GLP-1 Therapy: What the First Months Involve

GLP-1 receptor agonists have changed metabolic medicine, and the volume of marketing around them has made it unusually hard to find a plain account of what starting one actually involves. This is that account.

Eligibility is a real gate

These medications have defined criteria, and they are not a formality. Eligibility generally rests on BMI thresholds, with a lower threshold applying where weight-related comorbidities are present. More importantly, there are absolute contraindications. A personal or family history of **medullary thyroid carcinoma or MEN2** rules the class out entirely. A history of pancreatitis requires careful consideration. Pregnancy, planned pregnancy and breastfeeding are exclusions. A provider who does not ask about these is not evaluating you.

Titration exists for a reason

Therapy begins at a dose well below the maintenance dose and escalates in steps over several weeks. This is not caution for its own sake — gastrointestinal effects are dose-related, and going up slowly is what makes the medication tolerable. The most commonly reported effects during escalation are nausea, constipation, diarrhoea and reflux. They are generally most pronounced in the days after a dose increase and settle as you adjust. If they do not settle, that is a reason to speak to your provider rather than to endure it — holding at a dose for longer, or stepping back down, is a normal adjustment.

What gets monitored

Metabolic markers are reviewed before starting and periodically during therapy: HbA1c, fasting glucose, lipids, liver and kidney function. If you take medication for diabetes, particularly insulin or a sulfonylurea, that regimen may need adjusting to avoid hypoglycaemia. Report severe or persistent abdominal pain promptly. Pancreatitis and gallbladder disease are uncommon but are the events that warrant urgent attention rather than a scheduled review.

The question worth asking at the start

Appetite regulation generally returns toward its previous state once the medication is cleared, and weight regain is commonly observed after stopping. This is a recognised characteristic of the therapy, not a personal failure. It means the question to settle at the beginning is not "how much will I lose" but **"what is the plan over the next few years"** — whether that is long-term therapy, a planned transition, or something else. A programme that does not raise this with you at the outset has not thought past your first refill.

On compounded versions

You will encounter offers of compounded semaglutide and tirzepatide at prices well below the branded products. The regulatory position on these changed substantially. Compounding pharmacies were permitted to make copies while these drugs were formally in shortage. Those shortages were declared resolved — tirzepatide in October 2024, semaglutide in February 2025 — and enforcement discretion for outsourcing facilities ended in March 2025. Making copies of them is no longer permissible. What remains legitimate is patient-specific compounding where a prescriber documents an individual clinical need the approved product cannot meet. That is a narrow pathway, not a discount channel. In March 2026 the FDA sent warning letters to thirty telehealth companies over how compounded GLP-1 products were being marketed.

Questions worth asking any provider

• Which specific product am I being prescribed, and is it the FDA-approved one?
• What is the titration schedule, and what happens if I do not tolerate a step?
• Which laboratory work do you require before starting, and how often afterwards?
• What is the plan if I want to stop?
• What does the total monthly cost include?

A provider who answers these clearly is running a clinical service. One who cannot is running a fulfilment operation.