At the Tirzepatide Ceiling: How to Shed the Final 20 lbs?

Grogu

Grogu

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To keep it brief: I've been using tirzepatide for roughly 15 months, and this morning I injected 18mg. My total loss so far is 107lbs, and today's scale reading was 228. Getting down to 205 would push me into the "normal" BMI range for my height, which is what I'm aiming for. At the end of November I added a small semaglutide stack, and my weight kept dropping, but I halted it around March when my sleep fell apart. Looking back, I suspect sema wasn't the culprit.

This past Monday I took 5mg of tirz mid-week, and it felt great—though in hindsight, that seems like an extreme amount considering my weekly tirz dose has been 17mg.

My plan is to push protein harder and increase exercise, but I'm hoping someone here has suggestions for these last 20-23lbs. Currently my stockpile contains only tirz, sema, reta, and cagri. One idea was to pick up some maz or survo and run a "ghetto reta" combo, or would switching over to reta entirely make more sense? The one thing that gives me pause about reta is reports of weaker food noise suppression. Should I return to the sema stack and keep titrating sema upward until I hit sema's max dose? I had been at 1mg—or maybe I should reduce tirzepatide and go all-in on sema? Ordering max or survo is possible, but delivery will take a while. I'm just unsure which direction is best.
 
For two or three weeks now, my total has been 19.5mg. (It has to be three, going by the vial count.) I take 12.5 or 13mg on Wed./Thurs. The rest goes on Sat.

At first, a couple pounds a week came off, but then vacation hit and it all fell apart. I put 5lbs back on. Still, had I stayed on track, I figure I would have been fine.

In the same way, I'm sitting at 270 and aiming for 250. Another 6 months is what I'm allowing myself. If I get there, great. If not, I've still dropped 60/70lbs. As for what comes after those 6 months, I have no idea?
 
Sasquatch said:

For two or three weeks now, my total has been 19.5mg. (It has to be three, going by the vial count.) I take 12.5 or 13mg on Wed./Thurs. The rest goes on Sat.

At first, a couple pounds a week came off, but then vacation hit and it all fell apart. I put 5lbs back on. Still, had I stayed on track, I figure I would have been fine.

In the same way, I'm sitting at 270 and aiming for 250. Another 6 months is what I'm allowing myself. If I get there, great. If not, I've still dropped 60/70lbs. As for what comes after those 6 months, I have no idea?
Click to expand...

Adding 5mg next Monday is an option, which would bring my weekly total to 23mg. During Monday through Wednesday of last week, the only thing I noticed was a complete lack of appetite 🤣, though eating wasn't difficult at all.

Looking at the tirzepatide clinical trials, I've likely reached the stage where this medication stops producing further weight loss. That makes me question whether increasing the tirzepatide dose is actually the solution. It seems like a change of approach is needed.
 
Sure, I lean on the trials and studies since I don't really have any other solid guidance. (No disrespect to the folks here on the forum.) That's the reason I treat a year and a half as a milestone.

Dropping more than 100lbs.! You've already come out on top! It just depends how you look at it. Spend time on this proactive, positivity-focused forum and you'd get the impression that people just take the stuff and cruise straight down to their goal weight. Simple as that. Well, the "study" does show a big share of success, but a share is still just a share.

Truthfully, I'm fucking old and only getting older. I've dropped a fair amount. It isn't making me any better looking. The last coat was pretty dry well before I ever started this shit. Another 20 pounds would be good, but in percentage terms especially, it won't add up to much. I wish I could claim 15lbs. is only 3 healthy shits, but those days are gone.🤣
 
I just gave myself my 61st tirz injection. There are still 14 lbs left before I hit my goal, yet across 5 weeks the scale has only moved down by 1/2 lb. It honestly seems as though the medication has stopped working — the food cravings are creeping back. That said, my most recent injection was 20mg rather than 15mg, and the change is unmistakable: no food cravings whatsoever. I had previously tried 17.5mg, but it felt no different than 15mg. I'm hoping this doesn't mean the dose has to keep climbing higher and higher. Where that road ends, nobody can say.
 
If you haven't truly hit a plateau, what's the reason for changing anything? Ramp up how hard you train, using bursts of high intensity. Put your emphasis on building muscle rather than chasing weight loss. Those final pounds often come off very slowly.
 
At the midpoint to your next 17mg tirz shot, layer in 6mg of Reta. Trim the tirz down to 12-15mg. Then give it roughly 24-48 hours and check where your food noise sits before topping tirz up again ahead of the following Reta.
 
Summer48 said:

I just gave myself my 61st tirz injection. There are still 14 lbs left before I hit my goal, yet across 5 weeks the scale has only moved down by 1/2 lb. It honestly seems as though the medication has stopped working — the food cravings are creeping back. That said, my most recent injection was 20mg rather than 15mg, and the change is unmistakable: no food cravings whatsoever. I had previously tried 17.5mg, but it felt no different than 15mg. I'm hoping this doesn't mean the dose has to keep climbing higher and higher. Where that road ends, nobody can say.
Click to expand...

Lilly has a clinical trial underway right now that is evaluating tirzepatide at doses above the standard range, and since they haven't halted it over safety concerns, and the two of us have made it through larger doses without issue 🤣, it's fair to say 15mg isn't the ceiling. I figured I could push as high as 25mg without problems 🤷🏻‍♂️, though I'm not convinced that's the smartest route.
 
If a sema stack was working well for you, my advice is to stick with it. From an affinity standpoint, the two work well together: tirzepatide covers GIP while semaglutide covers GLP1. I'd continue that combination until you hit your target, then stop the sema and hold steady on tirz alone.

Best of luck! The final few pounds are often the toughest.
 
Devilseye said:

If a sema stack was working well for you, my advice is to stick with it. From an affinity standpoint, the two work well together: tirzepatide covers GIP while semaglutide covers GLP1. I'd continue that combination until you hit your target, then stop the sema and hold steady on tirz alone.

Best of luck! The final few pounds are often the toughest.
Click to expand...

Revisiting semaglutide is a valid idea. I did well on it, and I've since realized the sleep problem I had wasn't caused by sema. That might work as an option.
 
woundcarping said:

At the midpoint to your next 17mg tirz shot, layer in 6mg of Reta. Trim the tirz down to 12-15mg. Then give it roughly 24-48 hours and check where your food noise sits before topping tirz up again ahead of the following Reta.
Click to expand...

Honestly, the only reason I bought reta in the first place was because I figured tirz would eventually quit doing its job, and I'd need a different option to cross the finish line. So yeah, I'm absolutely open to trying reta — otherwise, why am I sitting on a stockpile of it? Nothing is set in stone. If reta doesn't sit well with me, I can always go back to stacking it with sema. Do you figure 6mg is too high for a first injection?
 
Cagri? Once I raise Tirz from 15 to 20mg, that's what I'll try next. Reta gives me trouble, and the Survo stack did little for me and came with sides.
 
cldfront said:

Cagri? Once I raise Tirz from 15 to 20mg, that's what I'll try next. Reta gives me trouble, and the Survo stack did little for me and came with sides.
Click to expand...

In hindsight, that's probably the reason cagri needs to be an option for me. I can't recall why I decided against Survo, but I did. After that, I came across the pH problem and the fibril concern tied to cagri, which made me a bit wary. Even so, I plan to revisit cagri.
 
Grogu said:

cldfront said:

Cagri? Once I raise Tirz from 15 to 20mg, that's what I'll try next. Reta gives me trouble, and the Survo stack did little for me and came with sides.
Click to expand...

In hindsight, that's probably the reason cagri needs to be an option for me. I can't recall why I decided against Survo, but I did. After that, I came across the pH problem and the fibril concern tied to cagri, which made me a bit wary. Even so, I plan to revisit cagri.
Click to expand...
Same situation here. After looking into it, I pulled this from a thread on this site since it seemed like the "best practices" approach. I ordered pH strips and 0.6% acetic acid from Amazon, and I'm ready to try it out (sorry, I don't know who originally posted this):

If you're someone who wants exact replication of Novo Nordisk's formula, this simple process works:

  • Combine your 10 mg or 5mg cagrilintide vial with 2 ml of regular BAC water. Swirl gently until it's fully dissolved—don't shake it hard.
  • Then, add roughly 0.2 ml of 0.6% acetic acid solution (sterile for pharmaceutical use) slowly. This mild acid is safe to inject.
  • Stir gently again and test the pH using narrow-range strips (you're aiming for about pH 4.0–4.5).
  • If the pH is still too high, add more 0.05 ml increments of the 0.6% acetic acid, testing pH after each addition. You'll probably hit the right level with a total of around .25-40 ml added.
  • After a few tries, this becomes really simple. It keeps your peptide chemically stable and matches what Novo would do if they offered a single vial.
 
cldfront said:

Grogu said:

cldfront said:

Cagri? Once I raise Tirz from 15 to 20mg, that's what I'll try next. Reta gives me trouble, and the Survo stack did little for me and came with sides.
Click to expand...

In hindsight, that's probably the reason cagri needs to be an option for me. I can't recall why I decided against Survo, but I did. After that, I came across the pH problem and the fibril concern tied to cagri, which made me a bit wary. Even so, I plan to revisit cagri.
Click to expand...
Same situation here. After looking into it, I pulled this from a thread on this site since it seemed like the "best practices" approach. I ordered pH strips and 0.6% acetic acid from Amazon, and I'm ready to try it out (sorry, I don't know who originally posted this):

If you're someone who wants exact replication of Novo Nordisk's formula, this simple process works:

  • Combine your 10 mg or 5mg cagrilintide vial with 2 ml of regular BAC water. Swirl gently until it's fully dissolved—don't shake it hard.
  • Then, add roughly 0.2 ml of 0.6% acetic acid solution (sterile for pharmaceutical use) slowly. This mild acid is safe to inject.
  • Stir gently again and test the pH using narrow-range strips (you're aiming for about pH 4.0–4.5).
  • If the pH is still too high, add more 0.05 ml increments of the 0.6% acetic acid, testing pH after each addition. You'll probably hit the right level with a total of around .25-40 ml added.
  • After a few tries, this becomes really simple. It keeps your peptide chemically stable and matches what Novo would do if they offered a single vial.
Click to expand...

This is really helpful — thank you! The guidance on getting the pH right sounds solid, and I think it’s a smart move. It would certainly put me more at ease.
 
That final 10 lbs was brutal for me as well. Once 15 mg tirz stopped working, I bumped it to 20 mg. After 20 mg stopped working, I switched to 20 mg every 6 days. Then for the past month, I've been doing 20 mg every 5 days. I experienced zero negative side effects. Now for maintenance, I take 10 mg tirz and occasionally add 2.5 Mazdutide. I've got Cagri and Reta sitting in the freezer in case I ever need them.
 
cldfront said:

Grogu said:

cldfront said:

Cagri? Once I raise Tirz from 15 to 20mg, that's what I'll try next. Reta gives me trouble, and the Survo stack did little for me and came with sides.
Click to expand...

In hindsight, that's probably the reason cagri needs to be an option for me. I can't recall why I decided against Survo, but I did. After that, I came across the pH problem and the fibril concern tied to cagri, which made me a bit wary. Even so, I plan to revisit cagri.
Click to expand...
Same situation here. After looking into it, I pulled this from a thread on this site since it seemed like the "best practices" approach. I ordered pH strips and 0.6% acetic acid from Amazon, and I'm ready to try it out (sorry, I don't know who originally posted this):

If you're someone who wants exact replication of Novo Nordisk's formula, this simple process works:

  • Combine your 10 mg or 5mg cagrilintide vial with 2 ml of regular BAC water. Swirl gently until it's fully dissolved—don't shake it hard.
  • Then, add roughly 0.2 ml of 0.6% acetic acid solution (sterile for pharmaceutical use) slowly. This mild acid is safe to inject.
  • Stir gently again and test the pH using narrow-range strips (you're aiming for about pH 4.0–4.5).
  • If the pH is still too high, add more 0.05 ml increments of the 0.6% acetic acid, testing pH after each addition. You'll probably hit the right level with a total of around .25-40 ml added.
  • After a few tries, this becomes really simple. It keeps your peptide chemically stable and matches what Novo would do if they offered a single vial.
Click to expand...
For my initial cagri preparation, I combined 2mL BAC water with 1ml AA, which gave a pH near 5, so I went with a 50/50 ratio the next time. Others have suggested doing the same.

I guess it comes down to how concentrated your AA is, which is why it's crucial to measure.

This reminded me that it was 5 weeks ago, so I'll need a fresh vial next week, despite having used only 2mg from the 5.
 
My starting point differs quite a bit, since I only turned to GLP's to keep hunger in check after I'd already dropped weight. Still, my reasoning went like this: reta turned out to be remarkably effective at low doses for producing weight loss — 9% at 1mg across a year — so I paired a modest dose of it with 15mg of tirz. Swapping wasn't appealing, because tirz gave me almost no side effects while ozempic hit me hard. I finished at 15mg tirz plus 5mg reta, and over 9 months I went from 79 to 66 kg, a further 13 kg lost. But I'd only been on tirz for 1 month before bringing in the reta, so I can't really speak to how plain tirz compares with tirz plus reta, beyond feeling less hungry on both.

My thinking is that you pick up a bit more GIP and GLP-1, along with the glucagon contribution from reta, and maybe fewer side effects than you'd get from higher reta doses alone. It isn't all that different from simply raising tirz, except you gain the glucagon agonism.

Another route is adding small doses of cagri, though that probably comes with somewhat greater odds of nausea and fatigue. So it may hinge on how sensitive you were to those effects from tirz — though I'm not sure how closely they track, since it works on different receptors in different brain regions.

My reasoning is that the dangers of above-standard doses or combinations are probably smaller than the dangers of severe obesity. If you've already dropped 107 lbs and still want to lose 20 more, you likely began in that category. I'd put the theoretical risks of cagri and fibrils in roughly the same territory — they could matter — but achieving and holding onto a large weight loss has a huge impact on long-term health risks. The relative risks are probably separated by orders of magnitude.
 
staffn1 said:

If you haven't truly hit a plateau, what's the reason for changing anything? Ramp up how hard you train, using bursts of high intensity. Put your emphasis on building muscle rather than chasing weight loss. Those final pounds often come off very slowly.
Click to expand...

I'm clearly stuck. Looking at the numbers, my weight has fluctuated, yet it's essentially unchanged from where I was in early March. That timing lines up with when I removed semaglutide from my regimen.
 
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