The slow GLP-1 step-up, as people actually do it
Written by Aaron Cuha
Reach a GLP-1 dose you can handle without the gut side effects, or stay below the label dose on purpose
Patterns that get passed around on peptide forums and in sellers' dosing guides. Nobody measured anything properly in any of these. They are listed here as reports, not findings.
Not advice. This is a record of a schedule, not a dose for you.
The schedule, as reported
Each field below is what the source states, not a rounded version of it. Where the source does not publish a detail, the field says so instead of filling the gap.
- Amount
- Pharmacy-mixed (compounded) vials, drawn to amounts the pens do not offer. People describe starting as low as 0.25 mg to 1.5 mg of tirzepatide a week, against the 2.5 mg the label starts at.
- How often
- Once weekly
- How it is taken
- A shot under the skin, drawn from a pharmacy-mixed vial instead of a fixed-dose pen
- How long
- Each step held for four weeks or longer, and often held at a low dose for good instead of stepping up at all
What was measured
Body weight on a home scale, and how the person feels. Almost nobody doing this measures any of the things the studies measured. And nobody is checking what dose actually reached them from a drawn vial.
What was reported
Reports, not findings. Nothing below came from a fair side-by-side test.
People describe staying on a low dose because it is enough for them, or because it costs less, instead of stepping up to the label's ongoing dose.
Nausea is the reason most often given for holding a step longer than four weeks.
The approved step-up is treated as the fastest you should go, not a target to reach.
These are accounts of what people chose to do. No weight loss number from any study applies to any of them.
Where this comes from
Write-ups on tiny doses (microdosing) of pharmacy-mixed tirzepatide, and the practice people usually tie to r/tirzepatidecompound on Reddit. What it is compared to is not in dispute: the approved schedule is 2.5 mg once a week for four weeks, then 2.5 mg more every four weeks. That is the schedule SURMOUNT-1 used.
Reddit blocks automated reading, so those threads could not be read for this entry. The below-label starting amounts above come from published microdosing write-ups. Several describe licensed prescribers using them outside the label. Nothing here shows how many people do this or what happens to them.
What this protocol cannot tell you
Required on every entry in this registry, and never empty.
Every result that makes people want a GLP-1 came from a study that stepped up to a full ongoing dose and stayed there. Someone who stops at a fraction of that dose has no number to expect. Nobody has tested below-label doses against the label schedule. So nobody knows whether a slower ramp cuts nausea overall, or just pushes it later. Pharmacy-mixed vials are not checked for what is in them the way an approved pen is. And drawing a dose from a vial is less exact than clicking a pen. Nobody is keeping watch on any of this.
The compounds in this protocol
Each profile has the full evidence record, the legal status and what the studies did not show.
- TirzepatideStrong. At least two finished studies in people, and at least 1,000 people who took it. 9 completed trials, 22,802 people given it.11 reported
A once a week shot that works on two hunger and blood sugar signals, GIP and GLP-1. In studies it led to more weight loss and lower blood sugar than drugs that work on GLP-1 alone.
- SemaglutideStrong. At least two finished studies in people, and at least 1,000 people who took it. 12 completed trials, 42,363 people given it.10 reported
A once a week shot for type 2 diabetes and weight loss. It is approved, and big studies show it also lowers the risk of heart attack and stroke.