Dr.PathRoch said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

Thank you — that is the clearest version of this I have read, and I have read a lot of them. Printing the relevant bit and taking it with me.

From the other side of the consultation, briefly.

Dose splitting update on split dosing: instead of 2.4mg once weekly, I've been doing 1.2mg twice weekly (Mon/Thu) with my doctor's approval. The appetite suppression is more consistent and side effects are noticeably milder.

Not medical advice, just sharing what's worked for me. Discuss with your provider before trying this.

Dr.LeslieOBGYN said:

Steady state is the thing most people miss.

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.

Worth separating that from semaglutide, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

One concrete data point for the thread. If you are comparing against somebody else’s result, check that you are comparing the same measurement taken the same way. Most of the apparent contradictions in these threads dissolve at that step.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part.