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 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 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.