TRT & Weight Management

Medical Evaluation

As an initial part of your sexual health evaluation, particularly if you are being evaluated for symptoms of low testosterone, and possible testosterone replacement therapy,  you will undergo a thorough medical history, physical examination, and bloodwork.

Metabolic Evaluation:

As part of your initial evaluation, you will undergo InBody testing and a RMR (resting metabolic rate) test.  V02 max testing may also be performed..

• InBody Testing: this body composition analysis looks at how much fat and muscle you have as well as your total body water ratios, which can identify specific areas of inflammation and swelling.
• RMR Testing: this test looks at the quantity of calories that you are burning per day, and the types of calories your body is burning at rest to ensure the body is burning the proper types of calories at the appropriate time.
• VO2 max: this cardiovascular assessment tool shows how efficiently your body is utilizing oxygen and can indicate how fit you are, as well as estimate your all-cause mortality rate.

Nutrition & Diet:

You will have available to you our physician assistant both for initial assessment and for ongoing management if you would like. She has specialized in weight management and has expertise in nutrition.

Exercise:

You will also have the opportunity to work with our on-site trainer.  One goal is to teach you how to do resistance training, while minimizing any chance of injury.  The second goal is help you with a cardiovascular exercise regimen that is safe for you and also does not cause injury.

Weight Loss Medications

We are experts at weight loss medications.  GLP-1 agonists were first approved in 2010 with Victoza (liraglutide) for diabetes.  Saxenda (liraglutide) was the first GLP-1 to be approved for weight loss in 2014.  Ozempic (semaglutide) was first introduced in the US in December 2017.  The newer GLP-agonists have shown dramatic weight loss.

We are very good at prescribing these medications, getting insurance approval when necessary (and possible), finding generic versions that are cost effective, and prescribing higher dosages of the branded medications to help you stretch out your prescriptions.

However, there are many other medications on the market that specifically target weight loss which can be considered.

Also, other medications may have a secondary effect of weight loss (or unintended weight gain), and we often use this knowledge to change our patients’ treatments as well.

Management of other Medical Issues

After your comprehensive medical evaluation, we can begin treatment of other medical issues we find. Chief amongst them may be hormonal issues, particularly testosterone and thyroid. We will also begin treatment of any lipid/cholesterol issues you have.  

We will work with your other physicians on other medical issues we discover including hypertension, diabetes, and auto-immune disorders.

Nutrition

As stated above, we will make available our nutritionist both for an initial assessment and ongoing management.  This is an option, but not mandatory, particularly as many patients are very fluent with proper nutrition and diet management.

Exercise

We will make available our in-house trainer for an initial evaluation and to teach you safe and effective cardiovascular and resistance (weight) training.

As described above, after your initial evaluation is completed, we will sit down with you and come up with your goals and then a treatment/management plan, which can include medications, nutrition, and exercise.  

Quarterly Visits

You will need to be seen every three months.  Again, these visits will include a meeting with your practitioner, an InBody, and bloodwork.  These visits are mandatory, for multiple reasons, including:

• To assess your progress
• To make sure there are no adverse effects from the regimen
• To make changes as appropriate
• To enable us to obtain continued approval for your medications, as per most insurance company’s requirements.

InBody Testing is a type of body composition analysis that uses bioelectrical impedance analysis (BIA) to measure various parameters of body composition. It provides a detailed breakdown of body components, offering more insights than traditional methods like BMI. Here are the key aspects of InBody Testing.

Parameters Measured:

• Body Fat Percentage: The proportion of your body that is fat tissue.
• Skeletal Muscle Mass: The amount of muscle attached to the bones.
• Total Body Water: The amount of water in the body, which is crucial for determining hydration status.
• Visceral Fat Level: Fat stored around internal organs.
• Segmental Lean Analysis: Muscle distribution in different body segments (arms, legs, trunk).
• Basal Metabolic Rate (BMR): The number of calories the body needs at rest to maintain basic physiological functions.
• Weight: Total body weight.
• Lean Body Mass: The total weight of your body minus the fat mass.
• Body Mass Index (BMI): A basic measure of body weight relative to height.

Advantages over BMI:

• Comprehensive Data: InBody provides a detailed breakdown of body composition, including muscle mass and fat distribution, whereas BMI only considers weight and height.
• Accuracy: InBody can distinguish between muscle and fat mass, offering a clearer picture of body health.
• Tracking Progress: It allows individuals to monitor changes in muscle mass and fat over time, which is particularly useful for those on specific fitness or diet programs.
• Muscle Mass Tracking: By measuring skeletal muscle mass, InBody tests can confirm whether a person is losing muscle instead of fat. If muscle mass decreases significantly, it indicates that the diet might be too restrictive or lacking in protein.
• Segmental Analysis: This feature helps in identifying muscle loss in specific body regions, allowing for targeted interventions.

How it Works: 

• Standing on the Device: The individual stands barefoot on the device, and their hands hold the handles with electrodes.
• Measurement: The device sends a low-level electrical current through the body, which measures the resistance and reactance of different body tissues.
• Results: The test takes a few minutes, and the results are displayed immediately, providing a comprehensive report of the individual’s body composition.

InBody testing is a valuable tool for those looking to get a detailed understanding of their body composition, monitor their health and fitness progress accurately, and ensure that any weight loss efforts are targeting fat rather than muscle. It is a dramatically better tool to follow your progress in a weight loss regimen compared to BMI which only looks at height and weight.

Contraindications to InBody Testing

Implanted Medical Devices: Individuals with implanted electronic medical devices such as pacemakers, defibrillators, or cochlear implants should avoid using the InBody device. The electrical current may interfere with the functioning of these devices.

Epilepsy: Those with epilepsy should consult their healthcare provider before using the InBody device, as the electrical current could potentially trigger a seizure.

Purpose of the Test

VO2 max, or maximal oxygen uptake, measures the maximum amount of oxygen your body can utilize during intense exercise. This metric is crucial for evaluating cardiovascular fitness and aerobic endurance. Athletes and fitness enthusiasts use VO2 max to gauge their fitness levels, optimize training programs, and track performance improvements. Clinically, it helps in assessing patients’ cardiopulmonary health and potential risk factors for heart disease and other conditions.

How the Test is Performed

The VO2 max test is typically conducted in a controlled environment such as a laboratory or a specialized fitness facility. The test involves the following steps:

• Preparation: The individual is fitted with a mask connected to a metabolic cart that measures oxygen intake and carbon dioxide output.
  Warm-up: A brief warm-up session is conducted to prepare the body for intense exercise.
• Exercise Protocol: The individual performs a graded exercise test, usually on a treadmill or stationary bike. The intensity of the exercise increases progressively, either by increasing the speed, incline, or resistance.
• Monitoring: Heart rate, oxygen consumption, and carbon dioxide production are continuously monitored.
• Completion: The test continues until the individual reaches volitional fatigue or cannot maintain the required exercise intensity. The maximum oxygen consumption recorded during this period is considered the VO2 max.

How the Test is Interpreted

VO2 max values are interpreted based on several factors, including age, gender, fitness level, and training status. The results are usually expressed in milliliters of oxygen per kilogram of body weight per minute (ml/kg/min). Here’s a general guide to interpreting VO2 max scores:

• Excellent: Very high VO2 max values, often seen in elite athletes.
• Above Average: Higher-than-average values, indicating superior cardiovascular fitness.
• Average: Typical values for most healthy adults.
• Below Average: Lower-than-average values, suggesting potential room for improvement in aerobic capacity.
• Poor: Very low values, which may indicate poor cardiovascular fitness or underlying health issues.

How VO2 Max Changes Over Time with Exercise

Regular aerobic exercise can significantly improve VO2 max over time. Here’s how it changes:

• Initial Adaptation: Beginners may see rapid improvements in VO2 max due to initial cardiovascular adaptations, such as increased stroke volume and improved muscle oxygen extraction.
• Steady Progression: With consistent training, VO2 max continues to improve at a moderate pace. This phase is characterized by enhanced capillary density, mitochondrial efficiency, and cardiac output.
• Plateau Phase: Highly trained individuals may reach a plateau where further improvements in VO2 max become minimal. At this stage, specialized training techniques such as interval training or high-intensity interval training (HIIT) may be required to induce further gains.
• Maintenance: Maintaining a high VO2 max requires ongoing aerobic training. Periods of inactivity can lead to declines in VO2 max, but these can often be reversed with resumed training.

Overall, VO2 max is a dynamic measure of fitness that reflects both current cardiovascular health and the potential for improvement through targeted exercise programs.

Obesity is a complex medical condition characterized by an excessive accumulation of body fat that poses significant health risks. Managing obesity requires addressing various underlying medical issues, which can be broadly categorized into metabolic, hormonal, psychological, and lifestyle-related factors. Understanding and managing these factors are crucial for a comprehensive approach to weight loss. Here are the key medical issues underlying obesity that need to be managed:

Metabolic Dysregulation:

Insulin Resistance and Type 2 Diabetes: Excess body fat, particularly visceral fat, contributes to insulin resistance, which can progress to type 2 diabetes. This condition impairs the body’s ability to regulate blood sugar levels, leading to hyperglycemia and associated complications.

Dyslipidemia: Obesity often leads to abnormal lipid profiles, including elevated triglycerides, low HDL cholesterol, and high LDL cholesterol. These changes increase the risk of cardiovascular disease.

Hypertension: Excess weight increases the workload on the heart and blood vessels, often leading to high blood pressure, which is a major risk factor for cardiovascular diseases such as heart attack and stroke.

Hormonal Imbalances:

Low Testosterone Levels: Testosterone is very important in regulating weight, and when appropriate testosterone replacement therapy can have a dramatic effect on weight loss. (see below)

Thyroid Dysfunction: Hypothyroidism, a condition where the thyroid gland is underactive, can lead to weight gain and difficulty losing weight due to a slower metabolism.

Psychological Factors:

Depression and Anxiety: There is a bidirectional relationship between obesity and mental health disorders. Psychological stress, depression, and anxiety can lead to unhealthy eating habits and weight gain, while obesity can contribute to psychological distress.

Eating Disorders: Conditions such as binge eating disorder, night eating syndrome, and emotional eating are common among obese individuals and need to be addressed as part of a comprehensive weight loss strategy.

Lifestyle & Behavioral Factors:

Sedentary Lifestyle: Physical inactivity is a significant contributor to obesity. Increasing physical activity is essential for weight loss and overall health.

Poor Dietary Habits: High-calorie, nutrient-poor diets rich in processed foods, sugars, and unhealthy fats contribute to weight gain. Nutritional counseling and dietary modifications are critical components of obesity management.

Sleep Disorders: Poor sleep quality and sleep disorders such as obstructive sleep apnea are common in obese individuals and can exacerbate weight gain and metabolic dysfunction.

Inflammatory & Immune Responses:

Chronic Inflammation: Obesity is associated with a state of chronic low-grade inflammation, which contributes to insulin resistance, atherosclerosis, and other metabolic complications.

Immune System Dysregulation: Obesity affects the immune system, increasing susceptibility to infections and inflammatory diseases.

Genetic & Epigenetic Factors:

Genetic Predisposition: Certain genetic factors can predispose individuals to obesity by influencing appetite, metabolism, and fat storage.

Epigenetic Changes: Environmental factors such as diet and lifestyle can cause epigenetic modifications that affect gene expression related to metabolism and obesity.

A comprehensive approach to weight loss in obese patients must address these multifaceted medical issues. Effective management requires a multidisciplinary strategy that includes medical, nutritional, psychological, and behavioral interventions. By targeting the underlying causes of obesity, we can help patients achieve sustainable weight loss and improve their overall health and quality of life.

These medications reduce appetite and increase feelings of fullness, leading to reduced caloric intake.

Medications:

• Phentermine
  • Dosage: Typically 15-37.5 mg once daily before breakfast or 1-2 hours after breakfast.
  • Mechanism of Action: Stimulates the release of norepinephrine in the brain, leading to reduced hunger and appetite.
  • FDA Approval: 1959.
• Diethylpropion
  • Dosage: 25 mg three times daily before meals or 75 mg extended-release once daily in mid-morning.
  • Mechanism of Action: Similar to phentermine, it increases the release of norepinephrine.
  • FDA Approval: 1959.

These medications prevent the absorption of dietary fat, leading to reduced caloric intake from fat.

Medications:

• Orlistat (Xenical, Alli)
  • Dosage: 120 mg three times daily with each main meal containing fat (Xenical) or 60 mg three times daily (Alli).
  • Mechanism of Action: Inhibits pancreatic lipase, an enzyme that breaks down triglycerides in the intestine, thus reducing fat absorption.
  • FDA Approval: 1999 for Xenical, 2007 for Alli (over-the-counter version).

These medications mimic the incretin hormone GLP-1, which increases insulin secretion, slows gastric emptying, and reduces appetite.

Medications:

• Liraglutide (Saxenda)
  • Dosage: Initial dose of 0.6 mg subcutaneously daily, increasing to 3.0 mg daily.
  • Mechanism of Action: Mimics GLP-1, leading to increased insulin secretion, delayed gastric emptying, and reduced appetite.
  • FDA Approval: 2014.
• Semaglutide (Wegovy)
  • Dosage: Initial dose of 0.25 mg subcutaneously weekly, increasing to 2.4 mg weekly.
  • Mechanism of Action: Similar to liraglutide, it mimics GLP-1 to enhance insulin secretion, delay gastric emptying, and reduce appetite.
  • FDA Approval: 2021.

These medications activate both GLP-1 and GIP receptors, enhancing insulin secretion, reducing appetite, and improving metabolic functions.

Medications:

• Tirzepatide (Zepbound)
  • Dosage: Initial dose of 2.5 mg subcutaneously weekly, increasing to 15 mg weekly based on patient tolerance and response.
  • Mechanism of Action: Activates both GLP-1 and GIP receptors, leading to enhanced insulin secretion, delayed gastric emptying, reduced appetite, and improved glucose metabolism.
  • FDA Approval: 2023.

These medications combine two different drugs to target multiple pathways involved in weight regulation.

Medications:

• Phentermine/Topiramate ER (Qsymia)
  • Dosage: Starting dose of 3.75 mg/23 mg once daily, with potential increases up to 15 mg/92 mg once daily.
  • Mechanism of Action: Phentermine suppresses appetite while topiramate, originally an anticonvulsant, enhances feelings of fullness and reduces food intake.
  • FDA Approval: 2012.
• Naltrexone/Bupropion (Contrave)
  • Dosage: 8 mg/90 mg tablets, with a titration schedule starting at one tablet in the morning, increasing to two tablets twice daily.
  • Mechanism of Action: Naltrexone is an opioid antagonist and bupropion is an antidepressant that also suppresses appetite and reduces cravings.
  • FDA Approval: 2014.

GLP-1 receptor agonists, such as semaglutide, and dual GLP-1/GIP receptor agonists, such as tirzepatide, have significantly revolutionized the management of obesity and type 2 diabetes. These medications not only improve glycemic control but also promote substantial weight loss, making them valuable tools in the treatment of these chronic conditions. Their ability to mimic or enhance incretin hormones, which regulate insulin secretion and appetite, provides a multifaceted approach to managing weight and metabolic health.

Tirzepatide and semaglutide are both GLP-1 receptor agonists used to manage type 2 diabetes and aid in weight loss. This guide compares these two medications in terms of indications, efficacy, cost, and other relevant factors.

Brand Names & Indications-Because it is confusing!

Tirzepatide

• Mounjaro: Indicated for type 2 diabetes management.
• Zepbound: Indicated for chronic weight management.

Semaglutide

• Ozempic: Indicated for type 2 diabetes management.
• Wegovy: Indicated for chronic weight management.
• Rybelsus: Indicated for type 2 diabetes management:  Oral medication taken upon awakening- dose: 3mg, 7mg, 14mg daily

Costs:

Tirzepatide (Mounjaro/Zepbound): Generally expensive without insurance, with costs varying depending on the dosage and insurance coverage. Estimated around $1,000 – $1,500 per month.
Semaglutide (Ozempic/Wegovy): Also expensive without insurance, with costs around $1,300 per month for both diabetes and weight management formulations.

Administration:
Both medications are administered via subcutaneous injection once weekly.

Storage:
Both medications should be stored in the refrigerator before first use. After the first use, they can be stored at room temperature or in the refrigerator, but theoretically should be discarded after a certain period (56 days for Ozempic).

Semaglutide is a groundbreaking medication that has revolutionized the treatment of type 2 diabetes and obesity. It is marketed under brand names such as Ozempic for diabetes management and Wegovy for weight loss. Semaglutide functions as a GLP-1 receptor agonist, providing a range of metabolic benefits that make it a powerful tool in managing these conditions. This comprehensive overview will cover its mechanisms of action, dosing and titration guidelines, and strategies for optimizing its use.

Mechanism of Action
Semaglutide works by mimicking the action of the naturally occurring hormone GLP-1 (glucagon-like peptide-1). Its multifaceted mechanism of action includes:

• Enhanced Insulin Secretion: Semaglutide stimulates glucose-dependent insulin secretion from pancreatic beta cells, ensuring insulin is released in response to elevated blood glucose levels. This enhances postprandial blood sugar control and overall glycemic management.
• Reduced Glucagon Production: By suppressing glucagon secretion from pancreatic alpha cells, semaglutide decreases hepatic glucose production. This reduction in glucagon helps lower fasting blood glucose levels, contributing to better overall glucose control.
• Delayed Gastric Emptying: Semaglutide slows the rate at which food leaves the stomach, leading to a more gradual absorption of glucose into the bloodstream. This delay helps prevent postprandial glucose spikes, providing smoother blood sugar control throughout the day.
• Appetite Suppression: Activation of GLP-1 receptors in the brain, particularly in the hypothalamus, promotes satiety and reduces appetite. This appetite-suppressing effect is crucial for weight loss, helping patients reduce their caloric intake without feeling deprived.

Dosages and Titration
Semaglutide is administered via subcutaneous injection and is available in different formulations and dosages.

Ozempic (for Diabetes Management):

• Initial Dose: 0.25 mg once weekly for the first 4 weeks.
• Increase to: 0.5 mg once weekly after 4 weeks.
• Further Increase: If additional glycemic control is needed, the dose can be increased to 1 mg once weekly after another 4 weeks.
• Maximum Dose: 2 mg once weekly if necessary for additional glycemic control.

Wegovy (for Weight Loss):

• Initial Dose: 0.25 mg once weekly for the first 4 weeks.
• Increase to: 0.5 mg once weekly for the next 4 weeks.
• Further Increase: Incrementally increase by 0.5 mg every 4 weeks until reaching the maintenance dose.
• Maintenance Dose: 2.4 mg once weekly.

When to Increase Dosage
Increasing the dosage of semaglutide should be based on the following criteria:

Efficacy Assessment:

• Glycemic Control (Ozempic): Monitor fasting blood glucose and HbA1c levels. If levels remain above target after the initial dose and titration period, consider increasing the dosage.
• Weight Loss (Wegovy): Assess weight loss progress. If weight loss is insufficient (less than 5% reduction in body weight after several weeks), a dosage increase may be warranted.

Tolerance and Side Effects:

• Evaluate the patient’s ability to tolerate the current dose. If side effects are manageable or mild, a dosage increase may be appropriate.
• Assess the severity and duration of side effects. Persistent or severe side effects may require maintaining the current dose longer or slowing the titration process.

Patient’s Overall Health:

• Consider the patient’s overall health, including any comorbid conditions that may affect drug metabolism and response.
• Adjust the titration schedule based on individual patient needs and responses.

When to Decrease or Adjust Dosage
Slower titration or dose adjustments may be necessary under the following conditions:

• Severe or Persistent GI Symptoms: If nausea, vomiting, or diarrhea are severe or persist beyond the initial weeks of treatment, consider maintaining the current dose for an additional 4 weeks or more before increasing.
• Other Significant Side Effects: Any side effect that significantly impacts the patient’s quality of life or daily functioning should prompt a slower titration or a reassessment of the dosage plan.
• Patient Discomfort: If the patient reports significant discomfort or inability to perform daily activities due to side effects, consider a dose adjustment.
• Frequent Hypoglycemic Episodes: Monitor blood glucose levels closely. If hypoglycemia is frequent, even with dose adjustments of other medications, slower titration may be necessary.

Optimizing Use: Ozempic and Wegovy Pens
Ozempic Pen Strengths and Clicks:

• Pen Strengths:
  -0.25 mg (Starter dose)
  -0.5 mg (Maintenance dose)
  -1 mg (Higher dose)
  -2 mg (Maximum dose)
• Clicks to Dose Conversion:
  -The Ozempic pen is designed with a dial that clicks to measure the exact dose. Each pen is pre-filled to deliver multiple doses.
  -For example, the 0.5 mg dose may be delivered by setting the dial to 18 clicks. The 1 mg dose may be set at 36 clicks. The exact number of clicks will vary based on the pen and the specific instructions provided.

Wegovy Pen Strengths:

• Pen Strengths: Wegovy pens come in dosages of 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, and 2.4 mg.
• Dosing Flexibility: The availability of multiple strengths provides flexibility in titration and maintenance, ensuring patients can gradually adjust their dosage to the optimal level for weight management.

Summary
Semaglutide, marketed as Ozempic for diabetes management and Wegovy for weight loss, represents a groundbreaking advancement in the treatment of type 2 diabetes and obesity. Its action as a GLP-1 receptor agonist allows for comprehensive metabolic benefits, including enhanced insulin secretion, reduced glucagon production, delayed gastric emptying, and appetite suppression. By targeting both glucose and lipid metabolism, semaglutide offers a powerful tool for improving glycemic control and promoting significant weight loss.

The introduction of semaglutide as a GLP-1 receptor agonist represents a significant milestone in the treatment of type 2 diabetes and obesity. Its multifaceted approach provides comprehensive metabolic benefits that address the complex interplay between glucose and lipid metabolism. By offering improved glycemic control and significant weight loss, semaglutide empowers patients to take control of their health and achieve better outcomes.

At Maze, we are committed to harnessing the full potential of semaglutide to benefit our patients. Through our proactive and innovative strategies, we ensure that you have access to this groundbreaking medication, helping you navigate the challenges of treatment and achieve your health goals.

Tirzepatide is a revolutionary medication that has significantly impacted the treatment of type 2 diabetes and obesity. It is marketed under the brand names Mounjaro for diabetes management and Zepbound for weight loss. Tirzepatide functions as a dual GLP-1 and GIP receptor agonist, providing extensive metabolic benefits that make it a powerful tool in managing these conditions. This comprehensive overview will cover its mechanisms of action, dosing and titration guidelines, and strategies for optimizing its use.

Mechanism of Action

Tirzepatide works by mimicking the actions of the naturally occurring hormones GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide). Its multifaceted mechanism of action includes:

• GLP-1 Receptor Agonism:
  • Enhanced Insulin Secretion: Tirzepatide stimulates glucose-dependent insulin secretion from pancreatic beta cells, improving postprandial blood sugar control and overall glycemic management.
  • Reduced Glucagon Production: It suppresses glucagon secretion from pancreatic alpha cells, decreasing hepatic glucose production and lowering fasting blood glucose levels.
  • Delayed Gastric Emptying: By slowing gastric emptying, tirzepatide leads to a more gradual absorption of glucose into the bloodstream, preventing postprandial glucose spikes.
  • Appetite Suppression: Activation of GLP-1 receptors in the brain promotes satiety and reduces appetite, which is crucial for weight loss.
• GIP Receptor Agonism:
  • Enhanced Insulin Secretion: GIP complements the action of GLP-1 by further stimulating insulin secretion in response to glucose.
  • Glucagon Regulation: GIP modulates glucagon secretion under hyperglycemic conditions, aiding in better blood sugar control.
  • Lipid Metabolism: GIP influences lipid metabolism, promoting triglyceride storage in adipose tissue and enhancing fat oxidation, contributing to weight loss.

Dosages & Titration

Tirzepatide is administered via subcutaneous injection and is available in different formulations and dosages:

Mounjaro (for Diabetes Management):

• Initial Dose: 2.5 mg once weekly for the first 4 weeks.
• Increase to: 5 mg once weekly after 4 weeks.
• Further Increase: If additional glycemic control is needed, the dose can be increased to 7.5 mg once weekly after another 4 weeks.
• Maximum Dose: Up to 15 mg once weekly if necessary for additional glycemic control.

Zepbound (for Weight Loss):

• Initial Dose: 2.5 mg once weekly for the first 4 weeks.
• Increase to: 5 mg once weekly for the next 4 weeks.
• Further Increase: Incrementally increase by 2.5 mg every 4 weeks until reaching the maintenance dose.
• Maintenance Dose: Up to 15 mg once weekly.

When to Increase Dosage

Increasing the dosage of tirzepatide should be based on the following criteria:

• Efficacy Assessment:
  • Glycemic Control (Mounjaro): Monitor fasting blood glucose and HbA1c levels. If levels remain above target after the initial dose and titration period, consider increasing the dosage.
  • Weight Loss (Zepbound): Assess weight loss progress. If weight loss is insufficient (less than 5% reduction in body weight after several weeks), a dosage increase may be warranted.
• Tolerance and Side Effects:
  • Evaluate the patient’s ability to tolerate the current dose. If side effects are manageable or mild, a dosage increase may be appropriate.
  • Assess the severity and duration of side effects. Persistent or severe side effects may require maintaining the current dose longer or slowing the titration process.
• Patient’s Overall Health:
  • Consider the patient’s overall health, including any comorbid conditions that may affect drug metabolism and response.
  • Adjust the titration schedule based on individual patient needs and responses.

When to Decrease or Adjust Dosage

Slower titration or dose adjustments may be necessary under the following conditions:

1. Severe or Persistent GI Symptoms: If nausea, vomiting, or diarrhea are severe or persist beyond the initial weeks of treatment, consider maintaining the current dose for an additional 4 weeks or more before increasing.
2. Other Significant Side Effects: Any side effect that significantly impacts the patient’s quality of life or daily functioning should prompt a slower titration or a reassessment of the dosage plan.
3. Patient Discomfort: If the patient reports significant discomfort or inability to perform daily activities due to side effects, consider a dose adjustment.
4. Frequent Hypoglycemic Episodes: Monitor blood glucose levels closely. If hypoglycemia is frequent, even with dose adjustments of other medications, slower titration may be necessary.

Optimizing Use: Mounjaro and Zepbound Pens

Mounjaro Pen Strengths:

• Pen Strengths:
  • 2.5 mg Pen: This pen can be used to deliver various doses by adjusting the clicks:
    • 2.5 mg dose: Fixed dose, no adjustment needed.
  • 5 mg Pen: This pen offers a higher concentration
  • 7.5 mg Pen: Higher concentration
  • 10 mg Pen:
  • 15 mg Pen: Maximum strength

Zepbound Pen Strengths:

• Pen Strengths: Zepbound pens come in dosages of 2.5 mg, 5 mg, 7.5 mg, 10 mg, and 15 mg.
• Dosing Flexibility: The availability of multiple strengths provides flexibility in titration and maintenance, ensuring patients can gradually adjust their dosage to the optimal level for weight management.

Summary

Tirzepatide, marketed as Mounjaro for diabetes management and Zepbound for weight loss, represents a groundbreaking advancement in the treatment of type 2 diabetes and obesity. Its dual action as a GLP-1 and GIP receptor agonist allows for comprehensive metabolic benefits, including enhanced insulin secretion, reduced glucagon production, delayed gastric emptying, and appetite suppression. By targeting both glucose and lipid metabolism, tirzepatide offers a powerful tool for improving glycemic control and promoting significant weight loss.

The introduction of tirzepatide as a dual GLP-1 and GIP receptor agonist represents a significant milestone in the treatment of type 2 diabetes and obesity. Its multifaceted approach provides comprehensive metabolic benefits that address the complex interplay between glucose and lipid metabolism. By offering improved glycemic control and significant weight loss, tirzepatide empowers patients to take control of their health and achieve better outcomes.

At Maze, we are committed to harnessing the full potential of tirzepatide to benefit our patients. Through our proactive and innovative strategies, we ensure that you have access to this groundbreaking medication, helping you navigate the challenges of treatment and achieve your health goals.

Currently, there are significant barriers to accessing semaglutide and tirzepatide, including insurance coverage, preauthorization processes, and pharmacy shortages. At Maze, we have proactively developed innovative strategies to ensure our patients have access to these essential medications.

How Maze Secures Preapproval for Medications
Many insurance companies categorically do not cover semaglutide and tirzepatide. Even when they do, the preauthorization process can be lengthy and challenging. At Maze, we understand the importance of these medications for your health and have a dedicated team to handle the preapproval process. Our approach includes:

• Thorough Documentation: We meticulously prepare all necessary documentation and provide comprehensive justifications to support the medical necessity of semaglutide and tirzepatide.
• Persistent Follow-ups: Our team follows up persistently with insurance companies to expedite the approval process, addressing any queries or additional requirements promptly.
• Patient Advocacy: We advocate on your behalf, emphasizing the critical role these medications play in your treatment plan to increase the likelihood of insurance approval.

By taking these steps, we strive to minimize delays and improve your chances of getting the necessary approval for your medication.

Our Relationships with Pharmacies
At Maze, we have cultivated strong relationships with several pharmacies to ensure reliable access to medications:

• Priority Access: Our partnered pharmacies often prioritize their medication allotment for our patients, helping to mitigate the effects of nationwide shortages.
• Special Arrangements: We work closely with these pharmacies to arrange for timely refills and expedited shipping, ensuring that you receive your medication without interruption.
• Collaborative Efforts: Our collaboration with pharmacies involves regular communication to stay updated on stock levels and potential delays, allowing us to proactively manage any issues that may arise.

These partnerships are crucial in providing our patients with consistent access to their medications, even during times of high demand.

Utilizing Compounded Medications
If your insurance does not cover semaglutide or tirzepatide, we explore the option of using a compounding pharmacy:

• Cost-Effective Solutions: Compounded versions of these medications are often more affordable than their branded counterparts. We ensure that these compounded medications meet the highest standards of quality and efficacy.
• Custom Formulations: Compounding pharmacies can create custom formulations tailored to your specific needs, ensuring you receive the right dosage and formulation for your treatment plan.
• Safety and Quality Assurance: We work with reputable compounding pharmacies that adhere to stringent safety and quality standards, providing you with reliable and effective medication alternatives.

Our goal is to make these treatments accessible without compromising on safety or effectiveness.

Summary
At Maze, we are committed to ensuring that you have access to the medications you need, despite the barriers. We work tirelessly to secure insurance approval, maximize your medication supply, and explore cost-effective alternatives through compounding pharmacies. Our proactive and inventive approach ensures that you receive the best possible care and support in managing your health. Whether it’s through advocating for insurance coverage, optimizing dosage plans, leveraging pharmacy relationships, or utilizing compounded medications, Maze is dedicated to overcoming obstacles and providing you with the necessary resources for your health and well-being.