Getting Nerdy About Weight Loss Meds: A Deep Dive (Aug 2024)

We discussed how we sometimes use weight loss drugs in August, 2023. Since then, several studies about their use and effects have been published (heck, there’s a new headline almost every day!). So, we’re back to discuss some of the new information. We’re mostly concerned about using weight loss medications as a way to access surgery, but we’re going to talk about other intentional weight loss, too.

So What’s With Transgender Health Care, Body Size, and Anti-Fatness?

We want to make it very clear that we think that restricting access to treatments or procedures because of body weight, body shape, or body size is wrong.

We think that BMI limits on surgery are a steaming pile of crap and that medicine as an institution has to do better, but we also know that individual surgeons may not have full control over the patients they can see because their organizations may not invest in the tools and technology to adequately take care of patients of size. Some surgeons may be plain biased, too. (P.S. your BMI doesn’t tell you a damn thing about your health and the BMI calculation is racist.)

We also believe that it is bad medicine to link body size, weight, or composition to “bad” health.

We believe that health can’t be measured by one scale alone.

We also believe that we are healthier when we are able to freely and safely embody, celebrate, and express gender. We believe body diversity and size diversity are awesome – bodies come in all shapes and sizes and they are all fucking rad! Bodies are cool as shit.

We know that modern healthcare and modern western society is soaking in anti-fat bias and that this is a function of white supremacy. We are concerned that the popularity of weight loss drugs will increase the pressures of anti-fat bias and further marginalize fat people. While we are all-in for bodily autonomy and your right to do whatever you want with your body, we also think it is important to reflect and deconstruct how white supremacist western beauty standards are so very tightly tied to anti-blackness, and that anti-fatness is deeply embedded into American culture. It harms all of us, but it harms some of us more. We love to see fat liberation.

We want to acknowledge that the majority of the QueerDoc team (but not everyone – hey, the writer of this article is fat!) is smaller-bodied. As a team, we seek out training on our biases, whether they were learned in our medical training or in our home cultures. We are working on identifying and breaking down our biases, but we also know that we are not perfect. Two of our favorite learning and reflection resources are:

• Fearing the Black Body: The Racial Origins of Fat Phobia, by Sabrina Strings
• Belly of the Beast: The Politics of Anti-Fatness As Anti-Blackness, by Da’Shaun L. Harrison

We engage in conversations about autonomy and anti-fat bias and consume media that centers these conversations. Ones that have heavily contributed to our understanding and this article include:

• The Maintenance Phase podcast (Aubrey Gordon and Michael Hobbes – here’s their Ozempic episode.)
• Ragen Chastain’s Weight and Healthcare newsletter. Read her really powerful dissection of the Wegovy (semaglutide) SELECT trial here.
• Training on weight bias in healthcare with the Radical Health Alliance.
• We seek advice and guidance regularly from professional coaches who help us navigate intersections of race, fitness, and transness (such as Justice Roe Williams.)
• Conversations with our patients, friends, and clinician peers.

We believe that body policing is against our values. We love autonomy and believe that you get to do whatever you want with your body. We’re here to help you understand the risks and benefits of your care options so that you can make decisions that are aligned with your goals and values. Weight loss drugs are a tool that can be both beneficial and harmful. That’s why we do informed consent.

We also know that there are some very complicated relationships between gender, gender dysphoria, gender euphoria, safety, belonging, and body size both individually and in our communities. We want to support you in your euphoria and safety.

If a BMI limit is between you and accessing care, there are options that we are able to prescribe. So let’s talk about those options.

This is a very dense read, we know it. We love data and transparency, and you deserve to be able to access the sources, so we’re including lots of numbers and links…BUT, we know that a wall of text can be overwhelming.

Here’s a TLDR. Also look for the sections highlighted in LIGHT BLUE and in LIGHT PINK.

TLDR:

• Choosing to use a GLP-1 agonist should be an informed consent decision.
  • If you are diabetic or have significant cardiovascular disease risk, your informed consent discussion may be different, or may be best approached in tandem with your other providers (or you may be able to obtain coverage through those providers!)
• There are many ways to be healthy. Your starting and stopping goals are important.
  • If you lose weight on a GLP-1 agonist medicine, you will likely gain it back after stopping the medication.
  • If you want to maintain weight loss, are you prepared to be on one of these medications for a long time?
• Most people experience at least one side effect. What side effects are your deal breakers? (The list of common side effects is near the end of this article.)
• Talk to your prescriber about interactions with other drugs and possible changes to absorption of other drugs.
• Are there other tools or pathways that could help you access surgery?

Back to the weight loss drugs we’re talking about.

GLP-1 agonists are mostly what we’re talking about. One of these drugs (semaglutide) is a combined GLP-1 agonist and a GIP (tirzepatide.) There are some other weight loss medications, but the GLP-1agonists are hot right now, and semaglutide and tirzeptatide are most commonly used.

What’s a GLP-1?

This chemical affects how our bodies use sugars in the blood, how quickly our stomachs move food into our intestines, and some of the signaling pathways between our guts and our brain that affect hunger and feeling full. They also impact how our bodies use energy: GLP-1s are amazingly powerful and affect metabolism and how the body accesses and uses nutrients. (Muller, Gasbjerg, wikipedia, Seino)

GLP-1 stands for glucagon-like peptide 1. It is a hormone produced in our intestines, pancreases, and brains, and it does several things:

• Tells the pancreas to secrete insulin so that the body can better use the energy stored in carbs.
• Tells the stomach to slow down the process of moving food into the intestines.
• Tells the brain that hunger is satisfied.
• Influences how the kidneys manage sodium in the blood and how much urine to create.

GIP stands for glucose-dependent insulinotropic peptide. This hormone is also created in the intestines. It:

• helps regulate how much sugar is in the bloodstream.
• increases metabolism of fat tissue.
• decreases bone reabsoprtion.

What’s an agonist? What’s an antagonist?

Hormones in the body do their jobs by binding to receptors on cell surfaces and starting a job. They’re kind of like keys. Agonists are kind of like pass keys: they bind to a receptor and activate it, but they don’t have to be the exact key for the lock. They can help cells do their jobs better. If we’re going to keep going with this metaphor, antagonists are toddler door handle covers or other childproofing tools: they block the keys from getting into the locks.

GLP-1 agonists are substances that act like the GLP-1s that our bodies make, and enhance that activity in the body.

You’ve probably heard of some of the brand names:

• Ozempic (semaglutide) – a diabetes medication
• Wegovy (semaglutide) – same stuff, but marketed for weight loss in different dosages
• Rybelsus (semaglutide) – also the same stuff, but as an oral tablet, not an injection
• Mounjaro (tirzepatide) – a diabetes medication
• Zepbound (tirzepatide) – same stuff, used for weight loss.
• Trulicity (dulaglutide) – a diabetes medication
• Saxenda (liraglutide) – a weight loss medication

The original formulations of these medications were developed to treat diabetes, and their use has been expanded to include cardiovascular and kidney disease risk management, and to weight loss.

TIP: the differences between the brand names are often the dosages and timing of those dosages. Each FDA-approved use (“on-label”) of a drug goes through research and an approval process and gets the right to a new name, a new patent, and however many years of protection from lower-cost generic options. Lots of doctors use medications “off-label” all the time: some meds are used off-label more than they are used on-label! Off-label use is less likely to be covered by insurance policies. This matters for access and cost.

THE TAKEAWAY: We have nearly 20 years of data about GLP-1 agonists in diabetes management. We have far less data about using these medications for weight loss. Can we use some of the older data to inform our decision making about use in weight loss? Yes, with the caution that we don’t really know what happens to the body long-term in non-diabetic patients or when these meds are stopped or started and stopped repeatedly.

Note: Wegovy (semaglutide) is approved for use in adolescents 12+. Zepbound (tirzepatide) is not currently approved for use in adolescents.

The Exciting Headlines: these are very powerful drugs, especially in diabetes management.

• In patients with Type 2 diabetes:
  • These medications help reduce and control blood sugar levels.
  • Patients lose weight.
  • Kidney disease risk is lowered. (Perkovic)
  • Cardiovascular events are lowered.
  • Risks include higher rates of diabetic retinopathy compared to control group. (SUSTAIN 1-7)

Weight loss was not an intended function of these meds originally! But, once the researchers (cough, pharmaceutical companies, cough) saw weight loss happening, they started researching how these meds might be used for weight loss. (Chastain and Maintenance Phase.)

• In patients with impaired glucose sensitivity or pre-diabetes, these medications slow but do not stop the progression towards diabetes. (the SELECT trial (Wilding); Medscape – Ault)
• Wegovy (semaglutide) has been approved for cardiovascular risk reduction in adults with heart disease who are considered overweight or obese.
• A five-year study involving 17,600 patients with cardiovascular disease and BMIs categorized as overweight or obese but did not have diabetes found that the patient group receiving Wegovy had 20% fewer heart attacks, strokes, and deaths caused by cardiovascular disease compared to patients not receiving semaglutide. (SELECT trial (Wilding))
• This DOES NOT MEAN that losing weight improves cardiovascular risk. Cardiovascular risk, just like weight, is complicated.
• 16.6% of participants receiving semaglutide in this study dropped out due to adverse events.
• Check out Regan Chastain’s analysis and discussion of this study for some (weight loss) TEA.
• Semaglutide may be an anti-inflammatory. This same study found a 38% reduction in CRP (C-reactive protein) levels in patients receiving semaglutide regardless of their BMI, statin use, or cholesterol levels. A reduction in CRP was found even in patients who did not lose significant weight. CRP is a measurement of inflammation in the body. It can help us determine how strong an individual’s cardiovascular risk is and is part of the test panels used to diagnose auto-immune diseases such as rheumatoid arthritis and lupus. (Medscape, Mayo)
• Zepbound (tirzepatide) is also being studied for use in cardiovascular risk reduction. Other studies indicate that tirzepatide can lower blood pressure. (SURMOUNT-1 trial)
• See our article about cardiovascular risk and HRT.
• Wegovy and Zepbound are being studied for use in individuals with heart failure and people who have both cardiovascular disease and kidney disease.
• Both are also being studied for use in non-alcoholic fatty liver disease.
• Tirzepatide has shown to have some benefits for individuals with sleep apnea. Two studies with a total of 479 people found that tirzepatide lowered the total number of apnea episodes by half or more. 40% to 50% of the participants on tirzepatide were able to stop using their CPAP devices. They also lost weight and lowered their systolic blood pressure levels. Tirzepatide was used in conjunction with nutrition education, and instructions to reduce their caloric intake by 500kcal/day and get at least 150 minutes a week of physical activity. Enrollment was 70% men. (Medscape, NEJM)

But What About Using Them For Weight Loss?

For Wegovy (semaglutide) from a 68-week study of adults (The STEP 5 trial) without diabetes:

• 48% of participants lost 15% or more of their starting weight.
• 18% lost between 10% and 15% of their starting weight.
• 17% lost between 5% and 10%.

But,

17% of Wegovy participants and 22% of placebo participants discontinued treatment. (Wilding)

Some Things To Think About

If used for weight loss:

• A 2022 analysis of multiple studies found that the 322 patients in six separate studies using GLP-1 agonists lost an average of 15% of their body weight. (Sarma)

• Just like dieting, when people stop using these medications, the weight comes back. These medications change how the body seeks, uses, and stores energy while they are being used, but they are not permanent changes.

• Half the weight back after a year. In Zepbound’s 88-week trial, a portion of participants stopped taking tirzepatide at week 36. They regained about half of their lost weight in the next year (by week 88.) (the SURMOUNT-4 trial)

• Most of the weight back after a year. In a semaglutide (Wegovy) trial, 1961 adults received either semaglutide or a placebo. At 68 weeks, the mean weight loss for people taking semaglutide was 17.3%. Some of the patients (347) continued to be followed for another year. At the end of that year, they had regained most of the weight, even if they continued other lifestyle intervention methods, and ended at a loss of about 6% of their original weight. Any improvements they saw in cardiovascular/other metabolism markers also returned to their starting numbers. (Wilding)

• After about a year of use, continued weight loss slows down dramatically, and can reverse while still taking the medication. (Chastain)

• A big portion (40%) of the weight loss achieved by study participants appears to be muscle weight. This can also have big impacts on metabolism – muscle uses a lot more energy than other body tissues, so if you’ve lost weight by losing muscle, it’s going to be harder to maintain that loss. (Tong)

• We know that losing and regaining significant weight is harmful to the body. We don’t know if stopping and starting these medications acts just like yo-yo dieting. (Wanna know more about why yo-yo dieting is harmful? Ragan Chastain writes a great article here.) Note: we have counseled individuals who are interested in weight-cycling as a method of enhancing body fat distribution changes to go slow and strive to gain/lose 3-5 pounds over a couple of months. We believe that these smaller and slower fluctuations in weight are less harmful to the body.

We should also mention that:

• There’s no research to indicate that there is an effective “maintenance” dose.
• There is research looking at a single-dose gene editing GLP-1 treatment where a genetically modified virus is injected directly into the pancreas. The pancreas then starts producing more GLP-1. It’s very early stage research in mice and pigs! (Medscape, 6/24/24)

What Are Realistic Goals On These Meds? What About That F&*king BMI Barrier For Surgery?

Let’s loop back – in the Wegovy 68-week trial:

• 17% stopped treatment.
• 17% lost between 5% and 10% of their body weight.
• 18% lost between 10% and 15% of their body weight.
• 48% lost more than 15% of their body weight.

Let’s say that you are 5’7” and weigh 290 lbs. This puts your BMI at 45.4. If your stats worked like the study participants:

Say your surgeon has a BMI limit of 40.
That would be a target weight of about 255 lbs, or a loss of 35 lbs or 12% of your body weight.

Somewhere around 66% of trial participants were able to lose 12% of their body weight. A 66% chance of making that goal may be good enough reason for you to rty a GLP-1 agaonist.

Let’s runs some numbers for for a 5’7″ 290-lb person:

• You have a 17% chance of not tolerating the meds.
• You have a 48% chance of losing more than 15% of your starting weight. If the BMI 40 limit for surgery is 40, you’re in!
• You have an 18% chance of losing between 10 – 15% of your starting weight, which could get you to about 204, and a BMI of 31.9. If your surgeon has a cut-off at 32 BMI or higher, you’re in!
• You have a 17% chance of losing 10% or less of your weight. If you lost 10% of your weight, that puts you at 216, and a BMI of 33.8. If your surgeon’s BMI cut-off is 35 or higher, you’re in!

Those odds might sound very reasonable for you to try a GLP-1 if you’re okay with the potential side effects and you know that if you stop taking GLP-1s, you are unlikely to maintain your achieved weightloss. That’s why we do informed consent.

If you’d like to play around with the numbers, here’s a BMI calculator (this one doesn’t hit you in the face with a weight category result – just a number.)

What About Those Potential side effects and risks.

In Wegovy (semaglutide)’s 104-week trial for weight loss (Garvey, the STEP-5 trial):

152 individuals started treatment at a dose of 2.4mg /week.

During the trial:

• 146 (96.1%) experienced an adverse event
• 12 (7.9%) experienced a serious adverse event
• 20 (13.2%) discontinued use
  • 10 for adverse effects (6.6%)
  • 1 for it wasn’t working
  • 1 was removed by the researchers “for safety concerns”
  • 3 were lost to follow-up
  • 3 for “other”
  • 1 became pregnant
  • 1 death
• Of those that completed the study
  • 5 lowered their dosage to 1.7 mg
  • 7 lowered theirs to less than 1.7mg.

Known Side Effects (reported by % of patients taking Wegovy in trials; from Wegovy’s prescribing information):

• Nausea (44%)
• Diarrhea (30%
• Vomiting (24%)
• Constipation (24%)
• Abdominal pain (20%)
• Headache (11%)
• Extreme tiredness (11%)
• Indigestion (9%)
• Dizziness (8%)
• Bloating (7%)
• Burping (7%)
• Farts! (6%)
• Googly guts (gastroenteritis) (6%)
• GERD (5%)
• Upset stomach (gastritis) (4%)
• Stomach bug (gastroenteritis viral) (4%)
• Hair loss (3%)
• Change in how touch sensations are experienced (2%)

Some analysis we’ve come across claims that patients who start at higher weights (BMI of 40+) experience fewer side effects (or those side effects don’t bother them as much,) and have lower rates of stopping the meds. (Medscape Melville)

Here Are Other Things To Think About When Considering GLP-1 agonists:

They Are Flippin’ Expensive!

Some insurance policies do cover GLP-1 agonists for weight loss but coverage may be difficult to get or you may need to try other medications first and coverage may end after a BMI of 30 is reached. This may be exactly what you want: to reach your goal weight and stop. Depending on your health history, coverage may be available for diabetes management or cardiovascular disease management. However, we can see scenarios where insurance coverage gaps lead to weight re-gain, and that may not be what you want. The retail cost of a year of semaglutide can be up to $20k! (Medscape Melville)

We gotta also mention: there are complicated access issues due to the popularity of these medications that can lead to shortages. Shortages can cause direct harm to patients using GLP-1 agonists for diabetic management.

Compounded GLP-1 agonist Weight Loss Meds

Where there are shortages and inconsistent coverage, many people try compounded versions. . Here’s a problem with compounded GLP-1s: the chemical molecule in the prescribed name brand version (at least for semaglutide (Ozempic/Wegovy) is patented and a generic won’t be available for years. So the compounding pharmacy has to use something else that is similar, but NOT THE SAME.

We love when compounded meds improve access or address needs that the patented formulas don’t work for, especially for patients with allergies, but there are other risks when using compounded medications to consider: What Should I Know Before Using A Compounding Pharmacy) There are also reports of incorrect dosing using compounded formulations leading to hospitalizations:

There are also reports of counterfeit product. Here are the tips from the World Health Organization’s alert published June 27,2024:

Ways to identify falsified products:

Check the Lot Number and Serial Number: WHO advises not to distribute, use, or sell products labelled with batch numbers listed in Annex.
Examine the Pen: Falsified Ozempic pens may have a scale extending out from the pen when setting the dose.
Assess the Label Quality: The label might be of poor quality and may not adhere well to the pen.
Look for Spelling Mistakes: The carton may have spelling mistakes on the front of the box.

Once again, we love the Maintenance Phase podcast, especially this snippet (from the October 10, 2023 Ozempic episode) :

Interactions With Other Medications

• One of the ways these medications work is by slowing down the stomach. If the individual is taking other medications by mouth, those other medications may not be as effective because they will be absorbed at a different rate than expected. Some medications that we might be concerned about:
  • Anything “extended release” or “immediate release” (think ADHD and other brain meds!)
  • Oral contraceptives. There are reports of unplanned pregnancies due to oral contraceptives not getting into the bloodstream at sufficient levels.
  • Anything with a short half-life that needs to be taken frequently.
  • Anything that, if the concentration builds up in the stomach, could be harmful.

• Another potential risk to slowed stomach emptying: fasting before surgery! Restricting food and liquids before surgery helps prevent aspiration (when stomach contents end up in the lungs) and pneumonia. Under general anesthesia, your body isn’t as able to protect your lungs from foreign bodies. There have been reports of people on GLP-1 agonists who still have food in their stomachs after multiple days of fasting. If you’re still on a GLP-1 at your surgery date, you may need to fast longer before surgery, or your risk of aspiration may be higher. (Sen, Hicks)

• These medications change how the body releases insulin. They should be used carefully when taken in combination with other medications that also affect insulin or blood sugar levels.
  • Some of the meds we use in transgender health can impact blood glucose levels, including estradiol, leuprolide (and other blockers,) and progesterone. Before beginning a GLP-1 agonist in combination with any of these, consider getting blood glucose labs done, or if you are diabetic, carefully monitoring your blood sugars.

• Some medicines that are known to interact with GLP-1 agonists include: (“Severe” drug interactions are life-threatening or require intervention. “Moderate” drug interactions may cause a disease or condition to get worse or require that meds or dosages are changed. These are all moderate interactions.)
  • Levothyroxine (for thyroid disorders)
  • Albuterol (for asthma)
  • Cortisones (for autoimmune conditions, joint swelling, and pain)
  • Fluticasone topical (Flonase!)
  • Several antibiotics
  • Melatonin
  • Pseudoephedrine (Sudafed and other decongestants)
  • Venlafaxine (Effexor)
  • Warfarin (Coumadin)
  • This is not a complete list. Please talk to your prescribing doctor and your pharmacist about potential drug interactions. List pulled from Drugs.com interactions for semaglutide and tirzepatide.

Let’s Discuss A Little More About GLP-1s and Transgender Medicine

• If you’re using oral meds, talk to your prescriber about the risks and benefits of switching to a different medication pathway or medication.

• If you’re using estradiol, progesterone, or leuprolide and are diabetic or insulin-resistant, talk to your prescriber(s) about monitoring your blood sugars and any dosage changes.

• The majority of patients in the early weight management drug studies were white cis women. Do they even know anything about use in transgender and nonbinary patients?

Emerging Concerns and Information About Other Risks

Thyroid Cancer
A small study in France found an increased risk of thyroid cancers after using GLP-1s. A much larger Scandinavian study found no increased risk. It isn’t fully understood if GLP-1s increase thyroid cancer risk, but increased thryroid cancers were seen during animal (rat) trials. (Medscape – Young)

Disordered Eating
There is concern that GLP-1 agonists can trigger disordered eating in susceptible individuals because they change the hunger/satiety feedback loop in the brain and gut OR that these medications can be intentionally used to “kick-start” disordered eating. There are discussions in the industry about screening patients for disordered eating before prescribing these medications. (CBC Radio, Reed)

Impacts to Mental Health
There have been conflicting studies about GLP-1 use and increased depression, anxiety, and suicidal thoughts. We recommend that part of the informed consent process should include discussions about warning signs for worrisome mental health changes and what screening, if any, might be used to monitor mental health during use. (Newsweek)

For a first-person account, check out Regan Chastain’s Case Study – GLP-1 Agonists and Medication Absorption – Part 2 (and Part 1.)

Discussion About Using GLP-1s in UN-Evidence-Based Ways (hat tip to Ragen Chastain again!)

• Using GLP-1 agonists as a way to re-learn eating habits
• Lots of fat people already eat “healthily.” Weight loss is NOT as simple as “eat this, not that.” It is also not as simple as “just eat less.”
• There’s no link between using a GLP-1 agonist and magically acquiring nutritional knowledge, the money to purchase healthier options, the access to fresher foods, or the absence of advertising, cultural messaging, or societal pressures that encourage less nutritious eating.
• There’s no evidence that any behavior-based weight loss intervention “sticks” after you stop that intervention.
• There is evidence that stopping GLP-1 agonists without continued additional intervention results in weight re-gain. (Tong 2)
• There’s no evidence right now that there is an effective “maintenance” dose. If your goal is to keep the weight off, you may need to continue taking these medications. But there may be gene therapy options in the future that reduce or eliminate the need for long-term use.

Using Dosages Other Than The Ones Studied

• NGL, we won’t raise an eyebrow about body-hacking and testing hypotheses on our own bodies. Each of us has that right. But we do strive for harm reduction and utilizing the research we do have to make decisions about off-label use. We have very little information on use of GLP-1 agonists for intentional weight loss at low doses over long periods of time. We know that they’re pretty safe when used in diabetic treatment, but weight loss was an unintended side effect of these meds, not an original feature.

Check out the Medical Students for Size Inclusivity, GLP-1 Agonist Informed Consent Project for some additional informed consent reading.

The Wegovy Prescribing Information for weight loss and cardiovascular disease risk management

(get a copy at https://www.novo-pi.com/wegovy.pdf)

Note: prescribing information pamphlets are required to list side effects and adverse events experienced by participants in the clinical trials – these are not necessarily side effects caused by the medications.

Known contraindications (reasons not to prescribe):

• Personal or family history of medullary thyroid cancer or personal history of multiple endocrine neoplasia type 2 (a form of cancer that affects the thyroid gland, the parathyroid glands, and the adrenal glands.)

Things to watch/screen for because they happened during the clinical trials and could be serious:

• Acute Pancreatitis (rare, but happened: 0.2 cases per 100 patient years)
• Gallbladder Disease (1.6% of patients)
• Hypoglycemia (low blood sugar) (6.2% of Type 2 Diabetics)
• Acute Kidney Injury (0.4 cases per 100 patient years)
• Diabetic Retinopathy in Patients with Type 2 Diabetes (6.9% of adult patients with Type 2 Diabetes and BMI of 27+)
• Allergic reactions happened in:
• 16% of adult patients who developed antibodies
• 7% of adult patients who did not develop antibodies
• 3% of pediatric patients reported rashes
• Fractures
• Increased fracture rates of hip and pelvis reported in the cardiovascular outcomes trial among female patients (1% compared to 0.2% in the placebo group.) In patients aged 75+, 2.4% compared to 0.6%..
• Liver enzymes (one of the things we watch in gender care)
• 3% of pediatric patients in the trial had significant increases in their ALT
• In the adult cardiovascular trial, total bilirubin greater than 3x upper normal limit was seen in twice as many as compared to the placebo arm.

Our Takeaway On Weight Loss Drugs:

Affirming medicine saves transgender lives.

For some people, affirming care includes surgery. Some surgeons have BMI limits and will not operate on patients outside of their accepted BMI range (usually this applies to people with higher BMIs, rather than lower ones.)

Losing weight can lower BMI.

Weight loss is complicated and may be more harmful to the body than maintaining weight.

While all medical interventions have risks, and risks may not be known, GLP-1 agonists are a tool that can help people lose weight.

We include GLP-1 agonists in our tool box for patients who are unable to access surgery without weight loss.

Stay Checked In With QueerDoc (get an email every now and then from us!)

Citations and References

(For those who are reading this far, yes, you are correct! We haven’t standardized our citation format. No time for that!)

Gasbjerg LS, Gabe MBN, Hartmann B, Christensen MB, Knop FK, Holst JJ, Rosenkilde MM. Glucose-dependent insulinotropic polypeptide (GIP) receptor antagonists as anti-diabetic agents. Peptides. 2018 Feb;100:173-181. doi: 10.1016/j.peptides.2017.11.021. PMID: 29412817.

Müller TD, Finan B, Bloom SR, D’Alessio D, Drucker DJ, Flatt PR, Fritsche A, Gribble F, Grill HJ, Habener JF, Holst JJ, Langhans W, Meier JJ, Nauck MA, Perez-Tilve D, Pocai A, Reimann F, Sandoval DA, Schwartz TW, Seeley RJ, Stemmer K, Tang-Christensen M, Woods SC, DiMarchi RD, Tschöp MH. Glucagon-like peptide 1 (GLP-1). Mol Metab. 2019 Dec;30:72-130. doi: 10.1016/j.molmet.2019.09.010. Epub 2019 Sep 30. PMID: 31767182; PMCID: PMC6812410.

https://en.wikipedia.org/wiki/Gastric_inhibitory_polypeptide

https://en.wikipedia.org/wiki/Glucagon

Seino Y, Fukushima M, Yabe D. GIP and GLP-1, the two incretin hormones: Similarities and differences. J Diabetes Investig. 2010 Apr 22;1(1-2):8-23. doi: 10.1111/j.2040-1124.2010.00022.x. PMID: 24843404; PMCID: PMC4020673.

Perkovic V, Tuttle KR, Rossing P, Mahaffey KW, Mann JFE, Bakris G, Baeres FMM, Idorn T, Bosch-Traberg H, Lausvig NL, Pratley R; FLOW Trial Committees and Investigators. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med. 2024 Jul 11;391(2):109-121. doi: 10.1056/NEJMoa2403347. Epub 2024 May 24. PMID: 38785209.

Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, Lingvay I, Rosenstock J, Seufert J, Warren ML, Woo V, Hansen O, Holst AG, Pettersson J, Vilsbøll T; SUSTAIN-6 Investigators. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016 Nov 10;375(19):1834-1844. doi: 10.1056/NEJMoa1607141. Epub 2016 Sep 15. PMID: 27633186. (https://www.nejm.org/doi/full/10.1056/NEJMoa1607141)

V.R. Aroda, A. Ahmann, B. Cariou, F. Chow, M.J. Davies, E. Jódar, R. Mehta, V. Woo, I. Lingvay,
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Antonia Reed. Ozempic is everywhere and that’s triggering for people in recovery from eating disorders, specialists say
Alarm raised that patients are prescribed without proper screening for eating disorder history. · CBC Radio · Posted: Nov 19, 2023 1:00 AM PST | Last Updated: January 17