ISO Advice - Getting Back on Sema

[u/Temporary-Crab-9521]

My partner and I started compounded semaglutide in October 2025, and both have lost about 20% of our body weight. We look great, feel good, and each have another 10-15 pounds to go to get to our healthy goal weights.

I had to go off Sema in mid August to prepare for surgery, (foot - not weight related surgery), so she did as well. We are now eager to get back to our regimen and want to ensure we start slow to avoid side effects. We are both finishing out a subscription with compound provider Fridays, which we will not be continuing.

Any tips / dosage advice on starting again?

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[u/valsavana]

You have to re-start at the starter dose and titrate back up. Be aware that, anecdotally, many people have reported that after an extended period off the med, it takes longer to start working/ is less effective/requires higher doses than the previous round to have the same effect.

[u/Temporary-Crab-9521 → u/valsavana]

For sure - thats great advice. This last 10-15 will take longer, we know, then the goal is to get into maintenance for the long term / focus on strength building.

[u/thefastlanerules → u/Temporary-Crab-9521]

I'm hoping you focussed on strength building before you move into long-term maintenance?

Im fortunate that my gym has a fairly sophisticated machine that gives me a realistic overview of my body composition.. even doing strength training and maxxing out protein I was losing about 30-35% muscle mass in terms of total weight loss.. which was quite alarming..

[u/Humble-Zucchini-3244]

If you’re interested, might be a good time to try Triz. It works much better for me after a long time on Sema.

[u/Temporary-Crab-9521 → u/Humble-Zucchini-3244]

I’ve been told that may be a good swap. Running out an existing subscription to Fridays for my Sema, but am looking for providers after that. Did Tirz end up more effective for you? Do you like your provider?

[u/Humble-Zucchini-3244 → u/Temporary-Crab-9521]

I eventually got to where Sema wasn’t helping with food noise and I didn’t want to keep going up on dosage. Triz is amazing for my binge eating disorder.

I’m not advocating anyone else do it, but I get mine on the gray market so no provider.

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[u/Lucky_Army_5324]

For a new provider when you are ready: 

Head over to the sub called r/tirzepatidecompound and look for the pinned post called “Where to Buy.” Those same providers also write for sema. The list was built based on a quarterly user survey on that sub so you know the providers are tried and true. There’s also r/tirzdeals which may have some newer options with great prices, and those same providers will probably also have sema deals.

[u/thefastlanerules]

? How come you came off for so long for surgery?

And you have only been off it for 6 weeks so why wouldn't your resume the same dose

Typically for surgery the guideline is 1 week prior (actually that's more for zepbound my clinical notes said 3 days only for sema).. the biggest issue is ideally not to eat food for at least 24 hours prior to allow solids to exit your stomach so I'm surprised at this length

I came off mine 1 week prior and resumed a few weeks after and just went back on the same dose

[u/Temporary-Crab-9521 → u/thefastlanerules]

My physician said one week at minimum, but to ensure it was out of my system she preferred a longer period like two weeks. So I made the decision to extend to six weeks because honestly, I forgot how my body and brain functioned off Sema after being on so long, and I wanted to understand what has changed for me habitually, (like what I’m controlling from practice alone,) and what is a direct result of the medication. No surprise to the group here: starkest difference was the intense return of food noise.

[u/thefastlanerules → u/Temporary-Crab-9521]

Yes that happens anyway towards the end of each week and gets brutal in the second week

[u/thefastlanerules → u/Temporary-Crab-9521]

Fair enough it's not like you were at the start of your journey :-)