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There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

arstechnica.com

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Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#21

Post by Aurornis »

gtirloni wrote: post #12
tyleo wrote: post #4

Interesting. Saying, "there may not be a safe off-ramp," doesn’t feel quite right. The article describes people losing weight while on the drugs and then regaining weight after stopping them. That's not ideal, but it does imply an off-ramp, just with regressions. Compare that to something with no real off-ramp: testosterone replacement therapy. Once you're on TRT, you can permanently suppress your body's own testoste…

If you're on TRT, you are already not producing enough on your own.

Unfortunately that’s not true any more. TRT over prescribing is a major problem right now.

Studies of TRT patients have even shown that 1/4 of TRT patients may not have had their testosterone levels measured before being prescribed TRT: (Source https://pmc.ncbi.nlm.nih.gov/articles/PMC6406807/ ) Completely unacceptable given how cheap testosterone testing is, but its happening.

TRT clinics have also become a big business. Their business model relies on prescribing TRT to anyone and then charging them monthly or quarterly to continue receiving those prescriptions, which as the parent comment noted become physically necessary after TRT causes the testes to atrophy.

The trick the clinics are using now is “diagnosing by symptoms”. They have a long list of “symptoms of low T” and the patient is basically prompted to check off enough boxes to justify TRT. It’s the same model as the medical marijuana card businesses where you can go in and the doctor will “find” a reason to give you the prescription.

It’s a real problem when combined with social media influencers who tell people that everything is a symptom of low testosterone and TRT will fix it.

Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#22

Post by perelin »

As a GLP-1 user im really surprised that this is newsworthy. The mechanism of how these drugs lead to weight loss is appetite reduction. On GLP-1s -> less appetite, off GLPS-1s -> more appetite. Given the general health benefits that are being observed with GLP1-s the only reason to get off them is costs imo. They are absurdly expensive. Hope this will change in the next 10 years with patents running out and generics being available for cheap. The actual cost of production seem to be quite low. Gray/black market has them available for around a tenth of the otc price.

Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#23

Post by theptip »

gtirloni wrote: post #12
tyleo wrote: post #4

Interesting. Saying, "there may not be a safe off-ramp," doesn’t feel quite right. The article describes people losing weight while on the drugs and then regaining weight after stopping them. That's not ideal, but it does imply an off-ramp, just with regressions. Compare that to something with no real off-ramp: testosterone replacement therapy. Once you're on TRT, you can permanently suppress your body's own testoste…

If you're on TRT, you are already not producing enough on your own.

But TRT suppresses endogenous production further, so if you go off it you’re worse than when you started.

Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#24

Post by lkey »

The body yearns for its prior homeostasis. This is true when you lose weight with a strict diet. It's true when you lose it using a medication.

The struggle doesn't stop when you stop losing. My personal experience was that it takes about 2 years for the new 'normal' to kick in. (I lost 60lbs when I was in my early 20s and kept it off until today. The 'after' period was as taxing as the 'losing' period, but in a different way)

At that point only can you 'relax' a bit around your body's cravings for calories.

This has already been studied extensively:

https://pmc.ncbi.nlm.nih.gov/articles/PMC5764193/

It's not the worst thing in the world to be on a medication for a couple years rather than a few months, but long-term study of this class of drugs is certainly warranted and necessary.

Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#25

Post by Argonaut998 »

It’s no different from people who undergo gastric bypass surgery. Those with food addictions/habits manifest them elsewhere such as gambling, or if they are seriously addicted, they continue to eat which bursts their band.

My wife is back devouring cookies after being on mounjaro for 4 months. Thankfully she lost most weight all by herself so wasn’t totally reliant on the medication. But it’s crazy how noticeable the difference of one’s eating habits when on and off it.

Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#26

Post by falcor84 »

NitpickLawyer wrote: post #20
bryanlarsen wrote: post #7

The headline doesn't seem to match the article? 20% of participants did keep the weight off and 40% kept half the weight off after stopping. So there appears to be an off-ramp, we just don't know what it is.

> we just don't know what it is. calories_in < calories_out seems to be a pretty good formula.

It's almost the same as saying that the off-ramp for a cat to get off a tree is to apply a=g until h=0. It's technically correct, but I don't think it would help the cat to be aware of this.

Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#27

Post by Argonaut998 »

constantcrying wrote: post #10

Or an alternative title: "36 months of tirzepatide permanently treated obesity in 17.5% of patients." I think that it is quite unsurprising that without the drug a large amount of people revert to their previous behavior and with that will revert to their previous weight.

Indefinitely, not permanently

Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#28

Post by mise_en_place »

tyleo wrote: post #4

Interesting. Saying, "there may not be a safe off-ramp," doesn’t feel quite right. The article describes people losing weight while on the drugs and then regaining weight after stopping them. That's not ideal, but it does imply an off-ramp, just with regressions. Compare that to something with no real off-ramp: testosterone replacement therapy. Once you're on TRT, you can permanently suppress your body's own testoste…

By what mechanism? That's not how it works. LH and FSH are suppressed when you're on TRT, but they stabilize after cessation. The question is, why would someone with clinical hypogonadism cease TRT?

Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#29

Post by Aurornis »

tortilla wrote: post #13
gtirloni wrote: post #12

Earlier quoted context omitted.

If you're on TRT, you are already not producing enough on your own.

Unless you went on when you weren't really low because the men's vitality clinic pushed you into a treatment protocol* * not me but I see it with men in my age range

I’m getting downvoted in another comment for saying this, but it’s a growing problem. In some surveys of TRT patients up to 1/4 of them didn’t even have their testosterone levels measured before being prescribed TRT. The men’s health clinics are finding excuses to diagnose everyone who calls. The lifetime value of a monthly TRT customer is very high.

Re: There may not be a safe off-ramp for some taking GLP-1 drugs, study suggests

#30

Post by sReinwald »

tyleo wrote: post #4

Interesting. Saying, "there may not be a safe off-ramp," doesn’t feel quite right. The article describes people losing weight while on the drugs and then regaining weight after stopping them. That's not ideal, but it does imply an off-ramp, just with regressions. Compare that to something with no real off-ramp: testosterone replacement therapy. Once you're on TRT, you can permanently suppress your body's own testoste…

Strange framing, isn't it?

Bariatric surgery shows 25-65% significant regain rates depending on definition and timeframe. And regular dieting is even worse. Nobody would frame that as a safety issue. That's... just how weight loss works, not a unique GLP-1 problem.

Calling a return of symptoms (obesity) a "safety issue" is like saying insulin has "no safe off-ramp" because diabetics get hyperglycemic when they stop taking it.

Fear gets clicks, I guess.

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