You’re tired of being overweight, and you’ve been a victim of the tyranny of the last ten, twenty pounds or much more as long as you can remember. You’ve tried everything. You’ve been dieting and nothing happens that ever lasts except hunger. You exercise to exhaustion, lose some pounds and gain them back. No matter what you do, your tummy is still there, slowly expanding; your thighs stretch the seams of your designer jeans. You are really tired of this! And yet, you know you’re not alone. 74% of Americans are considered overweight, 42% of these are obese. There are well over 60,000 book titles on Amazon when you insert ‘diet’ in the search engine. Diet pills, prescription or not, give no lasting benefit.
And now you see GLP-1’s everywhere. Those articles and TV ads for the new semaglutide and tirzepatide peptides (“Glucagon-Like-Peptides: Wegovy, Trulicity, Mounjaro, Ozempic, Zepbound with more to follow). Maybe a friend or two has cheerfully told you of her success. Currently 11% of Americans are using GLP-1’s for weight loss. Why not you?
These look simple enough to use. A weekly injection, tiny tiny (!) needle into a roll of your fat, GLP-1’s were originally FDA approved for Type 2 (adult onset) diabetes, and there was a marvelous side effect: users of the semaglutides lost weight, even more weight with the tirzepatides. And then FDA approved them for obese teens over age 12.
In a head-to-head competition of diet/exercise versus tirzepaide, after 16 months, overweight patients following diet/exercise alone lost 2% of their weight, but tirzepatidetide users lost 20%. Average: a pound a week.
Think about doing the math on yourself. Let’s say you weigh 190 lbs. After 64 once-a-week injections (16 months, 4 weeks a month) you could weigh 126 lbs. (Realistically, more like 140 lbs.) Maybe not enough to open an account at Brandy Melville (that was meant to be a joke). But then…three months later, off the tirzepatides, you’ve regained ten pounds. Don’t hyperventilate. Call for a refill. They’re FDA approved for lifetime use. OR—move to microdosing.
How Do GLP-1’s Work?
The GLP-1’s are peptides, short chains of amino acids (a “long chain” is a protein), called GLP-1 RA “Glucagon Like Protein Receptor Agonist”, that is stored in the lining of your small intestine and is released when food arrives to increase your insulin, lower your blood glucose, and reduce your hunger.
Not surprisingly, with a big winner on their hands, Big Pharma priced all the GLP-1’s very high (they average $1,300 a month without insurance). The insurance companies, fully aware of the obesity statistics, took one look at these prices and pressed the denial button every time a doctor wrote the prescription for GLP-1 when prescribed for obesity. Zepbound is approved for obesity with medically related conditions like obstructive sleep apnea. Like its GLP-1 siblings, it usually gets denied by insurers as well. The meds are covered for diabetes only after other therapies have been shown to fail.
Because GLP-1 are actually simple to manufacture, Big Pharma has been lowering their prices through discount coupons, feeling competition from online “compounding pharmacies” of (unfortunately) varying quality. But $300 a month sits a lot better than $1,300!
BUT THEN ALONG CAME MICRODOSING
During the past year, many patients whose insurance had been covering one of the GLP-1 medications received word that this coverage was ending. Frantic is an understatement. The medications are available from compounding pharmacies, averaging $300-$450 a month, obviously less than the Big Pharma price of over $1,200 a month, but then doctors (and patients themselves) discovered they could s-t-r-e-t-c-h their supply by reducing their remaining supplies, by giving themselves smaller doses.
They began “microdosing.”
What Is Microdosing GLP-1?
Microdosing GLP-1s means starting at significantly lower doses than standard guidelines—sometimes as low as 0.05 to 0.1 mg of semaglutide per week, compared to the usual starting dose of 0.25 mg. This is about one-fifth of the usual starting dose.
Tirzepatide follows the same pattern.
One of the general rules that you learn in medical school when giving a patient any medicine that is being considered for long term use is “start low and go slow.” If you are already using a GLP-1 meds, you’ll remember how your dose increased every month and then levelled off. This rule allows your body to adapt slowly and minimizes side effects like nausea, fatigue, or GI distress, while still gaining the benefits of appetite regulation, insulin sensitivity, and metabolic rebalancing.
Why Microdose?
Most patients are surprised to learn that more is not always better. Microdosing starts even lower, goes even slower and offers distinct advantages:
1. Fewer Side Effects
Some people stop GLP-1s early due to nausea, reflux, constipation, or fatigue. Starting at a microdose lets your body gently adjust to the medication, often eliminating your need for aggressive symptom management, like an anti-nausea medication.
2. Smoother Appetite Regulation
Microdosing avoids the intense appetite suppression or early aversion to food that some patients feel. Instead, it simply supports mindful eating—making it easier to build sustainable habits rather than relying solely on the medication to “do the work.”
3. Metabolic Health
When used at low doses, GLP-1s help correct blood sugar instability and insulin resistance even before any weight loss occurs. This is particularly useful in women with PCOS, perimenopausal weight gain, or metabolic sluggishness—where balancing hormones and blood sugar is key. Women who track blood sugar levels during perimenopause sometimes discover they are susceptible to uncomfortable and unpredictable swings of hypo- and hyperglycemia. The GLP-1 microdosing often corrects this.
4. Hormone-Sensitive Support
Women going through hormonal transitions (perimenopause, menopause, PCOS, postpartum) often need a more nuanced approach. Microdosing helps stabilize metabolic and mood shifts without triggering overwhelming physical changes too quickly.
5. Microdosing is a good starting dose for obesity among teenagers over age 12. With virtually no side effects from microdosing, and only once-a-week, this makes it a very acceptable therapy.
6. Both patients and their doctors have come to appreciate the widespread anti-inflammatory effects of the GLP-1 medications. This may be occurring because fat cells contain molecules of inflammation called cytokines. If you lose your fat cells, your cytokine population drops and you start feeling less “inflamed.” I have heard this self-reported description from many patients especially when they pass that 25 lb. mark. I’ve written more about this here.
Whether you’re getting your medication through your health insurance or you have to pay for it out of pocket, research is showing that because of a variety of health benefits beyond weight control, using microdosed GLP-1 for the rest of your life will very likely have an anti-aging effect.
Whether you’re getting your GLP-1 through your health insurance or paying for it from a compounding pharmacy, your supply will last three to four times longer if you microdose it.
Call and schedule a visit with your WholeHealth Chicago practitioner and we can review this in detail, add supportive nutritional supplements, order your semaglutide or tirzepatide from a reliable compounding pharmacy and schedule a visit with our nutritionist.
Be well,
David Edelberg, MD