What do to for last 20lbs on Tirz @ max dose

[chewonmysac]

For me, what worked is that once I hit my goal at the end of January, 280 to 200. Plateaued the final 60 days. Took forever to lose the final 6lbs. I went from 15mg Tirz to 12.5 one week. 10mg next week and stayed there for 3 weeks. The plan was to go to maintenance( whatever that is). 2 lbs up or down each week. Then I convinced myself I needed to lose 20 more pounds for an even 100lb loss. Titrated back up to 12.5 one week, then back to 15mg, where I remain today. Lost an additional 14lbs in 5 weeks. One Costco chicken away from my final goal. The dreaded 6 lbs. Sometimes you gotta take one step back to take two steps forward.

 

[Grogu]

Could always roll the dice on sleep and add Sema back…

Who needs sleep?

Yeah, trying Sema again is a good idea too. I just checked and the three months I stacked with Sema I lost 23 pounds. Stopped Sema and basically nothing since then.

 

[tubby]

I'll skip the stuff that I don't think you'd be as receptive to, but I'll point out that in a certain sense, losing the last 20 pounds (while on a GLP) in many ways would be very similar to losing the first 20 pounds (had you never discovered the world of GLPs). There isn't really a universal "best" approach, but more a universe of different approaches that will vary from person to person in effectiveness.

Cagrilintide seems to be the obvious choice in terms of aligning with your personal weight loss belief system, as it's pulling an obviously different lever and would help you eat even less than you're currently eating.

Glucagon-agonism (via ghetto reta) would probably come next on the list for you, as the added sema would help you with perceived hunger control, which would align with your weight loss belief system, while continuing to lose weight.

Transitioning to reta itself would probably come after that because although it would be similarly adding in glucagon-agonism, you'd likely perceive greater hunger and appetite for an extended period and psychologically you'd feel like you were forced to tackle those head on, likely torturing yourself chasing calorie goals during that extended transition period.

GHSs (*morelin) would probably come last on the list because although it's likely to be highly effective, you'd face similar challenges to reta and that would be compounded by potential muscle gain (as well as water retention) causing you to feel like you're losing progress on the scale and you'd probably face the same "calories" challenge reta would provide. Also, since GH tinkering ideally includes additional labwork, monitoring, and other unknowns it might not be the most psychologically comfortable or settling approach.

 

[ambot88]

seems like adding sema is going to be your best bet, you know it works and you have it on hand. Stacking with reta is the other option I'd consider. I'm currently stalled out on reta and was gonna add in tirz this week, love the ability to adjust and figure shit out being in the grey world, the doctor definitely isn't going to let us dial in medication this way.

 

[Grogu]

Cagrilintide seems to be the obvious choice in terms of aligning with your personal weight loss belief system, as it's pulling an obviously different lever and would help you eat even less than you're currently eating.

Although we don't always see eye-to-eye on weight loss philosophy, I really appreciate the comment and totally agree that cagrilintide is the most obvious choice for me — not only physiologically, but mentally too . That's probably why I opted to buy cagri over survo/maz a few months back.

I've been hesitant about the pH thing with cagri, but @cldfront provided a solid roadmap that I think will make me more comfortable with it. Now I just have to track down some sterile acetic acid solution. In the meantime, I'm thinking I'll restart sema on Monday while I work on getting the cagrilintide squared away.

GHSs (*morelin) would probably come last on the list because although it's likely to be highly effective, you'd face similar challenges to reta and that would be compounded by potential muscle gain (as well as water retention) causing you to feel like you're losing progress on the scale and you'd probably face the same "calories" challenge reta would provide. Also, since GH tinkering ideally includes additional labwork, monitoring, and other unknowns it might not be the most psychologically comfortable or settling approach.

Yes, I was thinking at some point I'd like to try tesamorelin, but as you mention (and I agree 100% again) that would come at the end. Because yeah, you've nailed it on the head, any increase on the scale would be unsettling for me . I guess I'm that easy to figure out.

 

[HereKittyKitty]

I mean if you were doing good with a sema stack I would just keep doing that. They compliment each other affinity wise. Tirz for GIP and sema for GLP1. I would just keep doing that until you reach your goal and then drop the sema and maintain on tirz alone.

Good luck! Those last few pounds can be the hardest.

If you had survo, I'd give it a whirl but you have two good options in your hands: cagri & sema.

If Sema is working - or was - I would titrate up a bit on it and leave my Tz dose where it is. Maybe I would try dosing halfway to next Sema dosing guidelines which would add 0.3-0.4mg to your dose, or go to the full 1.7mg Sema dose.

Sema was just approved in the US above originally approved 2.4mg max dosing so you have some runway.

Did you try changing the dosing timing? Full Tz dose, 3 days later Sema? Or shortening the cycle to 6 days - again with Tz + 3 days then Sema?

I currently pin on a 6 day cycle: Tz dose + 3 days to Survo + 3 days to Tz + 3 days to Survo. Just started this plan and very low dose Survo inline with the protocols I've seen.

If it's any consolation, I hit a huge analysis paralysis wall when I plateaued and wasn't seeing results. Started Tz in January. Down 7#. Not a lot but I don't have far to go.

Good luck!!!!

 

[tubby]

Although we don't always see eye-to-eye on weight loss philosophy, I really appreciate the comment and totally agree that cagrilintide is the most obvious choice for me — not only physiologically, but mentally too . That's probably why I opted to buy cagri over survo/maz a few months back.

I've been hesitant about the pH thing with cagri, but @cldfront provided a solid roadmap that I think will make me more comfortable with it. Now I just have to track down some sterile acetic acid solution. In the meantime, I'm thinking I'll restart sema on Monday while I work on getting the cagrilintide squared away.

Yes, I was thinking at some point I'd like to try tesamorelin, but as you mention (and I agree 100% again) that would come at the end. Because yeah, you've nailed it on the head, any increase on the scale would be unsettling for me . I guess I'm that easy to figure out.

Realistically, if I laid out a longer list it might be beneficial for others perusing this thread, but it just wouldn't be useful for you. LOL, it's not that I know you per se, just that I've been in the unorthodox "diet" theories space for a while and most people tend to land in certain categories, depending on the path they took to enter and which zigs and zags they've followed.

Weight loss is an area where it's hard to differentiate between ingenious insight and insane nonsense so it's very rational to put up certain barriers to try to protect yourself from the insane nonsense. If one prefers to frame strategies within a CICO model (which I totally respect), it's going to naturally come with certain preferences and biases. It can be fun to give occasional nudges in regards to that, but if I put myself in your shoes it's easy for me to see why certain outcomes would be distressing or undesirable and anticipate what those might be.

My only real pause with cagrilintide is that it's newer, but then the same could be said of glucagon-agonism (reta) so either way that's part of the rub here.

 

[94brian49]

I'm on the opposite end of the spectrum. Reta has been the strongest for me. When I first started dosing at 10mg, I couldn't eat at all, but it mellowed out after some time. I'm now at 12mg and it has been great so far.

I also stacked it with Sema 8mg. I would say Sema 4mg is equivalent to Reta 12mg in my anecdotal experience.

 

[RadicalCrimson]

When I did my first cagri I mixed 2mL BAC water and 1ml AA and pH was around 5, so I decided to do 50/50 next time. I’ve seen some people also recommend it.

I suppose it depends on your AA’s concentration, that’s why measuring is important.

This made me realize that this was 5 weeks ago, so time for a new vial next week, even though I only used 2mg out of the 5.

Sure enough, this time I mixed 50% Hospira BAC with 50% 0.6% AA, and the pH was right around 4.5.

 

[JuneBug1956]

Have reconstituted Cagri with BAC for a year now. I take Tirz (. 12 mg) Sema( 2.4 mg)and Cagri (2.4 mg) . Take them weekly but on different days. Down 110 lbs and at goal. Love them all. Cagri warms me up from the Tirz freeze.

 

[Spork]

The last 10 lbs was a bitch for me too. When I stalled on 15 mg tirz, I went up to 20 mg. When I stalled on 20 I went to 20 every 6 days. Then 20 every 5 days for the last month. I had no negative side effects. For maintenance I am on 10 mg tirz and I sprinkle in 2.5 Mazdutide every once in a while. I have Cagri and Reta in the freezer if I ever need them.

Did you have an intermediary step of 17.5mg in there, or did you just jump straight from 15mg to 20mg?