kate.chem said:

The dose-response is real but shallow at the top.

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.

Happy to go further on any of that.

Adding the numbers, since they settle part of this. Worth knowing that the injection site changes very little. Abdomen, thigh and upper arm are bioequivalent for semaglutide, so a site change is not a plausible explanation for a bad week.

Dr.NateNeph said:

The trial means are being read too generously in this thread.

There is a second half to this that has not been said yet. The pattern that distinguishes a bad batch from an exit is behaviour rather than product. A bad batch comes with communication, a reshipment offer and a batch number. An exit comes with slower replies, pressure toward less reversible payment methods, sudden discounting, and the same reassurance repeated without any new information. The product tells you less than the correspondence does.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

One thing that is still open after BiostatsBrad’s answer:

How people are distinguishing a supplier having a bad batch from a supplier on the way out?

Reporting back.

Update. I did go to 2.4mg in the end, and the honest report is that it bought me less than the step before it and cost me two bad weeks. Worth knowing rather than worth repeating.