Has anyone dealt with resistance training prevents 73% lean mass loss on semaglutide?

Dr.KarenChen said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

That holds for the injectable. The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people quote them as if they were.

FranDenver said:

Right, and protein targets should be set on a reference weight rather than current weight.

That reframing is the part I needed. Adding it to my notes with a link back to this thread.

Dr.KarenChen said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.

SaraMom3 said:

Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.

My endo's protocol for lean mass plateau: if weight loss stalls for 6+ weeks at current dose, we go through this checklist before titrating up:

1. Food diary review — is intake creeping up?
2. Protein check — minimum 100g/day
3. Activity audit — steps + resistance training
4. Sleep quality — poor sleep kills GLP-1 efficacy
5. Stress/cortisol management

Only after addressing all of these do we increase the dose. Often fixing one lifestyle factor restarts progress without needing more medication.

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source.