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ForumsMASH / Liver DiseaseSemaglutide liver fat quantification — my results so far

Semaglutide liver fat quantification — my results so far

MikeKY_noInsulin Fri, May 16, 2025 at 5:34 PM 11 replies 1,492 viewsPage 1 of 3
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MikeKY_noInsulin
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Oct 2024
Louisville, KY
May 16, 2025 at 5:34 PM#1

I moved from brand to compounded semaglutide at the same nominal dose and cannot decide whether what changed is the material, my titration, or my expectations.

What would genuinely help is knowing how much of the between-person variation is pharmacokinetic and how much is just adherence measured badly.

Not looking for reassurance. Looking for the part I have got wrong.

28 23sean_dublin, hannah_MT, Dr.SportsMedIN and 25 others
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DebRD_ATL
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Feb 2024
Atlanta, GA
May 16, 2025 at 6:12 PM#2

Taking the question as asked, rather than the general version of it. The dose-response is real but shallow at the top. Across STEP 1 and STEP 4 the gap between 1.7mg and 2.4mg is a couple of percentage points of body weight on average, and the average is carrying a wide spread — plenty of people at 1.7mg sit above the 2.4mg mean. If a dose is working and tolerable, "working" is the relevant variable, not "maximal".

27 22RegAffairsDC, BiostatsBrad, PeptideSynthNJ and 24 others
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steph_laguna
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Nov 2024
Laguna Beach, CA
May 16, 2025 at 6:50 PM#3
DebRD_ATL said:
The dose-response is real but shallow at the top.

Agreeing with DebRD_ATL, and the qualification matters more than the agreement. Steady state is the thing most people miss. The terminal half-life is about a week, so every dose step takes four to five weeks to fully express itself. Judging a step at day ten is judging the ascent, not the plateau, and it is the single commonest reason people escalate before they needed to.

26 21carl_compliance, DanielChem_CHI, marco_milano and 23 others
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dan_philly
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Philadelphia, PA
May 16, 2025 at 7:28 PM#4
MikeKY_noInsulin said:
I moved from brand to compounded semaglutide at the same nominal dose and cannot decide whether what changed is the material, my titration, or my…

That holds for the injectable. The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people quote them as if they were.

Last edited: May 16, 2025 at 10:28 PM
25 20Dr.CardioMD, EndoResFellow, PharmacoVig_BOS and 22 others
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pat_auckland
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Jun 2024
Auckland, NZ
May 16, 2025 at 10:58 PM#5

Adding the clinical framing, because it changes how the question reads.

MikeKY_noInsulin said:
...but the FDA says semaglutide...

Interesting point. I want to add some regulatory nuance: the FDA labeling reflects the specific clinical trial data submitted for approval. Real-world clinical practice often extends beyond the FDA label based on emerging evidence and clinical judgment.

Example: semaglutide was first approved for diabetes (Ozempic), then obesity (Wegovy). The molecule didn't change — our understanding of its applications expanded. Similarly, semaglutide may evolve as more data accumulates.

Last edited: May 17, 2025 at 2:58 AM
24 19dan_philly, MeganSA_TX, LarryQC_SD and 21 others
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