GLP-1s and PCOS — the evidence, the off-label reality and the patient demand
PCOS affects roughly 10% of women of reproductive age and has significant metabolic overlap with the conditions GLP-1s treat well. Off-label prescribing is widespread. The evidence is growing.
The cardiovascular outcomes data — what the SELECT trial actually proved
A 20% reduction in major cardiovascular events. Over 17,000 patients. Without any diabetes. The SELECT trial may be the most important GLP-1 finding since the weight loss data.
The plateau — why weight loss stalls and what you should (and should not) do
Weight loss plateaus on semaglutide typically occur around week 60 in trials. In real practice, many patients experience them much earlier. The mechanism is not what most people assume.
Will you need to take GLP-1s forever? What the evidence says about stopping
The honest answer involves the biology of obesity, the STEP 1 extension data, and an important distinction between “needing to” and “choosing to.”
Identity and body image after significant weight loss — the psychology nobody prepares you for
Losing 15–20% of your body weight changes how you look, how others treat you, and — in ways harder to predict — how you see yourself. Not all of those changes are comfortable.
GLP-1s and alcohol reduction — the emerging research and what it means
A 2025 JAMA Psychiatry RCT confirmed semaglutide significantly reduces alcohol consumption in people with alcohol use disorder. A Swedish cohort of 227,000 patients showed 36% lower hospitalisation risk.
The “quiet mind” effect — what patients report and what the neuroscience says
Patients describe a reduction in food obsession, anxiety and intrusive thoughts that goes beyond appetite suppression. The mechanism is real. The implications are extraordinary.
What the STEP trials said about exercise — and what they failed to measure
The landmark semaglutide trials included “lifestyle counselling” as a standard component. What that actually meant — and what structured exercise would have added — is a story the trials cannot tell.
GLP-1s and energy — when does it actually get easier to move?
Fatigue is commonly reported in the first months. Understanding the mechanism — and the timeline — helps patients build realistic expectations for when exercise becomes sustainable.
GLP-1s and muscle loss — why resistance training is non-negotiable
Most people on GLP-1s are losing weight. Many are also losing muscle. The STEP trials did not require resistance training. That omission may be their most important limitation.