My doctor wants to fast-track me to the highest dose. The internet says go slow. Who’s right?
So I just had my first appointment with a new endocrinologist and I’m honestly confused. I showed him my bloodwork and we talked about my weight loss goals (need to drop about 60lbs, have pre-diabetes). He wants to start me on semaglutide but his plan is to go from 0.25mg straight to 1.0mg after just ONE month, then to 2.4mg the month after that.
I’ve been lurking here for weeks and everyone talks about going slow, staying at lower doses longer, listening to your body, etc. When I mentioned this he kind of brushed it off and said the clinical trials moved people up faster and that’s the “proven protocol.”
I trust doctors obviously but I’m also the one who has to deal with the side effects right? I’ve read so many stories here about people who went up too fast and had awful nausea or worse. But then again he’s the one with the medical degree and I’m just some guy reading reddit and forums.
Has anyone else had a doctor push for faster titration? Did you follow their plan or push back? I don’t want to be difficult but I also don’t want to be miserable for weeks because we rushed it.
Your doctor is technically following the standard protocol from the prescribing info, but that doesn’t mean it’s right for everyone. I’m 42M, started at 240lbs, and my doc wanted the same fast track. I pushed back and asked to stay at 0.5mg for an extra month because I was still seeing results and the side effects were manageable. She was fine with it once I explained my reasoning. Remember the clinical trials had people drop out because of side effects too – they don’t tell you that part as much. You’re allowed to advocate for yourself, especially when it comes to tolerability.
I think the disconnect is that doctors are looking at efficacy and we’re looking at quality of life lol. Like yeah maybe I’d lose weight faster on a higher dose but if I’m hugging the toilet every morning what’s the point? I stayed at .25 for 6 weeks instead of 4 and had zero regrets. Still lost 12 lbs in that time. The medication works even at lower doses for a lot of people.
Just want to add that what MetabolicMike said about advocating for yourself is so important. I’ve learned that some doctors are just following the template without really individualizing care. My PCP was super receptive when I said I wanted to go slower – she literally said “that’s fine, you know your body better than I do.” If your doctor gets defensive or dismissive when you bring up legitimate concerns about side effects, that might tell you something about whether they’re the right fit tbh. But def have the conversation before just ignoring his recommendation.