What Is Semaglutide?
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist — a class of medication that mimics a natural gut hormone released after eating. It works by suppressing appetite, slowing gastric emptying, and improving insulin sensitivity. Originally developed for type 2 diabetes (as Ozempic), it was subsequently approved at a higher dose for chronic weight management (as Wegovy) after clinical trials demonstrated average weight loss of 12–17% of body weight.
Who Is It For?
Semaglutide is appropriate for adults who meet at least one of the following criteria:
- BMI ≥ 30 (obesity) with no weight-related comorbidities
- BMI ≥ 27 (overweight) with at least one weight-related condition (hypertension, type 2 diabetes, dyslipidemia, sleep apnea)
- Prior failed attempts at weight loss through diet and exercise alone
A physician consultation will confirm candidacy. Semaglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN2), and in those with a history of pancreatitis.
Clinical Evidence
The STEP (Semaglutide Treatment Effect in People with obesity) trial program, published in the New England Journal of Medicine (2021), established semaglutide 2.4mg once weekly as the most effective pharmacotherapy for obesity at the time of its approval.
- STEP 1: 14.9% average weight loss at 68 weeks vs. 2.4% placebo
- STEP 3: 16% average weight loss when combined with intensive behavioral counseling
- STEP 4: Patients who continued semaglutide maintained weight loss; those switched to placebo regained weight
Source: Wilding JPH et al., N Engl J Med 2021;384:989-1002. Claims based on clinical trial data for FDA-approved semaglutide dosing. Individual results vary.
Administration & Protocol
Compounded semaglutide is typically administered as a once-weekly subcutaneous injection using a small insulin-type needle. Injection sites include the abdomen, thigh, or upper arm. The dose is escalated gradually — starting low to minimize GI side effects — over a 4–16 week titration period.
Typical Dose Escalation
Weeks 1–4: 0.25mg/week
Weeks 5–8: 0.5mg/week
Weeks 9–12: 1.0mg/week
Weeks 13+: Up to 2.4mg/week (per physician protocol)
Your physician will personalize the titration based on tolerability and response.
What to Expect
Most patients notice appetite suppression within the first 1–2 weeks. Meaningful weight loss (3–5% of body weight) typically occurs within the first 4–8 weeks at lower doses. Side effects — primarily nausea — are most prominent during dose increases and usually resolve within a few weeks. Eating smaller portions and avoiding high-fat meals during the early titration phase significantly reduces GI side effects.
Cost in Tennessee
| Option | Monthly Cost |
|---|---|
| Compounded semaglutide (via TN telehealth) | $200–500/month |
| Wegovy (brand, without insurance) | $1,300–1,600/month |
| Ozempic (brand, without insurance) | $800–1,200/month |
Prices are estimates. Consultation fees vary. See our full cost guide.