Titrating down and Efficacy

[Mayostardayonnaise]

I am beginning the process of titrating down on Tirz. I am pretty much at my goal weight of 170 - my ultimate goal was 160, but I’m going to lose that very slow while I work on building muscle.

For those of you that have/are titrating down, did you ever titrate too low at first (meaning the hunger suppression wasn’t doing it, or you gained weight), then decided to go back up just a bit the next week? And if so, how did that affect the efficacy of the med, if at all?

 

[woundcarping]

Finding your maintence dose while still wanting to lose 6% of your weight seems confounding.

My plan is based around the idea that my cutting dose is higher than my equilibrium or maintence dose. My target is to have some abs visible, nothing extreme, just the uppers making a shadow of a line in great lighting works for me. I’ll start moving my dose down around that time and track my weight’s simple moving average to dial the dose in. There will be some back and forth for sure and DEXA scans to track/adjust baseline for composition changes. Signal noise will also have to be allowed for with some variety of practical guardrails in place, something like 185lb +5lb/-3lb(to be determined) to allow the system to stabilize into longer term cruising without as much oversight/micromanagement.

Trying to judge dose from static week to week weights will be chasing your tail.

 

[Mayostardayonnaise]

Thank you that clarifies the process for me a lot. I’m honestly not sure what my weight should be, but I’m close enough to 160 that my brain is doing a bit of a “f it let’s start reducing”. It’s possible I jumped the gun. The eagerness to reduce is from me not eating enough - I would say for the past month it has been really hard to eat over 1300/day. I’m open to taking it possibly forever.

P.S. Not gonna lie, I am nervous about maintenance.

 

[woundcarping]

Possibly don’t overthink it could be some decent advice,

…I would say for the past month it has been really hard to eat over 1300/day…

How do you feel? 1300 calories at 170lb doesn’t scream crazy low for a cut. That’s my approximate deficit over the last 22 weeks, I’ve dropped 54lb not counting the ~2-4lb of water creatine added (56-58lb in total, most likely).

Have you tracked your weight loss over time? I have an app, spreadsheet, and scans to calculate my deficit and project where I’m headed and when.

I’m not super worried about getting too skinny, that’s never been an issue so far in my life. If I feel fine and the metrics are ok, I don’t stress about it. When I get to maintence, it seems unlikely that I’ll accidentally drop below the 170’s when my target is likely 180-190lb. It’s not hard to adjust the knob either way, and with practical guardrails there shouldn’t be much anxiety with it.

 

[DunningKruger]

No need to be nervous about maintenance if you go slowly. Definitely listen to WoundCarping here. I would not focus on titrating with 10 lbs left to lose. The minute you drop the dose, you will likely stop losing entirely. I did.

I'm titrating off Reta atm, and it's a slow process that I monitor weekly. I had 20 lbs to lose (2.5 months) , only went as high as 4mg, and originally thought, "I'll just cut the dose in half for a few weeks, then halve it again for a few, and so on."

Nope. The hunger can come back with a vengeance, and after weight loss your body is running in a more energy-efficient state. When you start refeeding, metabolism doesn’t always rebound as quickly as appetite does, so the margin for error is small. I started gaining immediately, even with calories below what should maintain my size and activity.

Now I only drop by 0.5 mg every two to three weeks while increasing daily calories by 100–200. If my weight trend moves up, I hold the dose or bump it back up 0.5 mg. If I maintain for two weeks at the higher caloric intake, then I reduce again.

A smart scale or trend-tracking app helps a lot. Don’t make decisions off one weigh-in; use the trend.

It has taken me almost as long to get off Reta as it took to lose the weight. Letting the hunger signalling come back gradually has been much more tolerable than dropping the dose too quickly. An unexpected benefit is that by going so slowly, my Reta OMAD eating schedule has stayed the same, just with more calories. I still have no desire to snack midday unless I’ve had a hard workout that needs refuelling.

 

[woundcarping]

…The minute you drop the dose, you will likely stop losing entirely. I did.

…I had 20 lbs to lose (2.5 months) , only went as high as 4mg…

Them ain’t big’n numbers!

Right now I plan on cutting my dose by a third when I start maintenance. We’ll see what happens with appetite and such, but practically I don’t expect crazy things regarding appetite. On the high side maybe I can get down to 8mg/week but we’ll see. Practically it doesn’t matter all that much based on existing data of long term risks.

 

[Mayostardayonnaise]

I have more research to do, wow thanks you guys. The immediate ravenous hunger and possible substantial weight gain is not something I want. I’m staying on 6. Everything you both said makes sense. I don’t think I’ve been at this weight long enough to do ANY of that yet.

 

[woundcarping]

I have more research to do, wow thanks you guys. The immediate ravenous hunger and possible substantial weight gain is not something I want. I’m staying on 6. Everything you both said makes sense. I don’t think I’ve been at this weight long enough to do ANY of that yet.

TLDR:

Assuming you’re intelligent enough to keep weighing yourself, mindful of your hunger/intake, and not blinded by anxiety; actually working the dose down isn’t exciting… the people who dropped to 0mg didn’t balloon uncontrollably fast, and they didn’t have a Chinese muzzle on hand.

Ravenous hunger sounds scary but it’s practically not a big deal and not something to be scared of or be dramatic about.

Let’s say that your maintenance is somewhere around 1800 calories. You undershoot your dose and you get “ravenously hungry.” Let’s say that in absolute fit of unbridled caloric decimating rage you consume a 5000 calories the first day, wake up and do it again the second day. Day three you realize in fact you’re a whole person with just a modicum of self awareness and tools at hand to make hunger a non issue. You take the remainder of your regular dose that you didn’t take before… but egads it takes a day to peak and you eat 4000 calories because you just can’t control yourself. Day 4 you wake up insanely full to the point of nausea, your Chinese food muzzle is back in full effect.

End result, high side you gained 2.5lb of fat that takes a few weeks for the muzzle to resolve. There would be varieties of water weight that would push the peak gain higher, almost assuredly.

Granted I haven’t done it yet, but the sustained ravenous hunger isn’t a thing unless you want it t to be. Gaining 2.5lb of fat in 3 days requires enormous concerted effort and amazing metabolic efficiency. Dramatic fear mongering is a peeve of mine; a general observation more than this thread specifically but “ravenous hunger” and “substantial weight gain” apparently set me off.

Looking at the trial data’s approximate averages, where ~2/3 of the participants were at 15mg/week of Tirz 1/3 at 10mg and they dropped to 0mg:

The average weight gain after a year was .6lb/week. The peak gain was in the first couple of months, peaking around .8-1lb/week.

 

[Grogu]

I am beginning the process of titrating down on Tirz. I am pretty much at my goal weight of 170 - my ultimate goal was 160, but I’m going to lose that very slow while I work on building muscle.

For those of you that have/are titrating down, did you ever titrate too low at first (meaning the hunger suppression wasn’t doing it, or you gained weight), then decided to go back up just a bit the next week? And if so, how did that affect the efficacy of the med, if at all?

There really haven't been any research studies, at least that I'm aware of, that have looked at the best way to transition from weight loss to maintenance on glp-1 medications. So, what we have is largely anectdotal evidence. Not that that isn't helpful, but the bottom line is that you're going to have to find what works best for you.

I have about 20lbs to lost to reach goal, so I'm not at that the maintenance point yet, but when I get there, my "plan" is to stay on whatever dose I am on of tirzepatide for at least a year. What we do know from the clinical trials is that weight loss on these medications plateaus and that study participants who stayed on the same dose of tirzepatide maintained stable weights. It will be refreshing for me to maintain a stable weight for a long period of time, which is something I've never been able to do. So, honestly, I'm in no rush to stop taking tirzepatide and will probably be on it the rest of my life. I'm also, actually, in no rush to titrate down quickly or at all. Eventually, if after a year or so of stable weight, I wouldn't mind trying to titrate down, but it would be something I do slowly and iteratively.

 

[longestyards]

You should also consider that if you’ve lost a lot of weight (say 20-30 lbs) and now you want to stay at maintenance that your body is still gonna send those hunger signals. It is gonna send it harder than before you lost the weight, because now it wants to get back those 20-30 lbs. So, you should consider that you might just gain everything back if you titrate down to nothing. I think it’s probably best idea to titrate down to a level where you can maintain without it being a willpower thing. Then keep using the dosage for at least a few years, but ideally as long as possible. The data shows that 80% of the people who lose weight regains it back in 2-5 years time… some studies shows it can take 5+ years before the body sets a new “set point”, where it no longer is trying to gain back those 20-30 lbs.

 

[lessthanhalf]

I agree that how much weight has been lost is important . If it has been 50 kilos or 100lbs it really is a different issue to 20 lbs, and if wanting to maintain a large weight loss , very careful titration down is a good idea , or better yet just stay at the dose that worked to get you there assuming you had stalled by then and weight loss had stopped. If you were still losing weight at your target then reducing doses is probably reasonable.

In the end it is the maintenance stage that really matters, it is the long term in terms of health effects, and it is where GLP drugs are vastly superior to any diet and exercise based weight loss, because maintaining them long term requires not a lot of effort, just an injection a week, rather than years of starving yourself. And the success rates long term of the two strategies reflect this difference.

The only real important issue with dropping doses after getting to target is to plan for what to do if or when weight goes back up and not let it get out of hand before you restart or increase doses.

In general in the studies once weight loss had stopped, maintaining that dose , maintained that weight long term for up to 4 years of follow up, so do not be surprised if you need to stay on the dose you were on . But there are quite a few on this forum who seem to be using much lower maintenance doses than losing doses so who knows.

 

[lessthanhalf]

You should also consider that if you’ve lost a lot of weight (say 20-30 lbs) and now you want to stay at maintenance that your body is still gonna send those hunger signals. It is gonna send it harder than before you lost the weight, because now it wants to get back those 20-30 lbs. So, you should consider that you might just gain everything back if you titrate down to nothing. I think it’s probably best idea to titrate down to a level where you can maintain without it being a willpower thing. Then keep using the dosage for at least a few years, but ideally as long as possible. The data shows that 80% of the people who lose weight regains it back in 2-5 years time… some studies shows it can take 5+ years before the body sets a new “set point”, where it no longer is trying to gain back those 20-30 lbs.

In the 3 1/2 years since I started losing weight, from 145 kg to 75 kg then 75 kg to 65kg, with or without GLP drugs, the number of calories per day required to stay weight neutral has not changed, about 1600-1900 kcal/day, with no signs of changing one way or the other , and almost exactly half what it was at 145kg. 58yo male 167cm. I wish that last statement was true , but my experience has been that energy expenditure goes down with weight loss and hunger goes up and this has been maintained long term, with no signs of improvement either in 2012-2015 or 2022 to 2026, not quite 5 years, but without GLP drugs hunger was always there after losing weight. The ability of GLP drugs to control hunger, even in this post weight loss state is possibly their biggest benefit.

 

[Grogu]

In general in the studies once weight loss had stopped, maintaining that dose , maintained that weight long term for up to 4 years of follow up, so do not be surprised if you need to stay on the dose you were on . But there are quite a few on this forum who seem to be using much lower maintenance doses than losing doses so who knows.

Yes, there are definitely folks on this forum on lower maintenance doses than they used for weight loss, folks who have spread out dosing, and folks using different stacks to maintain with success. It’s really a shame we don’t have better empirical evidence on maintenance strategies. But even if we did, it seems like there are so many responses to these medications themselves (e.g., from non-responders to hyper-responders) that what works for one person may not work for the next. I have a family member who’s lost 50+ pounds on weekly 2.5mg doses of tirzepatide. Go figure. Maintenance is probably going to look different for her than my maintenance dosing or regime.

 

[JCO79]

I’ve had the same experience that after weight loss without glp1, the increased hunger never goes away. I have been maintaining for about 4 years and it requires constant discipline and lots of will power. My hope with glp1s is to make this less of a struggle.

 

[LongevitybroTX]

You should also consider that if you’ve lost a lot of weight (say 20-30 lbs) and now you want to stay at maintenance that your body is still gonna send those hunger signals. It is gonna send it harder than before you lost the weight, because now it wants to get back those 20-30 lbs. So, you should consider that you might just gain everything back if you titrate down to nothing. I think it’s probably best idea to titrate down to a level where you can maintain without it being a willpower thing. Then keep using the dosage for at least a few years, but ideally as long as possible. The data shows that 80% of the people who lose weight regains it back in 2-5 years time… some studies shows it can take 5+ years before the body sets a new “set point”, where it no longer is trying to gain back those 20-30 lbs.

This is exactly correct, there are some data out there from studies that show it takes minimum 6-months for grehlin/leptin to calm their asses back down after a substantial weight loss. Those first few months can be hell as your body wants to get back to it's 'set point' (I dont truly believe in a 'set point', but I've gained and lost enough weight over the years that I sure do understand how difficult maintenance can be).

As someone who lost around 90lbs on Tirz over the course of a year, and now have been maintaining for about a year and a half, I never titrated down in maintenance, but I'm the type who's always been able to 'eat through the tirz'. Now, I'm starting to experiment with adding a bit of Reta on top and reducing the tirz a bit, mostly for funsies.

 

[longestyards]

In the 3 1/2 years since I started losing weight, from 145 kg to 75 kg then 75 kg to 65kg, with or without GLP drugs, the number of calories per day required to stay weight neutral has not changed, about 1600-1900 kcal/day, with no signs of changing one way or the other , and almost exactly half what it was at 145kg. 58yo male 167cm. I wish that last statement was true , but my experience has been that energy expenditure goes down with weight loss and hunger goes up and this has been maintained long term, with no signs of improvement either in 2012-2015 or 2022 to 2026, not quite 5 years, but without GLP drugs hunger was always there after losing weight. The ability of GLP drugs to control hunger, even in this post weight loss state is possibly their biggest benefit.

Probably how I worded it badly but what you wrote here from your experience is exactly what I tried to convey.

This is exactly correct, there are some data out there from studies that show it takes minimum 6-months for grehlin/leptin to calm their asses back down after a substantial weight loss. Those first few months can be hell as your body wants to get back to it's 'set point' (I dont truly believe in a 'set point', but I've gained and lost enough weight over the years that I sure do understand how difficult maintenance can be).

As someone who lost around 90lbs on Tirz over the course of a year, and now have been maintaining for about a year and a half, I never titrated down in maintenance, but I'm the type who's always been able to 'eat through the tirz'. Now, I'm starting to experiment with adding a bit of Reta on top and reducing the tirz a bit, mostly for funsies.

lol I feel I can eat through reta as well. Like if I start eating, I can easily just not stop. But I do stop because I am conscious about losing weight. But I definitely get you.

 

[Grogu]

(I dont truly believe in a 'set point', but I've gained and lost enough weight over the years that I sure do understand how difficult maintenance can be).

There are many issues with "set point" theory. I think that issue that has troubled me the most is the directional asymmetry. Specifically, that it's rather difficult to reduce a person's set point, but returning to a higher previous set point seems pretty easy.

Rather than think of a set point, I've come to apprectiate the concept of defended fat mass. Specifically, that your body has a specific amount of fat it has decided it needs to survive, and it will fight hard to keep that amount. When fat stores drop below that level, your brain responds by making you hungrier, slowing your metabolism, and reducing your energy (all at the same time) until the fat comes back.

The problem is that this defended level can creep upward over time, but almost never resets downward on its own. So the body that once defended 180 pounds of fat mass will, after years of obesity, defend 240 pounds just as fiercely, and after weight loss, will work relentlessly to get back to 240, not 180.

Set point theory seems to suggest that if we stay at a lower weight long enough or adjust our behaviors well enough, that our bodies will reset to a lower set point. I haven't seen any data to suggest that anything less than bariatric surgery will have a lasting effect on a person's set point, if one even exists.

I would say that bariatric surgery does appear to have adjusted my "set point" if I had one. Prior to surgury in 2003, I weighed 455 pounds. Since then, I've gained and lost weight, but never weighed more than 335. Not that that is good, but it's better than 455.

 

[UghItsStupidNIHateIT]

TLDR:

Assuming you’re intelligent enough to keep weighing yourself, mindful of your hunger/intake, and not blinded by anxiety; actually working the dose down isn’t exciting… the people who dropped to 0mg didn’t balloon uncontrollably fast, and they didn’t have a Chinese muzzle on hand.

Ravenous hunger sounds scary but it’s practically not a big deal and not something to be scared of or be dramatic about.

Let’s say that your maintenance is somewhere around 1800 calories. You undershoot your dose and you get “ravenously hungry.” Let’s say that in absolute fit of unbridled caloric decimating rage you consume a 5000 calories the first day, wake up and do it again the second day. Day three you realize in fact you’re a whole person with just a modicum of self awareness and tools at hand to make hunger a non issue. You take the remainder of your regular dose that you didn’t take before… but egads it takes a day to peak and you eat 4000 calories because you just can’t control yourself. Day 4 you wake up insanely full to the point of nausea, your Chinese food muzzle is back in full effect.

End result, high side you gained 2.5lb of fat that takes a few weeks for the muzzle to resolve. There would be varieties of water weight that would push the peak gain higher, almost assuredly.

Granted I haven’t done it yet, but the sustained ravenous hunger isn’t a thing unless you want it t to be. Gaining 2.5lb of fat in 3 days requires enormous concerted effort and amazing metabolic efficiency. Dramatic fear mongering is a peeve of mine; a general observation more than this thread specifically but “ravenous hunger” and “substantial weight gain” apparently set me off.

Looking at the trial data’s approximate averages, where ~2/3 of the participants were at 15mg/week of Tirz 1/3 at 10mg and they dropped to 0mg:

The average weight gain after a year was .6lb/week. The peak gain was in the first couple of months, peaking around .8-1lb/week.

Sorry Chinese food muzzle is now my new favorite phrase

 

[Grogu]

Sorry Chinese food muzzle is now my new favorite phrase

Yes, Chinese food muzzle is pretty funny, but true.