hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and micronutrient contributions, and the trial incidence data.

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14 questions · sorted by votes

58 votes 3 answers37k views

Hair started shedding at month three. Does the timing tell me whether it is the drug or the weight loss?

Started tirzepatide in February. Nothing unusual until early June, when the shedding started, and it is now substantial: handfuls in the shower, hair on the pillow,…

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsnutrition

nutrition

Eating on a suppressed appetite: hitting nutritional targets inside a small energy budget, micronutrient risk, meal structure, and what the trial…

92 questionsclinical-trials

clinical-trials

Reading the primary literature properly: estimands, intention-to-treat versus per-protocol, confidence intervals, absolute versus relative…

913 questionsprotein-intake

protein-intake

Protein targets in grams per kilogram, per-meal distribution and the leucine threshold, and the evidence for a higher intake specifically during…

53 questionsfood-noise

food-noise

The reduction in intrusive, appetitive thinking about food that most people on the class describe. Its likely basis in central GLP-1R signalling,…

14 questionsasked by nadia_kowalczyk 14k · 2.0 years ago

53 votes 3 answers25k views

How much of the fatigue is actually drug-attributable, and what did the placebo arms report?

I am five months in, down 16 kg, and flattened. Not sleepy, exactly. More that everything costs more than it used to: stairs, conversations, training sessions I used…

fatigue

Tiredness on treatment: how much is energy deficit, how much is dehydration or electrolyte drift, how much is genuinely drug-attributable, and…

38 questionsclinical-trials

clinical-trials

Reading the primary literature properly: estimands, intention-to-treat versus per-protocol, confidence intervals, absolute versus relative…

913 questionsnutrition

nutrition

Eating on a suppressed appetite: hitting nutritional targets inside a small energy budget, micronutrient risk, meal structure, and what the trial…

92 questionselectrolytes

electrolytes

Sodium, potassium and magnesium during reduced intake and GI losses: what the symptoms of a shortfall look like, when a panel is worth drawing,…

36 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by h_villanueva 50k · 22 months ago

40 votes3 answers16k views

Would switching agents help the shedding, or is the rate of loss the only variable that matters?

Second wave of shedding, nine months in, and I have been told by two people in strong terms that switching from tirzepatide to semaglutide will fix it because…

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionssemaglutide

semaglutide

A GLP-1 receptor agonist with a fatty-acid-acylated backbone and a roughly one-week half-life, marketed for type 2 diabetes and for weight…

360 questionstirzepatide

tirzepatide

A dual GIP and GLP-1 receptor agonist. Questions here cover the SURPASS and SURMOUNT programmes, the practical differences from a pure GLP-1…

162 questionsdiscontinuation

discontinuation

Stopping treatment: tapering versus abrupt cessation, what the trial withdrawal arms measured, clinically driven stops, and the practical planning…

21 questionsasked by siobhan_deasy 16k · 12 months ago

32 votes 3 answers8.7k views

How do I quantify shedding well enough to know whether it is getting better or worse?

I am four months into a shedding episode and I genuinely cannot tell whether it is slowing down, stable or worse. My perception changes daily and is heavily…

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsharm-reduction

harm-reduction

Reducing avoidable risk where a decision has already been made: independent verification before use, sterility practice, dose arithmetic checked…

445 questionsnutrition

nutrition

Eating on a suppressed appetite: hitting nutritional targets inside a small energy budget, micronutrient risk, meal structure, and what the trial…

92 questionsbloodwork

bloodwork

Laboratory monitoring: which panels are worth ordering, sensible intervals, reference-range versus optimal-range arguments, and how to read a…

284 questionsasked by tare_and_weigh 18k · 6 months ago

31 votes 5 answers19k views

What does SURMOUNT-1 tell me about headache at the 50 mg dose?

What I have: SURMOUNT-1 · headache · 50 mg. I can parse the result. I am less sure what it licenses me to conclude. I have deliberately not looked at anyone else’s…

clinical-trials

Reading the primary literature properly: estimands, intention-to-treat versus per-protocol, confidence intervals, absolute versus relative…

913 questionsgi-side-effects

gi-side-effects

The gastrointestinal cluster as a whole - nausea, vomiting, diarrhoea, constipation, reflux, early satiety - with trial incidence rates, dropout…

416 questionstitration

titration

Stepwise dose increases over weeks, why the label schedules exist at all, and what tolerability-driven deviation from a schedule looks like in…

444 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by tess_amankwah 48k · 14 months ago

26 votes0 answers13k views

Is hair shedding at month three telogen effluvium or something else?

It has now persisted for three weeks, which is what moved this from tolerable to worth asking about. I can parse the result. I am less sure what it licenses me to…

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsnutrition

nutrition

Eating on a suppressed appetite: hitting nutritional targets inside a small energy budget, micronutrient risk, meal structure, and what the trial…

92 questionsprotein-intake

protein-intake

Protein targets in grams per kilogram, per-meal distribution and the leucine threshold, and the evidence for a higher intake specifically during…

53 questionsasked by wren_calloway 14k · 16 months ago

26 votes 5 answers5.2k views

How do I tell reflux from an energy deficit on 1,200 kcal a day?

Numbers first: reflux · 1,200 kcal. I have a result I cannot explain, and I would rather diagnose it than guess. I have checked the obvious explanations and…

fatigue

Tiredness on treatment: how much is energy deficit, how much is dehydration or electrolyte drift, how much is genuinely drug-attributable, and…

38 questionsnutrition

nutrition

Eating on a suppressed appetite: hitting nutritional targets inside a small energy budget, micronutrient risk, meal structure, and what the trial…

92 questionselectrolytes

electrolytes

Sodium, potassium and magnesium during reduced intake and GI losses: what the symptoms of a shortfall look like, when a panel is worth drawing,…

36 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by drawn_and_capped 15k · 5 months ago

23 votes 5 answers19k views

Does holding at 15 mg for ten weeks before escalating reduce fatigue?

The particulars: 15 mg · ten weeks · fatigue. I understand the observation; what I do not understand is the mechanism behind it. I have read the two review articles…

titration

Stepwise dose increases over weeks, why the label schedules exist at all, and what tolerability-driven deviation from a schedule looks like in…

444 questionsnausea

nausea

The dominant tolerability signal in every trial of the class: incidence, timing relative to a dose step, duration, and the distinction between…

346 questionsdose-escalation

dose-escalation

The decision to move up a step: what evidence supports a four-week interval, what happens when you compress it, and how trial protocols handled…

88 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by net_peptide 16k · 18 months ago

12 votes0 answers1.1k views

Is headache on a GLP-1 receptor agonist dose-dependent or dose-rate dependent?

What I am working with: headache · a GLP-1 receptor agonist. The empirical answer seems settled. The explanation does not. If the honest answer is that nobody knows,…

nausea

The dominant tolerability signal in every trial of the class: incidence, timing relative to a dose step, duration, and the distinction between…

346 questionstitration

titration

Stepwise dose increases over weeks, why the label schedules exist at all, and what tolerability-driven deviation from a schedule looks like in…

444 questionsgi-side-effects

gi-side-effects

The gastrointestinal cluster as a whole - nausea, vomiting, diarrhoea, constipation, reflux, early satiety - with trial incidence rates, dropout…

416 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by Dr_Aoife_Brennan 50k · 26 days ago

11 votes 3 answers6k views

What did FLOW do with participants who could not tolerate a step?

My records go back to the first dose with dates, so I can reconstruct the timeline exactly. I have read the primary source rather than the summary, which has left me…

titration

Stepwise dose increases over weeks, why the label schedules exist at all, and what tolerability-driven deviation from a schedule looks like in…

444 questionsclinical-trials

clinical-trials

Reading the primary literature properly: estimands, intention-to-treat versus per-protocol, confidence intervals, absolute versus relative…

913 questionsgi-side-effects

gi-side-effects

The gastrointestinal cluster as a whole - nausea, vomiting, diarrhoea, constipation, reflux, early satiety - with trial incidence rates, dropout…

416 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by rukhsana_iqbal 14k · 2 months ago

7 votes0 answers875 views

Does holding at a lower dose for longer reduce total side-effect burden?

My records go back to the first dose with dates, so I can reconstruct the timeline exactly. I keep seeing this stated as a fact with no explanation attached, and…

titration

Stepwise dose increases over weeks, why the label schedules exist at all, and what tolerability-driven deviation from a schedule looks like in…

444 questionsnausea

nausea

The dominant tolerability signal in every trial of the class: incidence, timing relative to a dose step, duration, and the distinction between…

346 questionsgi-side-effects

gi-side-effects

The gastrointestinal cluster as a whole - nausea, vomiting, diarrhoea, constipation, reflux, early satiety - with trial incidence rates, dropout…

416 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by gel_pack_warm 13k · 22 days ago

6 votes 5 answers24k views

Is a micronutrient panel worth drawing after six months of low intake?

I have three DEXA scans on the same scanner at twelve-week intervals, fasted, same time of day. This is a planning question. I know what my options are; I do not know…

nutrition

Eating on a suppressed appetite: hitting nutritional targets inside a small energy budget, micronutrient risk, meal structure, and what the trial…

92 questionsbloodwork

bloodwork

Laboratory monitoring: which panels are worth ordering, sensible intervals, reference-range versus optimal-range arguments, and how to read a…

284 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by eoin_mcgarry 16k · 2.2 years ago

5 votes 5 answers17k views

Is headache on mazdutide dose-dependent or dose-rate dependent?

Stated plainly: headache · mazdutide. I keep seeing this stated as a fact with no explanation attached, and unexplained facts make me suspicious. My background is…

nausea

The dominant tolerability signal in every trial of the class: incidence, timing relative to a dose step, duration, and the distinction between…

346 questionstitration

titration

Stepwise dose increases over weeks, why the label schedules exist at all, and what tolerability-driven deviation from a schedule looks like in…

444 questionsgi-side-effects

gi-side-effects

The gastrointestinal cluster as a whole - nausea, vomiting, diarrhoea, constipation, reflux, early satiety - with trial incidence rates, dropout…

416 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by bounty_hunter_q 18k · 22 months ago

4 votes 5 answers12k views

Does reflux at week seven of liraglutide usually resolve without a dose change?

Details up front: reflux · seven · liraglutide. I can find plenty of assertions about this and almost no reasoning, which is usually a sign that nobody has checked.…

gi-side-effects

The gastrointestinal cluster as a whole - nausea, vomiting, diarrhoea, constipation, reflux, early satiety - with trial incidence rates, dropout…

416 questionstitration

titration

Stepwise dose increases over weeks, why the label schedules exist at all, and what tolerability-driven deviation from a schedule looks like in…

444 questionsnausea

nausea

The dominant tolerability signal in every trial of the class: incidence, timing relative to a dose step, duration, and the distinction between…

346 questionshair-loss

hair-loss

Telogen effluvium following rapid weight loss versus a drug-attributable effect: the timing signature that distinguishes them, protein and…

14 questionsasked by lyoph_cake 95k · 2.3 years ago

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