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

Answering the narrow version, because the broad one does not have a single answer. The honest range is roughly 20 to 40% of total loss as lean mass without deliberate resistance training, and roughly 10 to 20% with it plus adequate protein. Both numbers need a caveat that matters: "lean mass" on a DEXA is not muscle. It includes water, glycogen and the lean fraction of organs, and glycogen alone carries about three grams of water per gram. A large early lean drop is mostly the glycogen and water going, which is why the first scan flatters and the second is the honest one.

Dr.ObesityLA said:

The honest range is roughly 20 to 40% of total loss as lean mass without deliberate resistance training, and roughly 10 to 20% with it plus adequate…

Right, and protein targets should be set on a reference weight rather than current weight. Setting 1.6 g/kg on a starting weight of 130kg produces a target nobody hits on a suppressed appetite.

SaraMom3 said:

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

This matches mine closely enough to be worth saying so. There is also a quality change that the scan cannot see. Weight loss shifts fiber-type distribution toward Type I and improves mitochondrial density and insulin-stimulated glucose uptake per fiber — so the muscle you keep is metabolically better even though there is less of it. That does not make the loss irrelevant, but it explains why function often holds up better than the number suggests.

From the other side of the consultation, briefly.

Body composition tracking via bioimpedance on lean mass (InBody scan every 3 months):

Note: skeletal muscle mass dipped initially then recovered with consistent resistance training + high protein. The visceral fat reduction is where the metabolic magic happens.