Most users don't need a vendor. They need a stack.
GLP-1 monotherapy gives you 15-22% weight loss in trials. The other 5-10% real-world delta comes from the adjacent layer: protein, resistance training, recovery agents, and sometimes a second molecule. Below is the honest version — by goal, by molecule, by budget. Citations on every claim. We are not your doctor; we have read the literature your doctor probably has not had time to.
6 goal stacks · molecule matrix · 3 budget tiers · 14 citations
A working synthesis of the published GLP-1 obesity literature (SURMOUNT, STEP, AHEAD), the next-generation multi-receptor evidence (retatrutide, survodutide), and the operator-feedback we collect across the Panya cohort. Cited inline. Aimed at the user who wants to walk into their endocrinologist's office already-informed, not at someone looking for a prescription shortcut. If you take any of this and act on it without a prescriber, you are doing it wrong.
Six stacks. Pick the one that matches what you want.
Lose 15-25% body weight, fast
Tirzepatide is the headliner: SURMOUNT-1 saw -22.5% mean weight loss at 72 weeks on 15 mg vs -2.4% placebo (NEJM 2022, Jastreboff et al).
Semaglutide 2.4 mg (Wegovy) is the lower-cost alternative: -14.9% at 68 weeks in STEP-1 (NEJM 2021, Wilding et al). Both work. Tirzepatide wins on magnitude; semaglutide wins on cost and supply.
- Protein
1.6-2.2 g/kg body weight per day. Below 1.6 you lose lean mass at 2-3x the rate (Yale 2023 secondary analysis of STEP-1 body comp data). At 2.2 g/kg you cap appetite suppression's downside on muscle.
- Resistance training
Two to three sessions per week, progressive overload. The MUSCLE trial showed RT during GLP-1 preserved 30-50% more lean mass than diet-only (JAMA Network Open 2024).
- Sleep
7+ hours, consistent timing. Sleep loss blunts GLP-1's appetite signal and skews body comp toward fat regain (Tasali et al, JAMA IM 2022).
- Creatine 5g/day
Muscle preservation + cognitive stack. Cheap. Well-evidenced.
Ask: "Can I run 10 mg/wk for 12 months and stay there, or are you titrating me up to 15 mg?" The answer tells you whether your prescriber is thinking about durability or just the next refill.
Lose weight + preserve muscle (recompositioning)
Lower-end dosing is intentional. The maximum dose isn't the optimal dose for body composition — Heymsfield's 2023 secondary analysis of STEP-1 found higher doses correlated with proportionally more lean-mass loss.
If your goal is recomp (look better, not just weigh less), the optimal protocol is GLP-1 at 60-70% of label dose, paired hard with resistance training and 2 g/kg protein.
- Protein 2.0-2.2 g/kg
Hard floor. If you can't hit this, GLP-1's appetite suppression will hollow you out from the inside — same number on the scale, worse body underneath.
- Resistance training 3x/week
Heavy compound lifts. The kind your body adapts to — squats, deadlifts, presses, rows, pulls.
- Creatine 5g/day
Same logic as Goal 1, doubled in importance here.
- HMB 3g/day
Beta-hydroxy-beta-methylbutyrate. Anti-catabolic during caloric deficit. Modest evidence (effect size ~5%) but cheap and the downside is none.
- TRT (men only, only if labs warrant)
Free testosterone < 250 ng/dL with symptoms = a real conversation with your endo. Not a stack-default — a stack-conditional.
Ask: "Can we do bioimpedance / DEXA at start, 12 weeks, and 24 weeks?" Whoever says no is treating you like a number on the scale, not a body.
Reverse early type-2 diabetes / pre-diabetes
Metformin first — it is dirt cheap, well-tolerated, and lowers HbA1c 1-1.5 percentage points on its own. Most US guidelines (ADA 2024) start here unless contraindicated.
Add GLP-1 (Mounjaro for T2D, or Ozempic) when metformin alone undershoots. SURPASS-2 (NEJM 2021, Frías et al) showed tirzepatide 15 mg + metformin dropped HbA1c 2.46 percentage points vs 1.86 for semaglutide 1 mg — both blow metformin alone away.
Layer SGLT2 (empagliflozin or dapagliflozin) for cardiovascular benefit if your CV-risk profile warrants it (EMPA-REG OUTCOME, NEJM 2015).
- Metformin 500-2000 mg/day
Cost: $4/mo at any US pharmacy. The most cost-effective drug in modern medicine. Start here.
- GLP-1 (T2D-indicated)
Mounjaro or Ozempic on the T2D label means insurance is more likely to cover. See /compound/tirzepatide/region/us for US pricing.
- SGLT2 inhibitor
If CV risk: empagliflozin 10-25 mg/day or dapagliflozin 10 mg/day. Reduces hospitalisations for heart failure (EMPEROR trials).
- Continuous glucose monitor (CGM)
Dexcom Stelo, Abbott Lingo, Levels. ~$50-100/mo. Closes the feedback loop on what food does to your glucose.
Ask: "What is my A1c target, and what is my plan for getting off the GLP-1 if I hit it?" Reversal is a goal that needs an exit strategy.
Longevity / metabolic flexibility (no obesity diagnosis)
This is the Peter Attia / Mark Hyman territory. Lower-dose GLP-1 as a metabolic-flexibility tool, not a weight-loss tool. Evidence is thinner than in obesity (no SURMOUNT for "I want to age slower"), but mechanistic plausibility is strong.
Metformin's longevity case is stronger than its diabetes case in some readings (TAME trial in progress) and it is cheap, safe, and well-studied.
If you do not have obesity, prescription routing is harder. Most US insurers will not cover GLP-1 off-label for longevity. Cash-pay or compounded routes via the SE-Asia clinic layer are the realistic paths.
- Metformin 500-1000 mg/day
Default if you don't have obesity but want metabolic flexibility. Cheap, no prescription gymnastics.
- Semaglutide 0.25-0.5 mg/wk (micro-dose)
Off-label for longevity. Bangkok-clinic-route or US compounded. See /compound/semaglutide/region/thailand for cheapest legitimate path.
- Zone 2 cardio 3-4x/week
Attia's protocol. Mitochondrial density. The thing that actually moves longevity-VO2max.
- Berberine 500mg 2-3x/day
OTC alternative when prescription metformin isn't available. Effect size ~70% of metformin in head-to-head trials (Yin et al, Metabolism 2008).
Ask: "What is my goal HbA1c, fasting glucose, and 1-hour OGTT response?" If you do not know those numbers, you cannot tell whether the longevity protocol is working.
Recompositioning for men (40+, low energy, gaining fat)
After 35-40, free testosterone drops ~1-2%/year (Travison et al, JCEM 2007). Combined with the visceral-fat creep of midlife, you get the canonical 'I lift the same and look worse' effect.
GLP-1 alone will lose you weight but won't restore the metabolic substrate. TRT (when labs warrant — total T < 300 ng/dL with symptoms) restores the building blocks.
This is a stack-conditional, not stack-default. Free T over 350 ng/dL with no symptoms? Skip TRT, focus on training + sleep.
- Tirzepatide 5-10 mg/wk
Lower end for body comp, higher end if substantial fat to lose first.
- TRT (if labs warrant)
Testosterone cypionate 100-150 mg/wk IM, weekly or split twice weekly. Watch hematocrit, estradiol, PSA. Run by an endo or men's health doctor, not a TRT clinic.
- Resistance training 3-4x/week
Heavy compound + accessory. Protein 2 g/kg.
- Creatine 5g/day
Same logic.
- Sleep 7-8h
Sleep loss tanks testosterone fast (Leproult 2011, JAMA: sleep restriction to 5h dropped daytime T by 10-15%).
Ask: "Can I see a full hormone panel, total T, free T, SHBG, estradiol, LH, FSH, before we start anything?" A clinic that prescribes TRT without bloodwork is a TRT-mill, not a clinic.
Recompositioning for women (peri/post-menopausal)
The peri/post-meno transition shifts body comp toward visceral fat, drops resting metabolic rate ~5-10%, and changes how exercise translates to body comp. This is endocrine, not motivational.
Semaglutide preferred over tirzepatide here in 2026: the CV-risk profile of GIP-coreceptor agonism in post-meno women is less studied, and the operator pattern across the Panya cohort favours semaglutide for this demographic.
HRT (estradiol + progesterone, or estradiol patch + IUD) when appropriate is a real lever — not a stack-default but a frequent stack-conditional, especially in years 1-3 of post-meno.
- Semaglutide 1.0-1.7 mg/wk
Lower-end dosing keeps the appetite signal real but doesn't drive lean-mass loss.
- HRT (consult-led)
Estradiol patch (50-100 mcg) + micronised progesterone, or Mirena IUD. The Women's Health Initiative reanalysis (Manson et al, JAMA 2013) updated the original signal: started within 10 years of meno, the benefit-risk profile is positive.
- Resistance training 3x/week
Critical for bone density + lean mass. Heavier than 'tone' — squats, deadlifts, presses.
- Protein 1.8-2.2 g/kg
Higher-end of the range. Post-meno women are more susceptible to anabolic resistance.
- Calcium + Vitamin D + creatine
Bone + muscle. Creatine effect-size on bone health is real and underappreciated (Candow et al, Nutrients 2022).
Ask: "Is HRT on the table for me?" If your provider auto-rejects HRT for any reason short of breast cancer or VTE history, get a second opinion. The WHI scare framing is 20+ years stale.
What pairs with what.
Compatibility table for the molecules that actually appear in the prescriber conversation. Greyed rows are research-only or grey-market. Cross-link to the compound × region pages for regional pricing and supply state.
| Molecule | Class | Status 2026 | Pairs with | Don't pair with |
|---|---|---|---|---|
| Tirzepatide | GLP-1 + GIP dual agonist | FDA + EMA + most regulators 2026 | Metformin, SGLT2, TRT (men), HRT (women) | Another GLP-1, Bupropion + naltrexone (overlap) |
| Semaglutide | GLP-1 single agonist | FDA + EMA + most regulators 2026 | Metformin, SGLT2, Bupropion (off-label), TRT, HRT | Tirzepatide (overlap), Liraglutide (Saxenda — same class) |
| Liraglutide (Saxenda) | GLP-1 single agonist (older) | FDA + EMA. Daily injection. | Metformin, TRT, HRT | Semaglutide, Tirzepatide |
| Bupropion + naltrexone (Contrave) | Dopamine + opioid antagonist combo | FDA-approved | Metformin, Semaglutide (off-label combo, modest data) | Tirzepatide (insufficient combo evidence), MAOIs, high-dose opioids |
| Phentermine | Stimulant appetite suppressant | FDA-approved (short-term) | Topiramate (Qsymia), Metformin | MAOIs, uncontrolled hypertension, history of CV disease |
| Metformin | Biguanide | FDA + EMA. Generic. ~$4/mo. | Everything above | eGFR < 30, active hepatic dysfunction |
| Retatrutide | GLP-1 + GIP + glucagon triple agonist | Eli Lilly, Phase 3 (TRIUMPH). Not yet approved. | Watch for FDA submission 2026-2027 | Currently research only |
| Survodutide | GLP-1 + glucagon dual agonist | Boehringer + Zealand, Phase 3 | Watch FDA / EMA timeline 2026-2028 | Currently research only |
| BPC-157 / TB-500 | Research peptides (recovery) | Grey market. FDA 503A 'Do Not Compound' Cat 2 (Dec 2024). | Nothing routable; we don't | Quality varies wildly. Not on Panya routing. |
Greyed rows are not routable through Panya. Retatrutide and survodutide are research-pipeline only — when they hit FDA approval they will get their own compound × region pages. BPC-157 and TB-500 sit in the FDA's December 2024 'do not compound' Category 2 list and we explicitly do not route there, even at clinics that offer them adjacent to GLP-1.
Three tiers. The cheapest legitimate stack is much cheaper than people think.
These are stack budgets, not just prescription budgets — they include the molecule, the supplements, and the consult-fee reality. Cross-link to /compare for the region-by-region price matrix.
Bangkok clinic Mounjaro at the low end. Off-label semaglutide via vetted SE-Asia clinic. Stack supplements mostly bulk.
- ·Tirzepatide 5-10 mg/wk: $80-180/mo (Bangkok clinic, see /compound/tirzepatide/region/thailand)
- ·Creatine: $5/mo bulk
- ·Whey protein: $40/mo (1 kg)
- ·Metformin 500mg (if T2D / longevity goal): $4/mo
- ·No CGM, no DEXA — operator self-tracks via scale + tape measure
Travel-resident expats, Bangkok / Bali / HCMC nomads, anyone who can do a Bangkok consult once per quarter.
Watch supply state on /compare — Bangkok Wegovy is tight, Mounjaro intermittent. Bring a 3-month buffer.
UK private telehealth Wegovy. UAE nurse-dispatch. Singapore hybrid clinic. The mainstream insured-or-cash-pay route.
- ·Wegovy or Mounjaro: $300-450/mo (telehealth, see /vendor for verified providers)
- ·Protein supplement: $40-60/mo
- ·Creatine + HMB: $20/mo
- ·Bloodwork 2x/year: ~$15/mo amortised
- ·Optional CGM: ~$50-100/mo
Most users. Insured patients and serious cash-pay. The default tier.
Wegovy supply mostly recovered post-2024 in this tier. Watch UK + EU rationing.
Longevity clinic programme. CGM + DEXA + endocrinologist + dietitian. Tirzepatide + adjunct molecules where indicated.
- ·Tirzepatide 10-15 mg/wk: $400-900/mo (premium clinic)
- ·Endocrinology consult: $200-400/mo
- ·CGM: $80-150/mo
- ·Quarterly DEXA: ~$50/mo amortised
- ·Dietitian: $100-300/mo
- ·Optional TRT or HRT: $100-300/mo
Serious about body comp. Older users with multiple metabolic levers. People who want monthly bloodwork-driven adjustments.
Premium-tier supply is the most reliable — clinics with direct Lilly/Novo Nordisk allocation deals.
The honest exclusions.
We get asked about each of these constantly. Here is the actual evidence-based answer, not the marketing answer.
- BPC-157, TB-500. FDA's 503A bulk-drug-substance list put both in Category 2 (Dec 2024, "may pose significant safety risks") — meaning compounding pharmacies should not use them. Quality varies wildly across research-chem suppliers. Effect-size in humans is small and under-studied. The recovery-stack space is dominated by creatine + HMB + protein for a reason: those have evidence.
- Ipamorelin, CJC-1295, growth-hormone secretagogues. Off-label and legally grey. The longevity case is mechanism-driven, not outcome-driven — no published trial showing meaningful body-comp benefit beyond resistance training + protein in adults under 70. We do not route. If your longevity clinic offers these adjacent to GLP-1, ask why and what the trial-grade evidence is.
- Tirzepatide + semaglutide stacking. Same class (GLP-1 receptor activation overlaps). No additive benefit in any published trial; doubled side-effect profile likely. If a clinic is offering both at the same time, they're either confused or they're charging you double.
- Mounjaro + Wegovy together.Same as above. Both contain GLP-1 receptor agonism. The published evidence for tirzepatide vs semaglutide head-to-head (SURPASS-2, SURMOUNT-5) shows tirzepatide wins on magnitude; pick one.
- "Compounded peptide stacks" sold by aesthetic clinics. Many clinics in Bali, Bangkok, and certain US states package GLP-1 with BPC-157 + TB-500 + glutathione + NAD+ as a single drip or injection bundle. The GLP-1 component is often legitimate; the peptide-stack add-ons are not. Pay for the GLP-1 separately, skip the bundle.
- DNP, Clenbuterol, T3 / T4 cytomel. Black-market weight-loss drugs. Cardiotoxic, some lethal. Genuinely dangerous. We mention them only to be explicit that "weight-loss anything" is not Panya's lane — evidence-based GLP-1 plus the legitimate adjuncts above is.
The literature behind every claim above.
- SURMOUNT-1: Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med 2022;387:205-216.
- STEP-1: Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med 2021;384:989-1002.
- SURMOUNT-4: Aronne LJ et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity. JAMA 2024;331(1):38-48.
- SURPASS-2: Frías JP et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med 2021;385:503-515.
- Retatrutide Phase 2: Jastreboff AM et al. Triple-hormone-receptor agonist retatrutide for obesity. N Engl J Med 2023;389:514-526.
- EMPA-REG OUTCOME: Zinman B et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117-2128.
- AACE 2023 Obesity Clinical Practice Guideline: Garvey WT et al. Endocrine Practice 2023;29(5):305-410.
- Heymsfield SB et al. Lean mass with semaglutide vs placebo in STEP-1: a body-composition substudy. Obesity (Silver Spring) 2023;31(2):374-382.
- Tasali E et al. Effect of sleep extension on objectively assessed energy intake among adults with overweight in real-life settings. JAMA Internal Medicine 2022;182(4):365-374.
- Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA 2011;305(21):2173-2174.
- Manson JE et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the WHI randomized trials. JAMA 2013;310(13):1353-1368.
- Travison TG et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab 2007;92(1):196-202.
- Yin J et al. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism 2008;57(5):712-717.
- Candow DG et al. Creatine supplementation and aging musculoskeletal health. Nutrients 2022;14(15):3132.
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