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

[chewonmysac]

In my case, the thing that did the trick was this: after reaching my target at the end of January, going from 280 down to 200, I stalled out over the last 60 days. Those final 6 lbs took an eternity to come off. I dropped from 15mg Tirz to 12.5 for 1 week, then 10mg the following week, and held at 10mg for 3 weeks. The idea was to shift into maintenance (whatever that even means), staying within 2 lbs up or down weekly. After that I talked myself into wanting another 20 lbs off so the total would be an even 100lb loss. I went back up to 12.5 for 1 week, then returned to 15mg, which is where I still am now. Over 5 weeks I dropped another 14lbs. I'm 1 Costco chicken away from the final target. That frustrating 6 lbs. At times you have to move back 1 step so you can move ahead 2.

 

[Grogu]

woundcarping said:

One option is to take a chance on sleep and reintroduce Sema…

Who needs sleep anyway?

Yeah, giving Sema another shot is a solid plan too. I looked back and during the three months I stacked it with Sema, I dropped 23 pounds. Once I quit Sema, pretty much no change since then.

 

[tubby]

I'll leave out the parts I figure you wouldn't want to hear, but one thing worth noting: in a way, dropping those last 20 lbs while on a GLP often ends up looking a lot like dropping the first 20 lbs would have, if GLPs had never entered the picture. No single "best" method really exists — instead there's a whole range of options, and how well each one works shifts from one person to the next.

For someone with your particular outlook on weight loss, cagrilintide looks like the clear front-runner, since it works through a distinctly different mechanism and would push your food intake even lower than it already is.

Next up would probably be glucagon-agonism (by way of ghetto reta), because the added sema would give you the hunger control you're after — fitting your weight loss outlook — while the pounds keep coming off.

After that comes switching to reta itself. Yes, it also brings in glucagon-agonism, but you'd probably feel more hunger and appetite for a long stretch, and mentally you'd feel cornered into facing that head-on — likely making yourself miserable while chasing calorie targets through that whole transition.

GHSs (*morelin) would likely land at the bottom of the list. They're probably quite effective, but you'd hit the same obstacles as with reta, made worse by possible muscle gain (plus water retention) that would make the scale look like you're going backwards, and you'd probably run into the same "calories" problem reta brings. On top of that, since GH tinkering ideally means extra labwork, monitoring, and other unknowns, it may not be the most psychologically easy or reassuring route.

 

[ambot88]

adding sema looks like the strongest option for you — you already know it does the job, and it's sitting right there. The alternative I'd weigh is stacking it with reta. Right now reta has me stuck, so my plan was to bring tirz in this week; being in the grey world gives you the freedom to tweak and troubleshoot, whereas a doctor would never sanction this kind of fine-tuning of meds.

 

[Grogu]

tubby said:

I'll leave out the parts I figure you wouldn't want to hear, but one thing worth noting: in a way, dropping those last 20 lbs while on a GLP often ends up looking a lot like dropping the first 20 lbs would have, if GLPs had never entered the picture. No single "best" method really exists — instead there's a whole range of options, and how well each one works shifts from one person to the next.

For someone with your particular outlook on weight loss, cagrilintide looks like the clear front-runner, since it works through a distinctly different mechanism and would push your food intake even lower than it already is.

Next up would probably be glucagon-agonism (by way of ghetto reta), because the added sema would give you the hunger control you're after — fitting your weight loss outlook — while the pounds keep coming off.

After that comes switching to reta itself. Yes, it also brings in glucagon-agonism, but you'd probably feel more hunger and appetite for a long stretch, and mentally you'd feel cornered into facing that head-on — likely making yourself miserable while chasing calorie targets through that whole transition.

GHSs (*morelin) would likely land at the bottom of the list. They're probably quite effective, but you'd hit the same obstacles as with reta, made worse by possible muscle gain (plus water retention) that would make the scale look like you're going backwards, and you'd probably run into the same "calories" problem reta brings. On top of that, since GH tinkering ideally means extra labwork, monitoring, and other unknowns, it may not be the most psychologically easy or reassuring route.

Even though our views on weight-loss approaches don't always line up, I genuinely value your input, and I'm completely with you that cagrilintide stands out as the clearest pick for me — for both physiological and psychological reasons . That's likely why, a few months ago, I chose to purchase cagri rather than survo/maz.

The pH concern with cagri had been holding me back, but @cldfront laid out a clear plan that should help me feel more at ease using it. So now my only task is to find some sterile acetic acid solution. Until then, my plan is to begin sema again on Monday while I sort out the cagrilintide.

tubby said:

I'll leave out the parts I figure you wouldn't want to hear, but one thing worth noting: in a way, dropping those last 20 lbs while on a GLP often ends up looking a lot like dropping the first 20 lbs would have, if GLPs had never entered the picture. No single "best" method really exists — instead there's a whole range of options, and how well each one works shifts from one person to the next.

For someone with your particular outlook on weight loss, cagrilintide looks like the clear front-runner, since it works through a distinctly different mechanism and would push your food intake even lower than it already is.

Next up would probably be glucagon-agonism (by way of ghetto reta), because the added sema would give you the hunger control you're after — fitting your weight loss outlook — while the pounds keep coming off.

After that comes switching to reta itself. Yes, it also brings in glucagon-agonism, but you'd probably feel more hunger and appetite for a long stretch, and mentally you'd feel cornered into facing that head-on — likely making yourself miserable while chasing calorie targets through that whole transition.

GHSs (*morelin) would likely land at the bottom of the list. They're probably quite effective, but you'd hit the same obstacles as with reta, made worse by possible muscle gain (plus water retention) that would make the scale look like you're going backwards, and you'd probably run into the same "calories" problem reta brings. On top of that, since GH tinkering ideally means extra labwork, monitoring, and other unknowns, it may not be the most psychologically easy or reassuring route.

Yeah, I had figured that at some stage I'd want to give tesamorelin a try, but like you said (and I'm 100% in agreement once more), that would be saved for last. Because you're exactly right — seeing any bump on the scale would throw me off . Apparently I'm that transparent.

 

[HereKittyKitty]

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.

Assuming survo were available to you, I'd suggest giving it a shot — but as things stand, you're holding 2 solid choices: cagri and sema.

If Sema has been doing its job — or used to — my move would be to bump that one up slightly while keeping my Tz amount unchanged. One idea: split the difference toward the next Sema step, which works out to roughly 0.3-0.4mg extra, or simply jump all the way to the 1.7mg Sema level.

Since the US has now cleared Sema beyond the original 2.4mg cap, there's still room left to climb.

Have you experimented with shifting when each shot goes in? Take the full Tz amount, then Sema 3 days afterward? Or compress the schedule down to 6 days — same idea, Tz followed by Sema 3 days later?

My own routine right now runs on a 6 day loop: Tz, then 3 days to Survo, then 3 days back to Tz, then 3 days to Survo again. I've only just begun this and the Survo amount is quite small, matching the protocols I've come across.

If it helps at all, I slammed into a wall of analysis paralysis myself once progress stalled and nothing seemed to be moving. My Tz start was January. 7# gone. Modest, but I don't have much left to lose.

Best of luck!!!!

 

[tubby]

Grogu said:

tubby said:

I'll leave out the parts I figure you wouldn't want to hear, but one thing worth noting: in a way, dropping those last 20 lbs while on a GLP often ends up looking a lot like dropping the first 20 lbs would have, if GLPs had never entered the picture. No single "best" method really exists — instead there's a whole range of options, and how well each one works shifts from one person to the next.

For someone with your particular outlook on weight loss, cagrilintide looks like the clear front-runner, since it works through a distinctly different mechanism and would push your food intake even lower than it already is.

Next up would probably be glucagon-agonism (by way of ghetto reta), because the added sema would give you the hunger control you're after — fitting your weight loss outlook — while the pounds keep coming off.

After that comes switching to reta itself. Yes, it also brings in glucagon-agonism, but you'd probably feel more hunger and appetite for a long stretch, and mentally you'd feel cornered into facing that head-on — likely making yourself miserable while chasing calorie targets through that whole transition.

GHSs (*morelin) would likely land at the bottom of the list. They're probably quite effective, but you'd hit the same obstacles as with reta, made worse by possible muscle gain (plus water retention) that would make the scale look like you're going backwards, and you'd probably run into the same "calories" problem reta brings. On top of that, since GH tinkering ideally means extra labwork, monitoring, and other unknowns, it may not be the most psychologically easy or reassuring route.

Even though our views on weight-loss approaches don't always line up, I genuinely value your input, and I'm completely with you that cagrilintide stands out as the clearest pick for me — for both physiological and psychological reasons . That's likely why, a few months ago, I chose to purchase cagri rather than survo/maz.

The pH concern with cagri had been holding me back, but @cldfront laid out a clear plan that should help me feel more at ease using it. So now my only task is to find some sterile acetic acid solution. Until then, my plan is to begin sema again on Monday while I sort out the cagrilintide.

tubby said:

I'll leave out the parts I figure you wouldn't want to hear, but one thing worth noting: in a way, dropping those last 20 lbs while on a GLP often ends up looking a lot like dropping the first 20 lbs would have, if GLPs had never entered the picture. No single "best" method really exists — instead there's a whole range of options, and how well each one works shifts from one person to the next.

For someone with your particular outlook on weight loss, cagrilintide looks like the clear front-runner, since it works through a distinctly different mechanism and would push your food intake even lower than it already is.

Next up would probably be glucagon-agonism (by way of ghetto reta), because the added sema would give you the hunger control you're after — fitting your weight loss outlook — while the pounds keep coming off.

After that comes switching to reta itself. Yes, it also brings in glucagon-agonism, but you'd probably feel more hunger and appetite for a long stretch, and mentally you'd feel cornered into facing that head-on — likely making yourself miserable while chasing calorie targets through that whole transition.

GHSs (*morelin) would likely land at the bottom of the list. They're probably quite effective, but you'd hit the same obstacles as with reta, made worse by possible muscle gain (plus water retention) that would make the scale look like you're going backwards, and you'd probably run into the same "calories" problem reta brings. On top of that, since GH tinkering ideally means extra labwork, monitoring, and other unknowns, it may not be the most psychologically easy or reassuring route.

Yeah, I had figured that at some stage I'd want to give tesamorelin a try, but like you said (and I'm 100% in agreement once more), that would be saved for last. Because you're exactly right — seeing any bump on the scale would throw me off . Apparently I'm that transparent.

Honestly, a bigger list from me could help other folks reading through this thread, but for your situation it wouldn't do much good. LOL, I don't actually know you — it's just that I've spent a long time around unconventional "diet" ideas, and most people end up falling into particular groups based on how they got here and the twists and turns they've taken along the way.

In weight loss, telling apart brilliant insight from complete garbage is genuinely difficult, so drawing some lines to shield yourself from the garbage makes total sense. If someone likes to think about strategies through a CICO lens (which I fully respect), that will come with its own set of leanings and blind spots. Throwing in the occasional nudge about that can be enjoyable, but imagining myself in your position, I can easily see why some results would feel upsetting or unwanted, and I can guess what those would be.

My one genuine hesitation about cagrilintide is simply that it's newer — though the same argument applies to glucagon-agonism (reta), so either way, that's just the nature of the situation.

 

[94brian49]

My situation is the reverse. For me, Reta has packed the biggest punch. At the beginning, when I dosed 10mg, eating was impossible, though that effect softened eventually. These days I'm on 12mg and it's been working really well.

On top of that, I stacked Sema 8mg with it. From my own anecdotal experience, Sema 4mg feels about the same as Reta 12mg.

 

[RadicalCrimson]

RadicalCrimson said:

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.

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.

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.

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.

As expected, on this occasion I combined 50% Hospira BAC and 50% 0.6% AA, which brought the pH to approximately 4.5.

 

[JuneBug1956]

For 12 months I've been mixing Cagri using BAC. My weekly stack consists of Tirz (0.12 mg), Sema (2.4 mg), and Cagri (2.4 mg), each injected on separate days. I've dropped 110 lbs and reached my target. All 3 work great for me. Cagri takes away the cold feeling that Tirz gives me.

 

[Spork]

swimmer said:

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.

Was there a middle dose of 17.5mg you used, or did you go directly from 15mg up to 20mg?