By HollyHerman.com Wellness Team | Updated May 2026
This article is for informational purposes only and is not medical advice. GLP-1 medications are prescription drugs that require evaluation by a licensed healthcare provider. Talk to your provider before starting any prescription weight loss medication.
Three years ago, “GLP-1” was a phrase only endocrinologists and diabetic patients used. Today, it's everywhere. Your sister mentions it. Your hairdresser is on it. The mom in the school pickup line dropped 40 pounds and won't tell you what she's doing because everyone keeps asking. The marketing has gotten a lot louder than the actual education, and the result is millions of women starting these medications without a clear understanding of what they actually do, what compounded means, and what makes semaglutide different from tirzepatide.
This is the article I wish existed when our readers first started asking. Plain English. No drug-rep marketing, no celebrity endorsements, no “miracle” framing. Just what these medications actually are, how they work, and what to know before you fill out a 3-minute quiz on a telehealth site.
What GLP-1 Actually Is (Before It's a Medication)
GLP-1 stands for glucagon-like peptide-1. It's a hormone your body already makes. When you eat a meal, cells in your small intestine release GLP-1 in response to nutrients arriving. The hormone does several things at once: it tells your pancreas to release insulin appropriate to the meal, it slows the rate at which your stomach empties so you feel full longer, and it sends signals to your brain that reduce appetite and food-seeking behavior.
For most of human history this system worked exactly as designed. People ate, the gut released GLP-1, satiety arrived, the meal ended, and people went on with their day. The problem in the modern food environment is that hyper-palatable, calorie-dense, low-fiber foods don't trigger the GLP-1 response the way whole foods do. You can eat a bag of chips without feeling full. Your stomach empties quickly, blood sugar spikes and crashes, and the hunger signal returns long before your body actually needs more energy.
GLP-1 receptor agonist medications work by mimicking the body's natural GLP-1 hormone — but in a longer-acting, more sustained way than the body produces on its own. Instead of releasing GLP-1 in pulses tied to meals, these medications keep GLP-1 receptor activation steady throughout the week. The result, for many patients, is a meaningful and persistent reduction in appetite that doesn't require willpower because the underlying biological hunger signal is dampened.
Semaglutide vs Tirzepatide: What's Actually Different
The two GLP-1 medications you'll see most often on telehealth platforms are semaglutide and tirzepatide. They are not the same medication. They work on different receptor pathways and they have meaningfully different efficacy profiles in published clinical trials.
Semaglutide is a single-pathway GLP-1 receptor agonist. It targets only the GLP-1 receptor. Brand-name versions include Ozempic (FDA-approved for type 2 diabetes), Wegovy (FDA-approved for chronic weight management), and Rybelsus (an oral form approved for type 2 diabetes). In the STEP 1 clinical trial, adults with obesity who took semaglutide 2.4 mg weekly lost an average of approximately 15 percent of their body weight over 68 weeks compared to placebo.
Tirzepatide is a dual-pathway agonist. It activates both the GLP-1 receptor and the GIP receptor (glucose-dependent insulinotropic polypeptide). Brand-name versions include Mounjaro (FDA-approved for type 2 diabetes) and Zepbound (FDA-approved for chronic weight management). In the SURMOUNT-1 trial, adults with obesity who took tirzepatide at the maximum dose lost an average of approximately 20 percent of their body weight over 72 weeks. The dual-pathway action appears to produce somewhat greater weight loss on average than single-pathway semaglutide, though individual response varies significantly.
Telehealth platforms typically offer compounded versions of both medications. Compounded tirzepatide tends to cost more than compounded semaglutide because the active ingredient itself is more expensive. On Novi specifically, compounded semaglutide starts at $174 per month and compounded tirzepatide starts at $283 per month — a price difference that reflects the cost difference in the active pharmaceutical ingredients.
What “Compounded” Actually Means
This is the part that gets glossed over in marketing copy and that you should actually understand before starting a compounded GLP-1 program. Compounded medications are prepared by licensed compounding pharmacies that combine active pharmaceutical ingredients into a finished medication, often customizing the dose or formulation. Compounding has been a part of pharmacy for over a century. It exists for legitimate clinical reasons — patients who need a specific dose not available commercially, patients who cannot tolerate an inactive ingredient in the brand-name version, and historically, patients who needed access to a medication that was on FDA-recognized shortage.
The compounded GLP-1 boom of the past few years was driven primarily by the FDA shortage list. When semaglutide and tirzepatide were declared to be in shortage in 2022, federal compounding rules permitted licensed pharmacies to prepare compounded versions to meet patient demand. Both shortages have since ended (semaglutide in early 2025, tirzepatide in late 2024), but compounded versions remain available through telehealth platforms operating within state-level pharmacy compounding rules.
The critical regulatory point: compounded versions of semaglutide and tirzepatide contain the same active pharmaceutical ingredient as the brand-name versions, but the compounded products themselves have not been individually evaluated by the FDA for safety, effectiveness, or quality. The pharmacy preparing the medication is licensed and inspected by state pharmacy boards, but the specific compounded formulation is not FDA-reviewed the way Wegovy or Zepbound is.
That doesn't mean compounded medications are dangerous. Many patients use compounded GLP-1 successfully. But the regulatory distinction is real, it matters, and any platform that doesn't disclose it clearly is one to be cautious about. Read more about Novi's compounded sourcing in my Novi review.
How These Medications Work in Your Body
Once the medication is in your system, three main effects start to compound over the weeks of treatment. First, gastric emptying slows. Food stays in the stomach longer, which means satiety signals last longer and you feel full from smaller meals. Second, GLP-1 receptors in the brain — particularly in the hypothalamus, which controls appetite — receive a steady signal that the body is “fed.” Hunger frequency decreases. Cravings, especially for high-calorie hyper-palatable foods, often diminish significantly. Third, insulin response to meals improves. This effect was the original FDA-approved indication for these medications in type 2 diabetes; the weight loss effect was discovered as a secondary benefit during diabetes trials.
Most patients begin to notice the appetite changes within the first one to two weeks of starting treatment. Measurable weight loss typically begins in weeks two to four, with the rate of loss varying significantly across individuals. Published trials showed weight loss continuing to accumulate over 68 to 72 weeks of treatment, with the most significant changes typically appearing after the first three months.
What Women Specifically Should Know
Most of the foundational GLP-1 trials enrolled both men and women, but a few considerations are particularly relevant for female patients. The first is that GLP-1 medications interact with the hormonal cycle in ways that aren't always discussed. Some women report that nausea side effects feel worse in the days before menstruation, which lines up with what we know about progesterone's effects on gastric motility. Others report that satiety effects feel stronger during the luteal phase. None of this is a contraindication — it's just useful to track if you start.
The second is contraception. GLP-1 medications can affect oral contraceptive absorption because of the slowed gastric emptying. The clinical guidance is that women using oral contraceptives should add a barrier method during the first four weeks of GLP-1 treatment and during dose escalations. This is not optional advice. Pregnancy is contraindicated on these medications and unintended pregnancy on a GLP-1 carries risk that needs to be discussed with a clinician immediately.
The third is bone density. Rapid weight loss of any cause — including GLP-1 mediated weight loss — has been associated in some studies with reduced bone mineral density, which is particularly relevant for women approaching or in menopause when estrogen-related bone loss is already a concern. Adequate protein, weight-bearing exercise, and calcium intake during treatment are not optional add-ons; they are part of doing this safely.
The fourth is muscle mass. Weight loss without resistance training tends to include a meaningful percentage of lean muscle loss. For women already at risk of sarcopenia in midlife, this is a significant consideration. Strength training during GLP-1 treatment isn't a “should” — it's a “must” if you want the body composition outcome rather than just the scale outcome.
Who's a Reasonable Candidate
The published clinical guidelines for GLP-1 weight management treatment are reasonably specific. Adults with a BMI of 30 or higher are generally appropriate candidates. Adults with a BMI of 27 or higher with at least one weight-related comorbidity (high blood pressure, type 2 diabetes, sleep apnea, dyslipidemia, cardiovascular disease) are generally appropriate. These are clinical guidelines, not arbitrary numbers, and they exist because the safety-benefit calculation for GLP-1 medications is most favorable in patients with this risk profile.
Telehealth platforms generally screen against these criteria during the intake quiz, though the screening rigor varies. A platform that approves anyone who fills out the form is one to be skeptical of. A platform that conducts a real medical review and is willing to decline candidates who don't meet criteria — and refunds the initial fee when they do — is one operating responsibly. For a detailed look at how Novi specifically handles eligibility screening, see my full Novi review.
Who Should Not Use GLP-1 Medications
The contraindications and warnings on these medications are real. Anyone with a personal or family history of medullary thyroid carcinoma should not use these medications. Anyone with Multiple Endocrine Neoplasia syndrome type 2 should not use these medications. Patients with a history of pancreatitis should discuss carefully with a clinician whether GLP-1 therapy is appropriate. Pregnancy and breastfeeding are contraindications. A history of severe gastroparesis is a contraindication. Severe gastrointestinal disease may be a contraindication depending on the specific condition.
The FDA boxed warning on both semaglutide and tirzepatide concerns thyroid C-cell tumors observed in animal studies. The relevance of those animal findings to humans is not fully established, but the boxed warning exists for a reason and the contraindication for patients with relevant thyroid history is firm.
For a much more detailed breakdown of side effects, what to expect during the titration period, and how to manage the most common gastrointestinal effects, see my GLP-1 side effects in women guide.
What Telehealth Programs Like Novi Add
The medication itself is just one part of what a telehealth program provides. The structural pieces that matter are: the clinical screening that determines whether you're a safe candidate, the prescription itself, the pharmacy that prepares the medication, the supplies needed for self-administration, the ongoing access to a clinician for dose adjustments and side-effect management, and — for some platforms — coaching support for the lifestyle changes that protect outcomes during and after treatment.
Novi bundles all of these into a single monthly subscription. Compounded semaglutide is $174 per month; compounded tirzepatide is $283 per month; consultation, medication, supplies, ongoing clinician access, and coaching are all included. There is a 3-month minimum commitment. For a detailed breakdown of what you actually get for that monthly fee and how it compares to alternatives, see the Novi cost breakdown.
The Honest Bottom Line
GLP-1 medications are a real medical advance. The published trial data is strong. Many patients have meaningfully improved their health outcomes — not just weight, but cardiovascular markers, blood sugar control, sleep apnea severity, and quality of life. For the right patient, with the right clinical oversight, these medications work.
They are also prescription medications with real side effects, real contraindications, and a real regulatory landscape that includes the compounded-versus-FDA-approved distinction patients should understand. The marketing in this category has been louder than the education. If you're considering starting a GLP-1 program through any telehealth platform, the homework is reading the actual published clinical evidence on the medication, understanding the difference between compounded and brand-name, knowing the contraindications, and planning the lifestyle scaffolding (protein, resistance training, sleep, hydration) that protects your outcome.
Telehealth platforms like Novi, MEDVi, and TrimRx all operate in this space with slightly different positioning. The choice between them is more about pricing, support model, and personal fit than about the underlying medication. Browse the full weight loss category for ongoing reviews.
Editorial note: This article references the published clinical trial literature on semaglutide (STEP 1, STEP 4, SUSTAIN, SELECT) and tirzepatide (SURMOUNT-1, SURPASS, SURMOUNT-5). Compounded semaglutide and compounded tirzepatide are not FDA-approved for safety, effectiveness, or quality. Individual outcomes vary based on multiple clinical factors. This article is for informational purposes only and does not constitute medical advice.
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