They can be, depending on your health profile and goals
I remember a specific case of a young man who came to me with chronic asthma but also had recurrent oral thrush (Candida on the tongue) and fungus in his toenails
It slows gastric emptying, reduces appetite signals in the brain, and improves insulin sensitivity
My general framework: Start with semaglutide if cost is a significant concern, or if there is no strong reason to expect poor tolerance Start with tirzepatide if the patient has tried semaglutide before and struggled with side effects, if faster initial response matters clinically, or if the patients goals require larger total weight loss Switch to tirzepatide if a patient on semaglutide is experiencing persistent nausea or has plateaued and escalation options are limited One pattern worth noting: men I see a consistent pattern with male patients who struggle to tolerate semaglutide nausea and GI disruption can be particularly disruptive for them, and theyre often less willing to push through it
This type can often improve significantly if alcohol intake is reduced or stopped early
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