Alice Oglethorpe
GLP-1 medications have gained attention for their effectiveness in supporting weight loss. Some people are trying microdosing—taking smaller, flexible doses, often through compounded versions of these medications—to minimize side effects while still reaping benefits. However, experts raise concerns about the safety and efficacy of this approach. If you're on weight loss medication, it’s essential to talk with your clinician before making any changes to your dose.
No class of medication has gotten more buzz in recent years than the glucagon-like peptide-1 (GLP-1) receptor agonist, better known by the brand names Ozempic, Wegovy, Zepbound or the generic name semaglutide or tirzepatide. These drugs have fundamentally changed the way many people lose weight and manage their blood sugar. The dramatic results patients show off in countless before-and-after photos have made them wildly popular.
Spend a few minutes on social media sites like TikTok and Instagram and you’ll find people talking about their experiences losing weight on GLP-1s and offering advice on how others can do it too. More and more, that advice describes a new way of using GLP-1s: Microdosing, or taking smaller amounts of the GLP-1 to get the benefits without as many of the potential side effects (which include things no one wants, like nausea and constipation). But does microdosing actually work? Keep reading to find out more about microdosing GLP-1s, how they can help with menopause-related weight gain, and what to know about trying it yourself.
Understanding GLP-1 for Weight Loss
GLP-1s have completely upended the world of weight loss. The efficacy of these medications is much greater than anything that has been available up to this point. Examples of GLP-1 meds that are FDA-approved for weight loss include Zepbound (tirzepatide) and Wegovy (semaglutide). Other GLP-1 medications, such as Ozempic (semaglutide) and Mounjaro (tirzepatide), are approved for diabetes but used off-label to help patients lose weight.
GLP-1 medications lower the amount of glucose (sugar) in your blood, slow stomach emptying and help you feel fuller after eating. It also helps quiet food cravings and what people call food noise, those constant thoughts about food (what to eat, when to eat, how much to eat) that can throw off your day, and take up way too much mental space.
GLP-1 medications have been shown to help people lose a significant percentage of body weight when paired with a healthy diet and regular exercise. Research shows that those who take semaglutide lose about 15% of their body weight after 68 weeks. For someone who weighs 200 pounds, that’s a weight loss of 30 pounds. For tirzepatide one can lose even more –over 20% of your body weight.
But these drugs can come with some side effects, which include nausea, vomiting, diarrhea, bloating, and indigestion. Depending on the severity, those side effects are enough to make some people resist taking the medications or stop taking them completely.
Why Menopausal Women Might Consider GLP-1s for Weight Loss
Among the unwelcome symptoms of perimenopause (the hormonally turbulent years before periods stop) and menopause, one rises to the top for many women: weight gain.
During the period of perimenopause and menopause, due to the change in hormone levels, your basal metabolism may burn 250–300 fewer calories per day than before. Menopause is linked to weight gain–especially belly weight gain that can have negative health consequences. It’s no wonder, then, that 87% of Midi patients complain of struggling with weight and body changes. The combination of dropping estrogen, the decline in physical activity that tends to happen as you age, and side effects of menopause like trouble sleeping all combine for a slow-and-steady weight gain. In the post-menpausal years women gain on average about 1.5 pounds per year–some even more.
Changes in hormones can also cause you to gain belly fat, and research has found that extra abdominal weight can lead to increased inflammation, which affects metabolism. An excess of belly fat can also lead to hypertension, insulin resistance, and cardiovascular disease.
What is Microdosing?
You may have heard the term microdosing connected to certain psychedelic drugs. If that’s your immediate association, we’ve got a comforting update for you. Microdosing is also used in many traditional therapies, and just as the name suggests, it means taking a very small amount of a medication compared to the standard dose.
Anytime you microdose you run the risk of not putting enough of a drug in your system to get its benefits, but experimenting with lower doses may also come with upsides, including fewer side effects. In addition, flexible dosing lets your doctor cater your treatment plan to your individualized needs instead of sticking strictly with the standard dose options.
When we talk about GLP-1s, a microdose is an amount that’s less than what the manufacturer recommends for weight loss. For example, semaglutide goes up to 2.4mg doses, but you could also take .25mg, .5mg, 1mg, or 2mg. “Microdosing GLP-1s means you use the smallest amount you can to get to the results you desire,” says Midi’s Chief Medical Officer Kathleen Jordan, M.D. Dr. Jordan built the weight loss program at Midi and has overseen care for thousands of women, with a focus on weight loss at midlife. That care can include GLP-1s, and in Dr. Jordan’s experience, “many women don’t need to go to the maximum dose when they’re using GLP-1s for weight loss.”
How Microdosing GLP-1s Works: Mechanism, Safety, and Evidence
While the majority of patients on GLP-1s take them at the standard doses, more and more people are starting to talk about microdosing instead. The idea is that microdosing can:
- Reduce side effects: It’s common to experience side effects when taking GLP-1s, especially gastrointestinal issues including nausea, vomiting, and diarrhea. The smaller the dose, the lower the odds of side effects, so microdosing can help someone feel good enough to stay on the medication.
- Support a more tailored approach: No two bodies are the same, and so the “right” dose of a medication may be very different for you than it is for someone else. By including the option of microdosing, your provider will be able to personalize your treatment plan to your unique needs. For instance, if you’ve reached your goal weight on a GLP-1, a microdose may be appropriate for maintaining your current weight over a long period of time.
The FDA does not currently have guidelines on microdosing GLP-1 medications and it’s clear that more study is needed to understand the risks, benefits, and efficacy of doses that are lower than those recommended by current prescription guidelines. For example, it’s not known yet if microdosing can actually result in the same level of weight loss as standard doses.
If looking to use a GLP-1 for help with weight loss, you will start with what is essentially a micro-dose: you start on the lowest .25mg dose of semaglutide and then gradually increase the dosing as tolerated, and as needed, as long as it dovetails with your weight loss goals. Once you reach a healthy weight-loss pace, which is one to two pounds a week, you’ll stay at that dose until you achieve your healthy weight goal, even if it’s less than the maximum 2.4mg. “And as soon as you hit your goal weight, you can go back down in doses until you reach the minimum amount you need to keep the weight off,” says Dr. Jordan. “We want to help avoid gaining everything back. So we go down on the dosing– essentially a trial of what some would call “micro-dosing”-- and check in periodically to make sure you aren’t drifting away from the weight loss goals you achieved.” Dr. Jordan says that some patients may only need to take lower amounts, some only need the GLP-1 intermittently—for example, every other week—while others may even be able to go off it completely. “We work with you to see what’s the least amount of the medication needed to support you in maintaining your best health.”
Who Might Consider Microdosing GLP-1s (and Who Shouldn’t)
GLP-1s in general are typically recommended and usually only covered by insurance for people with obesity (defined as a BMI greater than 30) as well as those with a BMI greater than 27 and one or more weight-related conditions such as high blood pressure, type 2 diabetes, or high cholesterol. But many experts know that BMI is an imperfect measurement and these cut-offs leave out many people whose health can still benefit from weight loss. Compounded versions of the drug can be a solution as they are more affordable and also offer more flexibility in dosing. The dosing can be customized— allowing more nuanced micro-dosing.
Midi offers a compounded version through reputable, strictly-regulated pharmacies. Our pharmacy conducts third-party testing, which means that their products are inspected for quality by an organization not involved with the pharmacy. Our pharmacy is also certified to provide sterile compounding, so you don’t need to worry about contaminated medication. We want all patients to have access to reliable and effective treatment, at a lower cost, with reliable supply.
Who shouldn’t take them, regardless of their weight or related health problems? People who have severe gastrointestinal conditions like inflammatory bowel disease (IBD) or gastroparesis should not go on GLP-1s, and neither should people with a personal or family history of multiple endocrine neoplasia 2A, multiple endocrine neoplasia 2B, medullary thyroid cancer, or pancreatitis. If you have issues like inflammatory bowel disease, pancreatitis, and gastroparesis you should discuss with a Midi clinician what is right for you. People who are pregnant or trying to conceive should not take GLP-1 medications.
If you rule out the above and are cleared to take GLP-1s, you still won’t know if the drug is working for you (at either standard doses or a microdose) until you start taking it. You essentially need to try the medication out so your provider can see how quickly you’re losing weight. “We may start you on a lower dose and as soon as we see that you’re dropping one to two pounds a week, we can keep you there,” says Jordan. You might also consider microdosing if you’ve reached your goal weight and want to reduce the amount of drugs in your system, which is more of a personal preference. “Many people don’t want to be so dependent on pharmaceuticals, which microdosing supports,” says Jordan. “For some, the time spent on GLP-1s has supported a change in habits and lifestyle that can help them maintain their weight loss on a low dose.”
GLP-1 Microdosing vs. Traditional Weight-Loss Medications: How Do They Compare?
GLP-1s are more effective than other weight-loss drugs, resulting in more weight loss and keeping the weight off. For example, semaglutide can help you lose 15% of your weight in 68 weeks, while an older drug, Contrave, has been shown to result in closer to a 5% weight loss.
But those statistics are based on the maximum dose of semaglutide. Because there haven’t been studies done on smaller doses of GLP-1s, it’s hard to say for sure how they stack up. That said, if you’re microdosing a GLP-1 under guidance of a knowledgeable provider, they will ensure you are still hitting your one-to-two pound weekly weight loss even on a smaller dose.
While GLP-1s can be more effective than lifestyle changes alone, including changes to your diet and increasing physical activity, it’s worth noting that the best approach to using GLP-1s is to combine them with those healthy habits. Concerns about muscle loss while on GLP-1s are real, so it’s important to talk with a healthcare provider about your eating and exercise plan to make sure that even as you’re losing weight you continue to get adequate nutrition (focusing on protein and nutrient dense foods) and stave off muscle loss. Why does muscle matter so much? Not only do you need it for physical strength, it’s also vital for bone health and maintaining a healthy metabolism.
Beyond Weight Loss: Other Emerging Uses of Microdosing in Healthcare
Microdosing is an area of research that is showing more and more promise. Taking smaller-than-standard amounts of a wide range of drugs may help with depression, anxiety, autoimmune disorders, and more.
With GLP-1s, microdosing has been identified as a potential way to help patients with addiction. The drugs have been shown to improve addictive behaviors in early studies, and Dr. Jordan has seen the effect in patients at Midi: “We had a patient who took GLP-1s to lose weight, but the drug also helped her to quit smoking. Now she wants to continue at a microdose to maintain smoking cessation,” she says. “Others might want to try it to reduce how much alcohol they drink.”
There are also a growing number of people interested in microdosing GLP-1s for longevity. “We know that GLP-1s help flatten the glucose curve and decrease inflammation, which are both linked to longevity,” says Dr. Jordan.
While nobody can say for sure what the future of microdosing GLP-1s holds, Midi is dedicated to staying updated on the best practices as evidence emerges. “Our commitment to patients is to stay on top of the research and latest information,” says Dr. Jordan, “because these drugs may be helpful for so many different conditions and so many different patients.”
Frequently Asked Questions
How can I increase my GLP-1 naturally?
Eating certain foods, like foods high in fiber and unsaturated fat, may naturally stimulate the production of GLP-1s. This food list includes whole grains, eggs, avocados, and nuts. However, dietary changes alone cannot raise GLP-1 levels nearly as much as GLP-1 agonist medications.
Can you lose weight on GLP-1 medication?
Yes, research shows GLP-1 medications like semaglutide and tirzepatide can result in weight loss of 15% to 20% (or more).
Does microdosing GLP-1 medications work?
You may not need to take the maximum dose of GLP-1s in order to successfully lose weight and keep it off. Microdosing GLP-1s, which simply means taking anything below the recommended effective dose, can work for many people. Your provider will be able to monitor your weight loss and determine if you are a candidate for GLP-1s, and whether microdosing could be effective for you.
Are GLP-1s safe to take?
Yes, GLP-1s are considered safe to take by the FDA. While there are possible side effects, they tend to be mild-to-moderate, like nausea and diarrhea. There is a potential for more serious side effects, but they are rare.
Who should avoid GLP-1 drugs?
You should not take a GLP-1 drug if you have severe gastrointestinal conditions like inflammatory bowel disease (IBD) or gastroparesis or a personal or family history of multiple endocrine neoplasia 2A, multiple endocrine neoplasia 2B, medullary thyroid cancer, or pancreatitis.
Can you take GLP-1 medication without diabetes?
Yes, GLP-1 medications are FDA-approved for weight loss in addition to helping manage type 2 diabetes. Providers are able to prescribe semaglutide, tirzepatide, and liraglutide specifically for weight loss in patients without diabetes.
The Takeaway
- Microdosing GLP-1s is when you take a dose below the recommended dose for weight loss. The hope is that by reducing the dose, you can still lose weight and keep it off without the side effects like nausea, vomiting, and diarrhea.
- However, research about these benefits has not been published and there are no national guidelines on the best way to approach microdosing.
- Before you change your dosage in any way, be sure to talk with a Midi clinician or a well-trained healthcare provider to go over your options and discuss the approach that may be best for your needs.
If you’re in perimenopause or menopause and want guidance from clinicians who specialize in women’s midlife health, book a virtual visit with Midi today.
Hormonal change is at the root of dozens of symptoms women experience in the years before and after their period stops.
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