Semaglutide changed what is realistically achievable in weight management. It also created an enormous grey market, a lot of confusing pricing, and a compounded-drug situation that has completely reversed in the last eighteen months.
What follows is a physician’s answer to the questions patients actually ask us, including the ones about compounded semaglutide, where the honest answer is not the one most websites are giving.
— Dr. Rick Spurlock, PhySlim
Semaglutide is a GLP-1 receptor agonist. It mimics a hormone your gut releases after eating, which slows gastric emptying and signals satiety to the brain. The practical effect most patients describe is that food stops occupying their attention.
It is sold under three brand names:
Semaglutide is the active molecule; Ozempic is one brand containing it. Asking whether semaglutide is Ozempic is a bit like asking whether ibuprofen is Advil — yes, and also there are others.
On average, trial data favors tirzepatide for total weight reduction. But tolerability, cost and insurance coverage all differ between individuals, and the better drug is the one you can take consistently and afford. We have had patients do better on semaglutide after struggling with tirzepatide, and the reverse. That is a conversation at a visit, not a spreadsheet.
This is the most-searched thing about semaglutide right now, and the answer has changed. Most of what is still online is out of date, and some of it is out of date on purpose.
Compounded semaglutide became widely available because the drug was in official shortage, which created a legal pathway for compounding pharmacies to produce copies of it. That shortage was declared resolved in February 2025.
Where that leaves things:
That second point is the one the industry glosses over. A cheap copy of Wegovy in a vial is the market that closed. A distinct formulation prescribed for a documented clinical reason is a different thing entirely.
If someone is still selling you a cheap copy of Wegovy in a vial, that is the market that closed. Ask hard questions.
It depends entirely on what you are being given and by whom. The practical concerns with the online grey market are real: concentration varies between pharmacies, and some products marketed as semaglutide have been salt forms — semaglutide sodium or acetate — which are not the substance studied in the trials and not what a prescriber intends. You often cannot tell from the label.
If you are currently on a compounded product from an online vendor, come and talk to us rather than stopping abruptly or continuing unsupervised. We would rather review what you are actually taking.
We prescribe a combination formulation — semaglutide with L-carnitine — compounded patient-specifically by a 503A pharmacy. That is not a copy of the approved drug. It is a distinct formulation, prescribed where there is a documented clinical reason the approved product does not address a particular patient’s situation.
The distinction matters legally and clinically, and we do not blur it.
This is a clinical determination made at a visit, not something you select from a menu. The situations where we have found the combination worth considering:
Semaglutide acts on appetite regulation and glucose handling through GLP-1 receptor agonism. That is well established, and it carries the bulk of the effect.
L-carnitine’s role is in fatty acid transport into the mitochondria, the step that makes stored fat available to be burned as fuel. I want to be straight with you about the strength of that evidence: randomized trial data on oral L-carnitine supplementation shows a modest effect on body weight in adults with overweight and obesity, on the order of about a kilogram across 37 trials. Effects on waist circumference and body fat percentage were not statistically significant.
We use the injectable form, where absorption is not limited the way it is with oral dosing. But I would rather you understood it as one component of a combination approach aimed at the metabolic picture, not as a weight-loss agent in its own right. The semaglutide is doing the heavy lifting.
If a clinic tells you the carnitine is what makes their formula special, be skeptical.
For many patients, FDA-approved semaglutide is the right choice, and manufacturer direct-pay programs have narrowed the price gap considerably. Novo Nordisk sells Wegovy directly to patients through NovoCare Pharmacy, and Lilly does the same for Zepbound through LillyDirect. Both are substantially below the old list prices, and most people have never heard of either. If you are on Medicare Part D, there is a separate route again — the Medicare GLP-1 Bridge — which matters because the manufacturers’ savings cards specifically exclude anyone on Medicare, Medicaid or TRICARE. That exclusion catches a lot of people out.
What we do is work out which of those you actually qualify for, and then handle the part that stops most people: checking your plan’s formulary, confirming whether weight management is covered at all, and writing and submitting the prior authorization with the clinical documentation it needs. We prescribe the approved product where that is the right answer. We will tell you which route we think fits you, including when that is the approved product rather than ours.
We are answering this because people search for it constantly, and the answer they usually find is wrong in a way that can hurt them.
FDA-approved semaglutide is dosed in milligrams through a pen that delivers a fixed dose. There is nothing to convert. The units question comes entirely from compounded vials drawn with insulin syringes.
The conversion depends on that specific vial’s concentration, which varies between compounding pharmacies. A number you found online, applied to a vial from a different source, can be several times your intended dose. Overdoses from exactly this mistake have put people in hospital.
If you are holding a compounded vial and you are not certain of its concentration and your prescribed dose in units, stop and call the prescriber who wrote it. Do not calculate it yourself from a website. That includes this one.
There is, and it is worth understanding what it is and is not.
Rybelsus is the FDA-approved oral semaglutide tablet. It is swallowed, and it is approved for type 2 diabetes rather than for weight management.
Separately, we prescribe a compounded oral disintegrating tablet — an ODT, which dissolves under the tongue rather than being swallowed. For some patients it is a reasonable alternative to a weekly injection.
The thing to understand is that you cannot compare these by milligrams. How much of a dose reaches your bloodstream depends on the route it takes to get there, and swallowed, dissolved and injected semaglutide are three different routes. A number that means one thing on an injection label means something else entirely on a tablet. Comparing them milligram to milligram — whether against your old dose, against a friend’s, or against something you read online — will mislead you.
Which form suits you is a conversation at a visit. If you switch between them, we will tell you what your new dose is; do not convert it yourself.
At your first visit we take a full history, review your medications, and order baseline labs: a complete blood count (CBC), a comprehensive metabolic panel (CMP), and a thyroid-stimulating hormone (TSH) level. Those cover your blood counts, kidney and liver function, electrolytes, blood sugar and thyroid status — the things that either change what we prescribe or need watching once you are on it. We are looking at thyroid history, pancreatitis history, gallbladder disease, kidney function, and whether there is a personal or family history of medullary thyroid carcinoma or MEN2 — which are contraindications, not cautions.
Semaglutide starts at 0.25 mg weekly for four weeks, then steps up gradually. The slow start is not caution for its own sake; escalating faster reliably produces nausea severe enough that people abandon treatment.
Monthly at first. While the dose is still moving is exactly when tolerance, side effects and titration decisions need an actual conversation, so we want eyes on you during that stretch.
Once you are on a stable dose and tolerating it well, visits spread out. Settled patients can go several months between appointments. There is no value in bringing you in to tell you nothing has changed, and we do not pretend otherwise.
Semaglutide reduces appetite. It does not build the habits that keep weight off afterward, and it does not protect the muscle you lose when weight comes off quickly. So the medication is one part of what we do, not the whole of it.
We measure your resting metabolic rate — what your body actually burns at rest, which is not what an online calculator estimates — and build a nutrition plan around that number, weighted toward protein so you hold onto muscle while the fat comes off.
Every follow-up visit includes body composition analysis. Not weight. Not BMI. Muscle mass, fat mass and water, measured and tracked across your whole course of treatment.
If you do not know where you are, it is hard to see where you are going.
Two things make up your cost: the visit, and the medication.
Visits are a flat fee. Your first appointment is a full in-person evaluation with a medical provider, including history, medication review and the baseline labs we order. Follow-up visits are shorter, cost less, and include body composition analysis.
Medication is priced by your weekly dose and dispensed monthly. Lower starting doses cost less than higher maintenance doses, so what you pay in month one is not what you pay at a full dose.
What we charge for our compounded formulation is not the price of Wegovy. They are different products on different pricing. If the FDA-approved product is the better route for you — and for some patients it is — we will say so, and manufacturer self-pay pricing is published on Novo Nordisk’s own site.
Call us or ask at your visit and we will give you the exact figure for your dose. No quote-on-request games; we just have not put the table on this page yet.
Yes — and this is worth getting right, because semaglutide is a peptide and heat degrades it.
Before you start it: unopened pens are stored in the refrigerator at 36–46°F (2–8°C). Keep it in the original carton, away from light, and away from the freezer compartment and the cooling element at the back of the fridge.
Never freeze it. If a pen or vial has frozen, or you think it might have, do not use it, even after thawing. Freezing damages the peptide and you cannot tell by looking. Call us for a replacement instead.
Once you are using it: the in-use window differs between products. Some pens can be kept at room temperature for a defined period after first use; others cannot. Our compounded formulation has its own storage requirements and beyond-use date set by the pharmacy. Follow the instructions supplied with your specific product. We will go through yours with you, and it will be on the label.
Traveling: keep it refrigerated where you can, use an insulated cooler with a cold pack for longer journeys, and do not let the vial or pen sit against the cold pack directly. That is how people accidentally freeze it. If you are flying, carry it in hand luggage; the hold gets cold enough to freeze.
If you are ever unsure whether a pen or vial is still good, call us before you use it. We would much rather replace it than have you inject something degraded.
It has a long half-life, roughly a week, which is why it is dosed weekly. Full clearance after stopping takes several weeks. This matters if you are planning pregnancy or surgery; talk to us about timing.
Many patients notice reduced appetite within the first week or two, even at the starting dose. The effect strengthens as the dose increases.
Appetite changes come first; meaningful weight change builds over the first three months and continues with titration. If nothing has changed after two months, that is a reason to reassess rather than wait it out.
The common ones are gastrointestinal — nausea, vomiting, diarrhea, constipation — and they are most pronounced in the days after a dose increase. For most patients they ease within the first week or two after each increase, as the body adapts. Smaller portions, eating slowly, and avoiding high-fat meals help more than people expect.
Fatigue is commonly reported early on. A large part of it is likely the consequence of eating considerably less rather than a direct drug effect. It is worth raising with us rather than tolerating, because it can also point to insufficient protein or dehydration. Both are fixable.
Some patients experience shedding. Current understanding attributes this to telogen effluvium — the shedding that follows rapid weight loss or physiological stress generally, rather than a direct follicular effect of the drug. It is usually temporary. Adequate protein and a more gradual rate of loss both help.
If shedding persists once your weight has stabilized, or if there is underlying pattern hair loss that the weight change has simply unmasked, that is a different problem and it is worth evaluating separately. We do prescribe compounded topical hair-growth formulations. Which one, if any, depends on the pattern of loss and your own history, and several of them contain finasteride or dutasteride, which can cause birth defects and must not be used or handled by anyone who is pregnant or may become pregnant. That is a conversation to have at a visit, not a product to pick off a list.
Semaglutide carries a boxed warning regarding thyroid C-cell tumors observed in rodent studies. It is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or MEN2. Pancreatitis, gallbladder disease and severe gastrointestinal reactions have been reported. This is a real medication with real risks, which is the argument for physician supervision rather than a website that mails you a vial.
Subcutaneous injection into the abdomen (avoiding the area immediately around the navel), the front of the thigh, or the back of the upper arm. Same day each week. Rotate the site each week rather than using the same spot repeatedly.
We walk every patient through their first injection in person.
And if you would rather not inject yourself at all, you do not have to. We can keep your vial here, labeled and stored for you, and you come in to have it given. Which days and hours that is available differs by location, so ask us what works at the site you use.
Your first visit is in person and takes about 45 minutes. We go through your full history, review everything you are currently taking, and order baseline labs.
Depending on what that history shows, treatment may start the same day or we may wait for lab results first. That is a clinical judgment rather than a fixed rule, and we will tell you which one applies to you and why. The labs matter either way — they shape how we manage you from there.
You do not need a referral. Bring a list of your current medications and supplements, and your insurance card if you have coverage — even if you expect it not to cover weight management, it is worth checking rather than assuming.
We will also go through the four ways people actually pay for this: insurance, the manufacturers’ self-pay programs, the Medicare route, and our own compounded formulation. Which one fits you depends on your plan, your dose and your diagnosis, and it is a five-minute conversation rather than a guess.
Most of our new patients can be seen within the week. Book now, or call or text with questions.
Semaglutide is the active molecule; Ozempic is one brand containing it. Wegovy and Rybelsus also contain semaglutide, with different approved indications and formulations.
Not as a cheap copy of the approved drug — that pathway closed when the shortage resolved in February 2025. We prescribe a semaglutide with L-carnitine combination formulation, compounded patient-specifically where there is a documented clinical reason the approved product does not fit.
It depends on what you are given and by whom. Concentration varies between pharmacies, and some online products marketed as semaglutide have been salt forms such as semaglutide sodium or acetate, which are not the substance studied in trials.
There is no universal conversion. FDA-approved semaglutide is dosed in milligrams via a fixed-dose pen. The units question applies only to compounded vials and depends on that vial’s specific concentration. Call your prescriber before drawing anything up.
Yes. Unopened pens are stored at 36 to 46 degrees Fahrenheit in the original carton, away from light. Never freeze it; a pen or vial that has frozen should not be used even after thawing. In-use storage differs by product, so follow the instructions supplied with yours.
Subcutaneously into the abdomen, avoiding the area right around the navel, or the front of the thigh, or the back of the upper arm. Same day each week, rotating the site.
Many patients notice reduced appetite within one to two weeks. Meaningful weight change builds over the first three months and continues as the dose is titrated up.
Gastrointestinal side effects are most pronounced in the days after a dose increase and typically ease as the body adapts. Smaller portions, eating slowly and avoiding high-fat meals help.
Fatigue is commonly reported early on, largely as a consequence of eating considerably less. It can also indicate insufficient protein or dehydration, so it is worth raising with your clinician rather than tolerating.
Semaglutide has a half-life of roughly a week, which is why it is dosed weekly. Full clearance after stopping takes several weeks, which is relevant if you are planning pregnancy or surgery.
We take a full history, review your medications and order baseline labs at your first visit, screening for contraindications including personal or family history of medullary thyroid carcinoma and MEN2. Whether treatment starts that same day or waits for those results is a clinical judgment we make case by case, and we tell you which applies to you and why.
Medically reviewed by Richard G. Spurlock, MD
Board-certified in emergency medicine by the American Board of Emergency Medicine. Undergraduate at the University of Florida, medical degree from the University of Miami Miller School of Medicine, and emergency medicine residency at Emory University. Practicing emergency medicine since 2007. He founded PhySlim in 2013 and still works clinical shifts alongside running it.
Last reviewed: August 18, 2026
More about Dr. Spurlock
