I keep getting the same question from different friends in different cities. Here's the version short enough to get through over coffee. The decision today (May 2026) is different from the one a year ago, and the difference is mostly about what you actually want from your supply chain.
A coach in Singapore told me the same thing my doctor friend in Bangkok told me: the people who quit tirzepatide almost all quit between week 6 and week 10. The reason isn't the side effects you'd guess. It's the gap between when the discomfort peaks and when the visible results start showing up.
A friend asked me last week whether to keep paying $179 a month for compounded tirzepatide from her telehealth provider. The honest answer involves the April 30 FDA proposal, the difference between 'still shipping' and 'safe to bet on', and a conversation about what brand pricing looks like once she does the math on insurance.
Most coverage is either too dismissive (\"just some nausea\") or too alarmist (\"brutal stomach issues forever\"). After watching a few hundred people start tirzepatide and semaglutide over the past year, here's the actual shape of the side effects most people get.
A reader sent me a denial letter from her US insurer. They covered Wegovy. They didn't cover Mounjaro. Same patient, same diagnosis, same prescriber. The reason isn't medical. It's a contract that nobody mentions.
A clinic in Bangkok used the phrase 'maintenance dose' three times in one consultation without ever defining it. The patient nodded each time. Then she asked me afterwards what it meant. The honest answer is that nobody knows for sure yet, but here's what we're learning.
I went through the homepage of a vendor a friend was about to buy from and counted 11 marketing tells in the first scroll. Here's what those tells look like and what to look for instead. The skill takes 90 seconds per site once you know what you're looking at.
Almost all the public conversation about tirzepatide is about the first six months. The trial data, the dramatic before-and-afters, the side-effects window. The second year is where the harder questions live: maintenance dose, plateau, lean mass, and the question nobody asks until they're in it.
A reader sent me a DM at 11pm on a Sunday: appointment Monday morning, what do I actually need to ask? The list most people Google online is too long, vague, and written by someone who has never had a 15-minute appointment. Here's the shorter list that matters.
A reader at month 12 asked me what happens if she stops. The honest answer involves the trial data on weight regain, the lifestyle changes that determine how much, and a more useful frame: stopping isn't a single event, it's a process that takes about as long as starting did.
A friend got scheduled for elective surgery and her surgeon told her to pause tirzepatide for a week before. Her telehealth provider had no idea this was a thing. The list of reasons to pause is longer than most providers acknowledge, and pausing is mostly fine.
The real differences between compounded tirzepatide from a 503A pharmacy and brand Mounjaro from Eli Lilly. Regulatory status, quality control, pricing, and when one is clearly better than the other.
Retatrutide hits three receptors instead of two. Phase 2 showed 24% weight loss. Phase 3 results expected late 2026. What it is, how it differs from tirzepatide, and why the molecule matters.
The SURMOUNT-4 trial tracked what happens when people stop tirzepatide after initial weight loss. Here is the honest version of the regain curve, what drives it, and how to think about maintenance.
GLP-1 drugs including tirzepatide reduce alcohol consumption for many users. Here is the mechanism, the observational data, the clinical caution, and how Panya routes patients who mention drinking on intake.