Men’s Health’s Ultimate Guide to Weight Loss Medicines

What are GLP-1s and what do they do?

This drug mimics a natural hormone that we release after we eat, explains Jyotsna Ghosh, MD, an obesity medicine physician at Johns Hopkins Medicine. These receptors are in the digestive system and brain, so targeting them can change our hormone balance, help increase satiety after a meal and slow the speed at which nutrients move through the digestive tract. “It’s going to change how our whole body works at the cellular level,” he says.

As you no doubt know from the advertising and chatter about them, there is more than one option for GLP-1s. Tirzepatide, as mentioned above, is a dual GLP-1 and GIP receptor agonist, which means it works on two different hormone receptors in the body. Because of this, terzapatide is more effective for weight loss: Studies show that semaglutide reduces weight by about 15 percent and terzapatide by about 20 percent, says Dr. Maher.

On the horizon is retatrutide. In addition to being a GLP-1 and GIP receptor agonist, “reta,” as it is known, activates a hormone called glucagon that is released by pancreatic endocrine cells. And — no big surprise — it’s been shown in early trials to be more effective than semaglutide or terzapatide, which sheds an average of 25 percent more weight, says Wajahat Mehr, director of Yale’s weight loss program. “Losing a quarter of your body weight is a lot of weight,” he says. “Retatrutide promises to be a very good drug.”

What can these drugs do for our health?

Beyond weight loss and all the associated benefits that come with it (like less joint pain), this drug can treat metabolic diseases including type 2 diabetes, sleep apnea, fatty liver disease and coronary artery disease.

Dr. Ghosh says that while her female patients are more likely to come in only for a diagnosis of overweight or obesity, her male patients often wait until they have another health condition at play. The good news is that with GLP-1s, it can treat obesity/overweight and These related metabolic diseases. “If we target lifestyle and use the right metabolic tools, whether it’s medicine or whatever tool we use, everything will get better,” says Dr. Ghosh. Often, this happens quickly.

What are the side effects of weight loss drugs?

As with any medication, GLP-1s come with their fair share of potential side effects. Dr. Ghosh says that men may be slightly more susceptible to certain side effects than women. “This is the only drug class studied where this is the case,” he says. “And this seems to be especially true in women who are pregnant [being] Less susceptibility to side effects (especially nausea) with the drug. He says that men have a little more nausea and constipation when starting this medication.

Otherwise, side effects are very similar between drug users. The most common one he sees is fatigue. At the lesser-known end of the spectrum is anhedonia, or loss of pleasure. “It’s really interesting because it can happen for things like exercise,” he says. These side effects can be a one-two punch of motivation in the gut: “I’ve also seen it where people are tired and they don’t get the endorphin rush that they get with exercise.” Dr. Ghosh says it’s important to track these symptoms over time and report them to your doctor, who may consider changing your dose or type of medication.

Muscle wasting is another common side effect but doctors are quick to point out that this is not unique to the drug; This happens with significant weight loss. This amount varies greatly, but 10 to 20 percent of the weight people lose can be muscle, says Dr. Maher, indicating that it can be reduced through exercise. “Weight training and eating enough protein—these can reverse the percentage of muscle mass loss over time,” says Dr. Ghosh.

When it comes to bowel side effects, not all medications may be the same. Both doctors report that the new drug comes with less severe and less widespread digestive side effects. Dr. Maher says that this is thanks to the fact that Terzapatide works on two receptors. “Thirsopeptide is primarily an agonist for the GIP receptor, and this approach induces less nausea,” he says.

What to know about GLPs and erectile dysfunction

“I am asked [ED] Because some of the older generations of weight management drugs, such as phentermine, have many urinary side effects, especially for men. help With organ function: “If anything, it should help improve blood flow, nerve distribution, and reduce inflammation, helping all systems function better.”

Dr. Mohib agrees that this medicine can Improve ED, especially since this condition is strongly associated with obesity and diabetes and other metabolic conditions that report ED in the early 50s. “As these conditions improve,” ED improves, he says.

There is also some preliminary data showing an increase in the availability of free testosterone thanks to this drug, as well as improved sperm quality, although the data is mixed. More research is needed, but Dr. Mehl says it indicates that eliminating diabetes will help improve health issues, possibly related to fertility. Still, some people report low libido and low sex drive (as opposed to activity), which is associated with anhedonia, says Dr. Ghosh.

What if I don’t like the look of injections?

Dr. Ghosh says Vigoi pills only hit the market earlier this year and some patients are eager for a non-injectable option. “I have some people who like to ease into the once-a-week injection and I have some people who are more regular and it’s easier for them to start with a pill every day.”

The downside of the pill is that it has to be taken at the same time every day on an empty stomach, and it’s a little less effective, says Dr. Mehr. “Oral drugs usually come in younger people, 11 to 13 percent weight loss, and their brain profile is worse than terzapatide,” he says.

At the end of the day, it’s largely a personal choice between the pill and the injection, both doctors say. “It gives people the freedom to choose what is most meaningful to them,” says Dr. Ghosh.

How much do GLP-1s cost?

Costs can vary widely depending on your insurance coverage and other factors, but the good news is that as the space grows, prices will likely come down, says Dr. Maher.

“Hopefully, as there are more options in the market, especially for people who don’t have insurance coverage, it will bring down the price because there’s more competition for our cash-pay patients or self-pay patients,” agrees Dr. Ghosh.

This may have the added benefit of making it easier for people to obtain more regulated drugs. “I hope that there are more affordable options for people, that they will be able to choose things that are regulated, that they know exactly what they are getting, that their doctor can give a prescription so that they don’t have to pay for another subscription model membership to a telehealth company outside of insurance or all these additional costs that accrue for people to try health.”

What happens when you stop taking GLP-1s?

“Clinical trials show it’s a lifelong treatment,” says Dr. Ghosh, although she has seen patients successfully transition to other classes of treatment. “It depends on a person’s specific biochemistry and their lifestyle, behavior and environmental plans,” he says.

Generally, though, if someone is doing well with a metabolic drug on board, it’s best as a “chronic treatment” even though he can adjust the dosage. “As body mass decreases, the concentration of the drug in the body increases, and so most people don’t need the same dose for maintenance that they need to achieve a certain weight,” he says. “So I have a lot of people who successfully lose weight over time.” More research is needed, but for now, it’s relatively trial and error to figure out what works best for a particular patient, rather than the opposite of diet. “We have nutrition guidelines, but not every nutrition plan works for everyone,” she says.

For his patients, Dr. Maher says, it comes down to lifestyle changes. If you stop taking GLP-1 and go back to the lifestyle (diet, exercise, sleep, etc.) you had before, your weight will go back to what it was before. But if you change the food you bring home and how you exercise and sleep, you can keep the weight off, he says. “It’s a little bit like antidepressants or any other drug in that if you stop it, the drug won’t continue to work, but if it helps you stay somewhere else like now that you’ve lost 40 pounds, now you enjoy running three times a week — that’s something you do now that you didn’t before, so you can lose weight.”

What’s on the horizon for this class of drugs?

Watch this space—doctors believe new options will come to market. Dr. Maher compares it to the place of high blood pressure medication. “Currently, there are 60 antihypertensive drugs that have been approved,” he says. “They are all very similar, and one may be slightly more effective or [come with] These side effects or those side effects, but the same thing is going on in the GLP-1 market, because it has been cleared of risk.” He says: “The first people who made this drug did not know that it would work, so it is clear that they took a big risk, but now the risk is very low. So I don’t know if there will be 60 in the end, but there will be a lot of drugs in that broad category.

Caitlin is a health and fitness journalist based in New York City. He writes for publications including The Wall Street Journal and The world of running. She has completed 12 marathons, including six international marathon majors, is semi-fluent in French, and volunteers as a greeter on the main line. Follow him on Instagram or LinkedIn.