Which GLP-1 Is Right for You?

If you're exploring GLP-1 therapy for weight, type 2 diabetes, PCOS, or cardiometabolic risk, the menu is more confusing than it needs to be. Brand names dominate the conversation. Mechanism, dosing, and individual fit don't.

This is a clinician's overview of what's actually different between the options — and how I choose.

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The molecules, briefly

There are four GLP-1 or GLP-1-adjacent options most patients will encounter:

• Semaglutide — single GLP-1 receptor agonist. Weekly injection. Branded as Ozempic (diabetes), Wegovy (weight), and Rybelsus (oral, lower-potency).
• Tirzepatide — dual GIP/GLP-1 receptor agonist. Weekly injection. Branded as Mounjaro (diabetes) and Zepbound (weight).
• Liraglutide — single GLP-1 agonist. Daily injection. Branded as Victoza and Saxenda. Older. Largely superseded.
• Compounded semaglutide or tirzepatide — same active molecule, prepared by a compounding pharmacy. Legal under specific conditions (e.g., during FDA-listed shortages or when patient-specific clinical need is documented).

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Mechanism in plain language

Semaglutide enhances one signal: GLP-1, which slows gastric emptying, increases satiety, and tightens glucose-dependent insulin release.

Tirzepatide does that AND activates GIP — a second incretin hormone that appears to improve insulin sensitivity and fat metabolism through a slightly different pathway. The net effect in the head-to-head SURPASS and SURMOUNT trials is meaningfully more weight loss on average (roughly 5–8 percentage points more total body-weight reduction at one year).

That doesn't make tirzepatide automatically better for you. It does make it the right starting point for many patients with significant weight or metabolic goals.

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How I actually choose

A real prescribing conversation considers:

1. What are you treating? Diabetes management, weight loss, PCOS, cardiometabolic risk reduction, or some combination — the indication shifts the calculus.

2. How is your stomach? GI side effects (nausea, reflux, constipation, delayed gastric emptying) are the most common reason people stop. A history of gastroparesis, severe GERD, or significant IBS pushes me toward lower starting doses or slower escalation regardless of brand.

3. What can you actually get? Insurance coverage, cash price, pharmacy availability, and supply status of brand product vs compounded option all matter. The best molecule you can't access consistently is worse than a workable one you can.

4. What's your dosing tolerance? Weekly injection vs daily, pen vs vial, the willingness to escalate slowly — these aren't trivial.

5. Family/personal history. Personal or family history of medullary thyroid carcinoma or MEN 2 is a contraindication. History of pancreatitis warrants caution. Pregnancy or active attempts to conceive: stop.

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On compounded versions

Compounded semaglutide and tirzepatide are not "fake." When prepared by a properly licensed compounding pharmacy from verified active pharmaceutical ingredient (API), they can be a legitimate option — particularly during shortages of the branded product.

The questions to ask any clinic offering them:

• Is the compounding pharmacy a licensed 503A or 503B facility, named on the prescription?
• Is the API sourced from an FDA-registered manufacturer with a certificate of analysis?
• Is there a clear adverse-event reporting pathway?

If a clinic can't answer those questions cleanly, that's the answer.

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What this looks like in my practice

I don't have a single house preference. I start most weight-focused patients on either semaglutide or tirzepatide depending on goals, tolerance, and access; I escalate slowly; I monitor labs, blood pressure, and symptoms; and I revisit the choice every 8–12 weeks.

If a medication isn't doing what I hoped, I change it. If it's doing too much (significant GI distress, rapid lean mass loss, lightheadedness), I change it. The medication is a tool, not an identity.

If you'd like a candid conversation about which option fits your situation, that's what a consultation is for.