Semaglutide (GLP-1) in San Ramon

Semaglutide has been in use since 2017 (diabetes) and 2021 (obesity). Long-term safety beyond 5 years is extrapolated from related GLP-1 agonists with longer track records. The signal so far is favorable; rare adverse events (pancreatitis, gallstones) occur at low rates.

Weight loss from any cause produces some lean mass loss. Resistance training and adequate protein (1.2–1.6 g/kg/day) attenuate it substantially. Without those, lean mass loss can reach 25–40% of total weight lost — clinically significant.

Rapid weight loss reduces facial fat pad volume, producing a hollowed look. This is not specific to GLP-1 — it happens with any rapid loss. Slower weight loss, hydration, and selective filler can address it if it occurs.

Compounded semaglutide is mixed by 503A/503B pharmacies, often with B12 or other additions. Cost is lower ($200–$400/month vs $1,000+ for Wegovy). Quality variance is the trade-off. As of 2025, the FDA shortage list ended; compounding may face increasing regulatory pressure.

Tirzepatide (Mounjaro/Zepbound) is a dual GIP/GLP-1 agonist with stronger weight-loss efficacy in head-to-head trials (~20% vs ~15%). Side effect profiles are similar. Choice often comes down to insurance coverage and individual response.

Many patients report dramatic reduction in alcohol cravings on GLP-1, an effect now being studied for alcohol use disorder. Drinking is not contraindicated but tolerance and pleasure both decrease for most people.