What I'd actually ask my doctor before starting Mounjaro

A reader DM'd me at 11pm on a Sunday. She had her appointment with a new GP the next morning and was anxious. Could I just tell her, in plain language, what to actually ask?

The list she'd Googled was 23 questions long. Most of them were either too vague to get a useful answer in a 15-minute appointment ("what are the long-term effects?") or things her doctor literally could not answer ("which insurance plan covers it best?"). She didn't need a longer list. She needed a shorter one.

Here's what I told her. Six questions, in order. Skip the others.

One: which medication are you starting me on, and why this one?

If you came in saying "I want Mounjaro," you'll probably get Mounjaro. If you came in saying "I'm not losing weight on what I've been doing," your doctor might suggest tirzepatide (Mounjaro / Zepbound), semaglutide (Wegovy / Ozempic), the new oral Foundayo, or older options like Saxenda. They are not the same. The differences matter for cost, side effects, and how much weight you can expect to lose. Make your doctor justify the choice. "Why this one and not the others" is a fair, useful question.

Two: what dose are we starting at, and how slowly will we step up?

This one matters more than people realize. The standard step-up schedule for tirzepatide is 2.5mg → 5mg → 7.5mg → 10mg, four weeks at each step. Some prescribers rush it. Don't let them. The faster you step up, the more likely you are to have GI side effects severe enough that you stop the medication. Slower works. Ask your doctor what the plan is and whether they're flexible on extending a step if you're not tolerating it well. If they're not flexible, that tells you something.

Three: what are the side effects you actually expect me to have, and what do I do about them?

Don't accept "you might have some nausea." Push for specifics. About half of people get noticeable GI symptoms in the first month or two. About a quarter get something more substantial. About one in twenty gets the harder thing that ends the medication. Ask your doctor how they want you to handle each. Hydrate? Specific over-the-counter helpers? When to call them? When to go to the ER? Get a plan, not a shrug.

Four: how are we going to monitor weight, body composition, and labs?

Weight is the easy number. Body composition (lean mass vs fat mass) and labs (kidney function, A1c if you're prediabetic, lipids) are the harder numbers and the more useful ones. If your doctor isn't checking labs at three months and again at six months, ask why. If they don't have a plan for tracking lean mass loss (DXA scan, bioimpedance, just measuring strength), that's a gap. Lean mass matters more than it gets credit for, especially after 40.

Five: when should we stop or pause?

Most prescribers think about starting. Few think about stopping. Ask. "If I get to my goal, what's the plan?" "If I have a medical event that needs me to pause, how do we restart?" "If I want to go off this for personal reasons, what does that look like?" The answers will tell you whether your doctor has thought about this as a medication you'll be on for a while or a quick fix. The good ones have. The honeymoon-only ones haven't.

Six: what's this going to cost me?

Cash price, insurance copay, prior authorization process, what happens if my insurance changes. Your doctor probably can't quote exact numbers but they should know the broad shape: "we'll do a prior auth, your copay should land at X if approved, here's our pharmacy partner if you need cash-pay, here's what to do if it gets denied." If they hand you a script and say "good luck with insurance," you're going to spend the next month doing paperwork yourself.

That's it. Six questions. Most of them are answerable inside a 15-minute appointment. None of them are the hand-wavy long-term-this-or-that questions that sound smart but get useless answers.

What I'd skip from the typical Googled lists: anything about "long-term safety" (the answer is "we don't have 30-year data on anything"), anything about "how does it work mechanistically" (your doctor's answer will be a worse version of the explainer videos you can watch later), and anything about diet or exercise specifics (those belong in a separate appointment with a dietitian or a coach, not your prescribing GP).

The other thing I told the DM-er: bring a friend or partner if you have one. Not for support specifically. For memory. The first appointment for any new medication is information-dense and the cortisol of being a patient makes you forget half of it. A friend in the room remembers different parts than you do. Compare notes after.

Good luck Monday.