This is the version of the explanation I wish somebody had given me, written down before I forget what confused me. It is about semaglutide, and it is deliberately narrow — everything I am not confident about is marked as such.
What is actually established
Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak. People who dose late are not losing a peak, they are letting the trough fall, and the appetite effect tracks the trough.
The condition it depends on
"tolerable" needs defining. A dose you tolerate by eating almost nothing is not tolerated, it is being paid for somewhere else — usually in lean mass, sometimes in adherence three months later.
The practical version
For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and subcutaneous bioavailability near 89%. Those four numbers explain most of the questions people ask about timing.
What I am not sure about
So the question, as narrowly as I can put it: what the dose-response curve actually looks like above 1.7mg, because the trial means hide how few people account for the extra loss. Numbers rather than impressions, if you have them.
— InsuranceTom · corrections welcome and will be edited into this post with credit