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ForumsSemaglutide (Ozempic / Wegovy)Semaglutide and lean mass: DEXA scan longitudinal data — need advice

Semaglutide and lean mass: DEXA scan longitudinal data — need advice

wendy_avl Mon, Dec 8, 2025 at 2:12 PM 8 replies 1,076 viewsPage 1 of 2
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wendy_avl
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Dec 8, 2025 at 2:12 PM#1

Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean. I want to know whether that ratio is bad, normal, or simply what happens.

What would genuinely help is knowing whether resistance training and protein change the ratio or only the absolute amount.

Practical detail welcome, however dull — the duller the better.

2 22SleepFixSam, PurityPaulOR
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kate.chem
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Dec 8, 2025 at 4:37 PM#2

Short answer first, then the reasoning. The intervention that works is boring and well evidenced: resistance training two to three times a week at a genuine effort, protein at 1.4 to 2.0 g/kg of reference body weight, and not making the deficit larger than the training can support. Cardio does not protect lean mass and in a deep deficit competes with recovery.

Happy to go further on any of that.

1 21VanRx_Mike
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TirzTom
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Dec 8, 2025 at 7:02 PM#3
kate.chem said:
The intervention that works is boring and well evidenced: resistance training two to three times a week at a genuine effort, protein at 1.4 to 2.0…

Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution. Hydration status moves the lean compartment by a kilogram or more between scans, so any comparison of scans done at different times of day or different hydration states is noise.

50 20Dr.EndoIndy, tom_AK, josh_phd_bmore and 47 others
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raj_cambridge
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Dec 8, 2025 at 9:27 PM#4
wendy_avl said:
Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.

Same position here, arrived at the long way round. The honest range is roughly 20 to 40% of total loss as lean mass without deliberate resistance training, and roughly 10 to 20% with it plus adequate protein. Both numbers need a caveat that matters: "lean mass" on a DEXA is not muscle. It includes water, glycogen and the lean fraction of organs, and glycogen alone carries about three grams of water per gram. A large early lean drop is mostly the glycogen and water going, which is why the first scan flatters and the second is the honest one.

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TinaHashiRN
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Dec 9, 2025 at 11:59 AM#5

From the other side of the consultation, briefly.

Regarding lean mass: I accidentally injected my dose intramuscularly instead of subcutaneously last week (went in at wrong angle, too deep). Called my pharmacist — they said it's not dangerous but may absorb faster, potentially causing more GI effects.

Sure enough, had worse nausea that day. Lesson learned: pinch the skin properly and use the right needle length for your body composition.

Last edited: Dec 9, 2025 at 5:59 PM
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