Dr.ObesityLA said:

Four weeks is the pharmacokinetics, not caution.

PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss. It's a titration dose to let your body adjust. Don't be discouraged if you don't lose much in the first month.

The therapeutic dose for weight management starts at 1.7mg (semaglutide) or 5mg (tirzepatide). Be patient with the ramp-up.

Following on from Dr.NateNeph — and this may be the naive question:

What the trials actually did with participants who could not tolerate a step, because that is the situation I am in and the protocol summaries skip it?

dave_SLC said:

PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss.

Dose escalation anxiety for titration: I was terrified to move from 0.5mg to 1.0mg based on horror stories in this forum. But my actual experience? Slightly more appetite suppression, zero additional side effects.

Remember that the people posting about terrible side effects are a biased sample. Most people titrate up without drama — they just don't post about it because it's uneventful.

OP back with an update, since a thread like this is useless without one.

Update — I came back down one step, held for a month, then went up again and it was uneventful the second time. Same ladder, slower.

JenPlateau said:

Dose escalation anxiety for titration: I was terrified to move from 0.5mg to 1.0mg based on horror stories in this forum.

Agreed on the arithmetic, with one condition: holding indefinitely at a dose that is not doing anything is not patience, it is a stall with a nice name. The distinction is whether appetite has changed at all at the current step.

Ask again with the specifics and you will get a better answer than this one.