From the other side of the consultation, briefly. The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either. Those three things can all be true at once, and most arguments here are two people holding different parts of that.
CarlaRPh_TPA said:The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either.
Agreed on the arithmetic, with one condition: holding indefinitely at a dose that is not doing anything is not patience, it is a stall with a nice name. The distinction is whether appetite has changed at all at the current step.
Correct me if the detail matters more than I have assumed.
CarlaRPh_TPA said:The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either.
There is a second half to this that has not been said yet. Four weeks is the pharmacokinetics, not caution. With a one-week half-life you need four to five half-lives to reach steady state, so at two weeks you are dosing on top of a concentration that has not finished rising. Escalating then stacks exposure and you get the side-effect burden of the higher dose before you have seen the benefit of the current one.
Worth separating that from the titration schedule, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.
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Shop Reference StandardsOne concrete data point for the thread. Worth knowing that the injection site changes very little. Abdomen, thigh and upper arm are bioequivalent for semaglutide, so a site change is not a plausible explanation for a bad week.
Following on from CarlaRPh_TPA — and this may be the naive question:
How much of the between-person variation is pharmacokinetic and how much is just adherence measured badly?