GLP-1s: The One Year Review

Content warning: literally this whole post is about weight loss (no photos though). Also it's pretty self-indulgent, sorry!

Every few weeks, like clockwork, another wave of GLP-1 discourse will crash over Bluesky. Usually someone has said something terribly stupid (like "put GLP-1s in the water supply"), and then everyone else feels the need to amplify it by weighing in. Sadly, that sometimes includes me.

Unresolvable discourse cycles are always tedious, but especially so because I actually have been taking GLP-1 medications for over a year. In that time I have come to realize something important: most people with opinions about GLP-1 drugs just haven't thought about them that much!

In an earlier post, I wrote about a desire to blog more expansively. So why not write up my own personal experiences, and how I moved from rolling my eyes at them to deciding they were right for me?

Background

In early 2025, I had an above-average amount of muscle, but also above-average amounts of body fat. And according to my BMI and to my abdominal fat, I had finally crossed into "overweight".

It didn't used to be that way. As a teenager, I had a freakish metabolism and was underweight with a height of 6'2" but a weight of 135 lbs. I got compared to a skeleton a lot!

It's not like that was from starving myself, either: I have always loved food. I love fine dining, and local cuisine, and cheap fast food slop too. And I like to grow my own food, and to grocery shop, and above all to cook. I cook everything from burrito nights for my co-op to multiple course dinner parties. I have been asked on multiple occasions if I'm a private chef.

So as you can imagine, every year, I'd put on another 5 or 10 pounds. I was starting from such a low weight that it didn't matter, was maybe even good for me... at first.

In my early 30s I started to get concerned with the trend. I have biological family on both sides who are obese, or have diabetes, or other related health issues. I was getting increasingly concerned that it wasn't enough to cook most of my meals, or just walk more.

I decided to get into powerlifting as an efficient and effective way to build muscle. It certainly helped with composition, and slowed the increase a bit - but it didn't reverse it, either.

And weirdly enough, I also began to dislike how other people enjoyed my high-muscle, high-fat look. People found me more attractive - but I didn't! I enjoyed being a kinda gangly and elfin nerd. The new me didn't feel right in the mirror.

I wasn't in crisis, and I was pretty healthy for someone my age. But I was at a point of no longer fitting into clothes I loved, or avoiding certain outfits because I didn't like how I looked in them.

Research

This is, maybe, the part that changes your mind?

I had first heard about GLP-1 medications in the context of people dissing celebrities for taking it. Wasn't it embarrassing to hear about yet another weight loss scam for rich people? Then I started to hear about the production shortages, and the skyrocketing pharma valuations. All of this seemed to emerge into the public consciousness out of nowhere.

At first I was really skeptical. But I like to challenge my assumptions, and I also enjoy reading biomedical and public health research for fun. I decided to do some cursory research, not for personal use, but just to understand why so many people were suddenly talking about these medications.

I came away shocked that we're not talking about them more.

I do not like the concept of nor the chase for a "miracle drug", but GLP-1s are one of the closest we've gotten to in a generation, perhaps right next to mRNA vaccines.

Let's go through what I mean by that. But first, a disclaimer that I absolutely do not want to discuss the specifics of technically complex and highly emotionally charged scientific research at length.

With that out of the way: diseases linked to the metabolic syndrome-inactivity-nutrition-obesity cluster have been extremely challenging for American public health. They all cause and are caused by each other, and they each contribute to pretty much every kind of death.

Intent on fixing this? The trajectory of these conditions can get locked in at a very young age, or in environment-dependent ways. A lot of interventions don't work at all at an individual level, and they tend to fare even worse at a population health level. Plus, you're fighting uphill against half the industries in America, including ones that undermine scientific research. It's not an exaggeration to say we were making negative progress on these issues.

And then GLP-1 medications came along, "out of nowhere", and suddenly everywhere. Like magic.

In reality, these drugs had a decades long development history (also much like mRNA vaccines). They only "came out of nowhere" because the early research didn't immediately lead to marketable treatments, and because we devalue tracking basic science.

At an individual level, GLP-1 drugs have a ton of desirable traits for a front line treatment. The effects start very quickly, but continue at a gradual and safe pace. They're easy for patients to titrate themselves to an effective dosage. And unlike many medications the same dosage can work as preventative treatment, for maintenance, and for people with severe preexisting conditions.

They also have a great risk profile. They're not a common allergy, and the most common side effects are minor and transient. The worst side effects can be quite serious, but they're very rare, in contrast to the common and complex health problems caused by the conditions that GLP-1 medications treat.

Going beyond the individual, GLP-1 medications rely on well-known biological mechanisms that generalize beyond humans, making them easy to study. They've already become a drug class rather than a single molecule, and we can keep iterating on new ones. There are also promising attempts to co-administer them with other medication, like for reducing the muscle wasting side effects.

This doesn't even get into everything else that GLP-1 medications might be doing. The direct effects on obesity and on diabetes make sense, but hunger and digestion are among the most foundational of biological systems. There's promising ongoing research around reducing addiction, inflammation, organ damage, even dementia! Improving outcomes on any one of those would be enough to justify the existence of the medication.

You might have read concerns about how "expensive" GLP-1 medications are. In reality, they are dirt cheap to manufacture: perhaps under a dollar per month at scale. Most of the expense is related to manufacturing ramp-up, or to patents, especially around autoinjectors or techniques to make them work as pills. And in the long run, even the current prices are still much cheaper than the conditions they treat.

It seems like every week there's another article about insurance plans dropping coverage of GLP-1 medications due to cost. The framing is that there's "too many" people trying to use these medications. Often, there's an implication that lazy people are misusing health benefits on something cosmetic.

Not everyone taking these medications is in immediate crisis: and that's good. That's ideally how medicine should work! The reality is that many of us know we're heading in the wrong direction, and are trying to do better before we suffer irreversible health consequences. GLP-1s can fill a vaccine-like role in easily, cheaply, and effectively preventing some of the hardest to treat medical issues.

So I encourage you to think of it a different way: GLP-1s are one of the best public health inventions of this century, and their rollout should be wider. The number of people in America on GLP-1s is being held back by the incorrect structure and incentive of the medical and insurance industries.

But that isn't what most people post about, because most people aren't policy wonks. The fights about GLP-1s aren't really about medical research, nor the arcane details of who bears what costs. People post about it because they have opinions on who deserves to have an easy way to manage their weight. It always comes back to a moral and emotional and ethical fight.

And why shouldn't it be one? After all, how many of us have been told to lose weight by doctors, or seen loved ones struggle with the same? How many of us have worried about losing access to insulin? How many of us have faced discrimination for being fat or made ourselves sick with diets?

GLP-1s are here, they work, they change everything - and none of us get a say over how they're available or who uses them. Apply that to an existing cultural context of guilt and shame - how could they not spawn endless and impossible to resolve discourse cycles?

Process

As I'd mentioned, I didn't start my research with a goal of giving GLP-1s a try. But by the end, I was questioning why the fuck I'd had doubts about anyone else's decision. Both because it's their fucking decision, and also, it kind of seems like the future of medicine. I came away with the impression: if I can afford it and can tolerate the side effects, why wouldn't I want to try this for myself?

I've told people that my final decision came back to 75% aesthetics, 25% health. Perhaps that's not popular to say, that it was never a "life or death" decision like it is for some people. But why would we ever want to build a system where people are denied treatments until they can prove they're virtuously suffering? Every system we've tried this - trans healthcare and pain management, to name two - has been a disaster for all patients.

I did a decent amount of research into medication and cost options before pulling the trigger. I'm thrifty and a bit adventurous, but not so much so that I wanted to fuck with grey market peptides. In the end I kept it basic and decided to order compounded semaglutide through Hims.

The business model of all of these neo-pharmacies is essentially a publicly traded pill mill. There's no real doctor-patient relationship here: you want some specific medication and they're providing it. Their job is just to make sure you don't have any gross medical contraindications, mainly for liability reasons.

Of course, they do have education and fitness tracking and what have you - but you can just ignore all of that and I wager that's what most of their customers do. For better or for worse, the business model is to sell you weight loss shots and dick pills on demand, with as little friction as possible, and as little medical oversight as justifiable.

If you've read this far, I'm going to assume that you're thinking about doing this yourself, or at least want to be empathetic about what it's like. So, here are some prep steps I wish I'd known about:

In the past few years I've gotten into 3D printing, so I decided to print a vial case in my signature color scheme:

After several months, the service switched vial sizes on me so this didn't work anymore. I found a fun parametric case design, tinkered around to make it work for me, and then printed it on holo plates with rainbow filament:

I get my medication delivered to my address with cold packs every month, and do my shots weekly, usually on Friday or Saturday right after I shower. Maybe I get a bit sick to my stomach later that day, but for the most part, it's just another weekly routine.

Fun little aside: I've had a severe needle phobia my entire life. I got over it for this pretty fast! Subcutaneous insulin needles are just so unlike even a blood draw that it barely registers for me. (Sadly, I do need to still need to sit in the special chair for blood draws.)

The effects

The short version:

A year of semaglutide has reduced my body fat percentage so much that it's a struggle to find good subcutaneous injection sites. That, even though my diet and exercise got worse in the past year (for unrelated reasons).

The longer version:

The most visible impact of GLP-1 medications is to reduce "food noise". This was a lot stronger in the first six months or so, where I sometimes didn't feel hunger at all and would accidentally skip a meal. Nowadays I do get hungry, but eat moderately less in each sitting and have fewer snacks in between meals. It feels more like a gentle push than anything else.

But a common misconception is that GLP-1 medications just "decrease appetite". They actually have wide-ranging effects on how food is processed. I've always struggled with acid reflux due to connective tissue problems, and that's become worse on GLP-1s, especially with spicy or oily food. I do need to be more careful than before.

Eating out at restaurants is a lot more intentional, and I am more aware of how comically large American portions are. I often find myself thinking about how to share, so that I can still sample more foods without filling up.

I found myself becoming more interested in fruits and vegetables. My guess is that I was getting incidental nutrition from eating larger volumes of food, but now needed more specific targeting for certain nutrients.

Visually, I look quite different, mainly because my body fat percentage is half of what it was at the beginning. Before I was soft everywhere and had a noticeable belly; now I'm significantly less "solid", but also have a lot more definition.

None of my clothes fit properly anymore. This is especially annoying because I'd recently done an "oh I'll never fit in that again" purge! But in fact, I not only fit back into my stretch-fabric, pasted-on jeans - but they're even a little loose.

The financial impact is a bit annoying. I currently pay (amortized) $299/mo out of pocket via Hims for the dose of compounded semaglutide that I'm on, though I'm sure you could get this for less by shopping around. This is a noticeable expense, but worth it to me for something that is obviously more effective than anything else I've tried. I'm lucky to not have other significant health costs, so much of this is from HSA/FSA funds.

(I do save a bit on food - not enough to offset the cost of the medication, but it is noticeable.)

There are some ongoing nausea and diarrhea issues at times, mainly around when I dose for the week. But the only negative body change for me has been excess skin. This honestly is something I'm not thrilled with, but at the same time it's... not that big a deal? I'm hoping putting a bit more muscle back on will mitigate it.

I expect in the future I'll change my medication or my dose. It'd be great to find something a bit cheaper, or with less muscle wasting. Or ideally, to switch to a pill as I do still hate needles.

But overall, the effects are worth it to me. I can't really think of a scenario where I'd want to stop: as-is, it's absolutely worth the annoyance and cost.

Reactions

In the past year I lost almost 25% of my body weight, and as far as I can tell, nobody in my professional life has commented or treated me differently at all. I think there are two important factors to this: I'm a man, and while I was overweight on paper, nobody would've called me "fat".

Before starting, I read a lot about others' experiences with this class of medication. It's crushing that a common side effect - for women especially - is being treated better. I can't imagine the mindfuck of having suspicions of fatphobia validated in such an overt way. Of knowing that any future promotions, respect, or basic decency will be tainted. I have read many cases of people worrying about starting these medications because they worry they'll realize just how badly they've been mistreated. I completely respect anyone who has misgivings or concerns about how these medications will impact our culture, which is something that no medical journal or public health study can answer.

Most of the comments I have received have come from intimate partners. But that's been interesting too; long term partners have seen massive changes in my body composition, while new partners have only known me this way. Frankly, I do get fewer compliments about being "hot" - but the ones I receive are more aligned with how I want to be perceived.

I feel fortunate that to the extent that my partners have commented, they've either been curious or hoping to support my health. I attribute this to other queer and trans people being far more understanding about bodily autonomy than near anyone in mainstream cishet culture.

Interestingly, I get a lot more "surprised at how strong I am" comments even though I've actually lost total muscle mass! Before I looked like I lifted weights, but now I look like a skinny nerd. Yet proportionally my muscle percentage increased and I can now pick up and carry someone of my own body weight.

I'm not shy about discussing my own GLP-1 experiences, even in a group. But I wouldn't bring up such an emotional topic for no reason, either; and one thing I have learned is that other people are anxious about talking about these drugs. In fact, my guess is that you probably know people who are taking these medications without telling you. I've had several situations where when I did bring up my GLP-1 prescription, someone else leveled that they've been on them too, but weren't sure how to bring it up or were worried that I might judge them for it.

I was operating under my own misgivings and misinformation for a while, so it would be hypocritical to not be willing to talk someone else through that. But beyond that, I think that if you're a decent person, you need to be comfortable facing some animosity as people use you to process their own experiences with weight. Ideally nobody would do that to you, but you know, we live in a society! How could people not have negative opinions about overbearing doctors and diet culture and deaths from eating disorders? These things have fucked up their lives.

But this isn't a compromise situation, either. People take these medications for all kinds of reasons, and being confident in your own reasons is a matter of bodily autonomy and of self-determination. For me, I want to meet people where they're at and hear their concerns about how this impacts them - but I can do that without giving them a vote on my own decisions.

What's next?

Are GLP-1s lifechanging? For some people, absolutely. There are truly people for which this is a necessary medication, without which their lives will be at higher risk or worse quality. People who in a previous generation would've gotten dangerous bariatric surgery or lived with life-threatening complications from diabetes. People who were forced into impossible decisions because their doctor told them they're killing themselves, and because they've already tried everything else.

And then there are people for whom GLP-1s are an amazing general health intervention. A single pill or shot that might slash double digit percentages off their cancer risk, improve their mobility and ability to exercise, add several extra years of healthy life. Not a "necessity", mind you - something they could happily live without - but also something completely justified as a preventative measure if the cost is right.

For me, though? My trajectory for long-term health is probably modestly better, but I was already doing well for my age. The most immediate impact is being happier with how I look and how my body feels, and more comfortable in the clothes I want to wear. The medications have changed my life, but more in the sense that they're a "nice-to-have" perk to have in a world that is hostile to maintaining healthy habits.

So when can we escape our discourse cycle? Probably only once the decision to take GLP-1s becomes boring. When prices crater to the level of a Netflix subscription. When it's not seen as something that influencers do to get skinny, but when it's most often encountered as a first line treatment for anyone who struggles to stop eating ultraprocessed food or doesn't get quite enough exercise.

Perhaps that is not inspiring, but who ever said that was the goal? Accessibility is not about limiting access to the most urgent cases, but instead about ensuring access so that everyone can benefit according to their desires. We are well past the shortages of the early days or any ongoing need for rationing, and one day soon these will be trivially affordable medications for anyone who wants them. And yes, that includes people with more marginal, short-term, or even trivially aesthetic desires.

Let's hope that before that happens, we can develop better cultures of scientific thinking, bodily autonomy, and above all respect for all people at all sizes. Our society is sick from lacking these, and there's no miracle pill coming.