, MD, MPH & Martin M. Miner, MD, discuss the potential benefits of semaglutide, a newly approved weight-loss drug.

Semaglutide is a medication that has been approved by the FDA to treat type 2 diabetes and has also been approved for obesity management under the brand name Wegovy [1][3]. It helps with weight loss by suppressing appetite, which can lead to a reduced intake of food [2].

semaglutide for weight loss.webp


Semaglutide works by mimicking a hormone called glucagon-like peptide-1 (GLP-1), which is naturally produced by the body. GLP-1 plays a role in regulating blood sugar levels and appetite. Semaglutide affects several processes in the body, including increasing the release of insulin, reducing the release of glucagon, and delaying gastric emptying [2].

The increase in insulin helps lower high blood sugar, while the reduction in glucagon release also contributes to better blood sugar control. Delaying gastric emptying means that food stays in the stomach for a longer time, which can help with satiety and decrease appetite [2].

The typical dose of semaglutide for weight loss is 2.4 milligrams, administered weekly as subcutaneous (under the skin) self-injections [3]. While semaglutide has shown promising results in weight loss, it is important to note that its effectiveness is dependent on continued use, and some experts are skeptical about its long-term safety and limitations [1].

In semaglutide studies, participants experienced significant weight loss. In one clinical trial, participants who received semaglutide lost 5% or more, 10% or more, 15% or more, and 20% or more of their baseline body weight at week 68, compared to those who received a placebo [1]. On average, participants taking semaglutide lost 15% of their body weight [2]. Some individuals lost as much as 40 pounds while participating in a clinical trial of the drug [2].

In another study, after 68 weeks of treatment, the semaglutide group lost an average of 16% of their baseline body weight, equal to 37 pounds. This was compared to a 5.7% average weight loss, or 14 pounds, for those assigned to intensive behavioral therapy combined with a placebo [3]. These results demonstrate the significant weight loss potential of semaglutide in clinical trials.

There are a few ways to save on semaglutide for weight loss, which is available as the brand-name medication Wegovy. One option is to use a copay savings card from the manufacturer. If you have commercial insurance, you may be eligible to pay as little as $25 for Wegovy using this savings card [1]. More information about the copay savings card and other coverage options can be found on the Wegovy website [2].

It's important to note that the cost of Wegovy before insurance is around $1,627 per month, and coverage for weight loss drugs like Wegovy can vary widely depending on the type of insurance you have and your location [3]. The $25 copay card provided by the manufacturer may help ease the cost, but only if your insurance plan covers the medication [3].

A more affordable way to get semaglutide when insurance does not pay is to have your doctor fax a prescription to a compounding pharmacy like EmpowerPharmacy.com. Their price runs approximately $350 per month.
 
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The caveat to that is that the majority of the negative side effects happen to those who are obese. Active people using these drugs don't have the same issues such as muscle wasting.

All in all, I think this may be a phase of these drugs that will eventually pass on to improved versions.
I am not obese by any stretch and experienced gastroparesis, gallbladder sludge and now stones due to being on a GLP-1 for a little over a month. This was NOT from any weight loss, mind you. These are known side effects. I expect more users of these GLP-1 meds to have significant gut issues as time goes on. For all the benefits, I would steer clear until improved version are available.
 
I am not obese by any stretch and experienced gastroparesis, gallbladder sludge and now stones due to being on a GLP-1 for a little over a month. This was NOT from any weight loss, mind you. These are known side effects. I expect more users of these GLP-1 meds to have significant gut issues as time goes on. For all the benefits, I would steer clear until improved version are available.
I completely understand. I did not have a good experience myself. However, the majority of those on these drugs do not have these side effects. It is working great for my wife and other people I know who are all very active and fit.

I had a rebound effect of increased hunger and gastric distress that has just now cleared. I am by no means defending these drugs, just reporting personal, anecdotal experience. I do however hold out some hope that future versions can eliminate the side effects that plague some users of the drugs. But, as all things go... maybe not.
 
I am not obese by any stretch and experienced gastroparesis, gallbladder sludge and now stones due to being on a GLP-1 for a little over a month. This was NOT from any weight loss, mind you. These are known side effects. I expect more users of these GLP-1 meds to have significant gut issues as time goes on. For all the benefits, I would steer clear until improved version are available.
Tirzepatide has changed my life for the better. It was the 2nd best decision I've made concerning pharma products, and the 1st was TRT once dialed in.

The good: when TRT & Tirz are combined with intense effort workouts, say goodbye to body fat and say hello to lean mass . I've made great changes in body composition and my overall energy has skyrocketed. My workouts are high intensity & perfect for my goals.

The bad: the side effects suck but typically last 24-48 hours max and it feels like a light hangover, totally worth it if you're stuck in fat land and everything else stops working.
Some foods & drinks also intensify side effects and must learn what that is through experience. For example, I couldn't drink more than 2 drinks or I would get the worst hangover. I couldn't overeat anything, even broccoli, which would cause major digestive issues but I learned to eat smaller and more frequently. Also dehydration sneaks up quickly so you need to increase electrolytes and fluids big time or constipation and midnight cramps pay a visit.

That said, every single one of us is different and may experience different results, but if you're stuck in fat land, speak with your doctor, get a script, and give it a try.
 

Prescribing Ozempic and Wegovy for Weight Loss is Associated with an Increased Risk of Erectile Dysfunction and Hypogonadism in Non-Diabetic Males​

B. Liao, C. Able, +1 author T. Kohn
Published in Journal of Sexual Medicine 1 February 2024
Medicine


Non-diabetic males with a prescription of semaglutide have a significantly higher risk of developing ED and testosterone deficiency, and these rates were surprised that these rates were so much higher than those not receiving semaglutide as it was expected that weight loss drugs would improve erectile function.

Abstract
The use of antidiabetic medications, such as metformin or sulfonylureas, can have diverse effects on sex hormones, potentially influencing erectile function. While both Ozempic and Wegovy (semaglutide) include sexual dysfunction as a side effect of the medication, no study has assessed how frequently men will experience sexual dysfunction with these medications. Recently, semaglutide was approved in June of 2021 for weight loss in non-diabetic patients and has exploded in popularity. Our objective is to assess the risk of developing ED in non-diabetic males after starting semaglutide using a large claims-based database. We queried the TriNetX Research database, a comprehensive insurance claims database. Our study cohort included males aged 18 to 50 who have been prescribed semaglutide after June 1st, 2021. We excluded individuals with a history of pelvic radiation, prostatectomy, pulmonary hypertension, diabetes mellitus, or any hemoglobin A1c measurement ≥7%. Propensity-matching was performed between the cohorts for age, ethnicity, race, BMI, hypertension, sleep apnea, and hyperlipidemia. Our primary outcome was comparing the proportion of men that received an ED diagnosis and/or prescription for phosphodiesterase-5 inhibitors (PDE5i) from one day to any time after the index prescription of semaglutide. The secondary outcome of interest included the risk of developing testosterone deficiency. Risk was reported using relative risk (RR) with 95% confidence intervals (CI). Statistical significance was set using a two-sided alpha at 0.05. We found 2,117 non-diabetic males with a prescription of semaglutide, which were compared to an equivalent number of propensity matched controls (Table 1). Compared to matched controls, males with a semaglutide prescription were significantly more likely to be diagnosed with ED and/or prescribed PDE5i (1.4%) when compared to control males who were never prescribed semaglutide (0.14%) (RR: 10.0, 95% CI [3.05 – 32.82]). Similarly, males with a prescription for semaglutide were more likely to receive a subsequent diagnose of testosterone deficiency (3.83%) compared to controls (1.7%), (RR: 2.25, 95% CI [1.53 – 3.32]) from one day to any time after the index prescription. In this claims-based analysis, we found that non-diabetic males with a prescription of semaglutide have a significantly higher risk of developing ED and testosterone deficiency. Rates of erectile dysfunction in men prescribed semaglutide are overall low at 1.4% but, we were surprised that these rates were so much higher than those not receiving semaglutide as we expected that weight loss drugs would improve erectile function. Further studies are needed to assess the impact of semaglutide in non-diabetic men to assess how this drug impacts the male hypothalamic-pituitary-gonadal axis. Despite its increasing popularity for weight loss, both clinicians and patients should be aware of potential hormonal effects when discussing and considering the medication.
 
 
Concerning data.

 
Concerning data.

Is it possible that a reduced calorie intake is pushing them over the edge? This cohort is close to being morbidly obese, which on its own may have a suppressive effect on the HPTA "... diet-induced obesity (Quennell et al. 2011) and diabetes reduce hypothalamic kisspeptin expression ..."[R] Then a calorie deficit hits from the other end: "In animal models, undernutrition results in hypogonadism with reduced expression of Kiss1 within the hypothalamus..."

These factors could eventually resolve if a healthy weight is reached and diet can be normalized.
 
Everyone I know that's on semaglutide has had excellent results. Improvement in their cholesterol panels and diabetes markers. I have not heard one person complain of any adverse effects.

I believe it also helps reduce the chance of many cancers and helps improve kidney function.
 
Everyone I know that's on semaglutide has had excellent results. Improvement in their cholesterol panels and diabetes markers. I have not heard one person complain of any adverse effects.

I believe it also helps reduce the chance of many cancers and helps improve kidney function.
Sorry to rain on your Ozempic parade Vince, but semaglutide shuts me down completely. It definitely decreases appetite, but constipation is horrendous for me. My wife handles it just fine.
 

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