u/Glad_Ad_2441

So I've been cooking up a long-term GLP-1 strategy that fits my financial reality and weird response pattern. I'd genuinely like to hear if this sounds stupid, dangerous, or maybe even reasonable. I know it's a lot, sorry in advance.

41 BMI, uncontrolled T2DM, MASH with liver fibrosis, systemic inflammation. I need to drop ~30 kg to get anywhere near a healthy range. So this isn't cosmetic—I'm trying to save my liver and pancreas.

I started Mounjaro (tirzepatide) 7 weeks ago. I did the usual 2.5 mg for four weeks, then 5 mg for another four. Just finished the last 5 mg shot. The problem? Zero appetite suppression. I mean nothing. Food noise still there, hunger unchanged.

Last year I briefly tried Ozempic 0.25 mg and it was completely different—appetite vanished within days. So my body seems to really feel pure GLP-1 agonism but isn't registering the lower GLP-1 component in tirzepatide at these doses.

Why I think this makes sense pharmacologically:
From what I've read, semaglutide is about 5 times more potent at the GLP-1 receptor than tirzepatide. In terms of pure GLP-1 activation, 1 mg semaglutide is roughly equivalent to 10 mg tirzepatide. Tirzepatide's superior weight loss in trials comes from adding GIP, but that GIP synergy seems to only fully kick in at 10-15 mg. Meanwhile, semaglutide also has a 7-day half-life vs. tirzepatide's 5 days, so it builds up to a more stable steady-state level in the body. I suspect that's part of why even low-dose Ozempic hit me harder—more constant GLP-1 activation.

Mounjaro is insanely expensive for me out of pocket. Ozempic is covered by government hospitals in my country. Through some loopholes and multiple hospital visits, I've managed to accumulate:

· 31 × 1 mg Ozempic pens
· 1 × 0.5 mg pen
· 1 × 0.25 mg pen
All with long expiry dates (2028+). I also have a limited Mounjaro supply left: the original 15 mg pen I started (which still has its overfill) plus 3 new 15 mg pens (no overfill). That's it—4 pens total.

My plan in a nutshell:

1. Finish Mounjaro titration using the 4 pens I have. I've already done 2.5 and 5 mg. Now I'll do 7.5 mg (4 weeks) → 10 mg (4 weeks) → 12.5 mg (4 weeks) → 15 mg. By my math, I'll get about 6-7 weeks at the full 15 mg dose before the pens run dry (late September 2026). I'll extract the overfill from the first pen as a bonus final shot.
2. Wait 7 days, then start the Wegovy schedule using my Ozempic stash. 0.25 (use the 0.25 pen) → 0.5 (0.5 pen) → 1.0 (fresh 1 mg pen) → 1.7 → 2.4 mg, all via click counting on the 1 mg pens.
3. For the higher doses I'll do multiple injections on the same day, always with a fresh needle. For 1.7 mg: one full 1.0 mg shot + 0.7 mg (50 clicks) from the same pen. For 2.4 mg maintenance: I'll keep two pens open. Pen A gives my two 1.0 mg shots (lasts 2 weeks). Pen B gives the single 0.4 mg shot (29 clicks, lasts 10 weeks). So each week I do 3 injections. I've mapped out the exact pen usage week by week, and my 31 pens will last exactly 63 weeks (16 weeks titration + 47 weeks at 2.4 mg), taking me from October 2026 to late December 2027.

I've thought about going to 7.2 mg someday, but not now—just 2.4 mg, which is the proven high-efficacy dose.

So my questions to anyone who's done similar:

· Multiple injections from one pen in a single day: I know it's off-label. How risky is it really if you use a new sterile needle each time, keep everything clean, and visually check the liquid? Does the pen mechanism actually hold up to being used 3 times in one day? Any infections or failures?
· Switching from max-dose tirzepatide to semaglutide: Anybody else make that jump? Did appetite suppression come back strong? I'm worried I'm abandoning tirzepatide too early, but I can't afford to stay on it forever.
· Using an Ozempic pen for 10 weeks (the Pen B): The manufacturer says discard 56 days after first use due to preservative. I'd be going a tiny bit beyond that. Real-world experience? Anyone done this long-term?
· Overall sanity check: Does this plan sound remotely reasonable given my health situation (MASH, fibrosis, DM)? I'm under a doctor's care generally, but they don't know the full details of my multi-pen setup. Am I missing any glaring danger?

I know this is a wall of text—thanks if you read this far. Just trying to make the best of a weird situation where I can get one med for free and the other costs a fortune, while my body seems to prefer the free one anyway.

So here is my question I read that there are methods in which MSV dose can be reduced so much without compromising the quality of ct images and that is done through a combination of reconstruction software with filtrations which are placed in the modern day scans. I wonder can I do chest CT and avoid the standard 7 msv even LDCT doesnt cut the msv enough for me. I read about certain protocols done in MRI that can make it as accurate as CT for chest imaging but I can’t find a facility that utilizes these protocols.

It was both verbal and physical abuse and happened at around the end of elementary school and all the way to halfway through middle school. He was a narcissist that failed to compete on normal terms and was using both verbal and physical abuse to kind of make feel bad and not compete with him not to mention that he enjoyed making problems between me and other kids and just loved feeling dominant over me honestly it was humiliating. His father intervened and put a stop to it but 10-12 years later i still feel angry i feel humiliated I can imaging him dealing with me in the same exact way as adults and i don’t know is this a grudge that I need to just confront him with or do I need to just go see a psychiatrist?! I have been dealing with dozen or so people hating on me so he wasn’t the only one but my life is just centered around him and other bullies in my head it is making feel so terrible.

Hey all. I’ve been lurking here for a while. I’m dealing with active MASH and stage 3 fibrosis, and I’ve been on a relentless mission to fix this. Diet completely overhauled (zero sugar, zero seed oils, intermittent fasting, heavy cruciferous vegetables), serious weight training, cardio, the works. Also on tirzepatide which has been huge for my metabolic side.

But I wanted something else that could actually help reverse fibrosis, not just improve bloodwork. Rezdiffra was a no-go for me. I live in Saudi and it's simply not available here, and after looking into the special access programs, the hoops are enormous. I know a lot of you are in the same boat—Rezdiffra isn't accessible in your country, or your insurance won't touch it, or you just don't have a path to get it. It's frustrating as hell.

So I went down a rabbit hole and found something I honestly wasn't expecting. Figured I'd share because a lot of people here probably haven't heard the details.

I stumbled onto a 2024 randomized, double-blind, placebo-controlled trial published in Hepatology that looked at a very specific form of curcumin called Meriva (it’s a curcumin-phospholipid complex, basically curcumin bound to something that massively increases absorption). They gave 52 patients with biopsy-proven NASH (71% had stage ≥F2 fibrosis) either placebo or 2 grams of Meriva a day for 72 weeks. These were real, sick patients—not mice, not mild NAFLD.

The results:

· 62% achieved NASH resolution with no worsening of fibrosis (placebo: 12%)

· 50% had at least one full stage of fibrosis improvement (placebo: 8%)

· 42% with significant fibrosis (≥F2) had regression (placebo: 0%)

I've spent hours reading liver papers and I almost never see placebo groups at 0% and treatment groups showing that kind of fibrosis reversal. Yeah, it’s a small pilot trial (52 people), and no large phase III trials yet, but the effect size is enormous. For me, with F3, that 42% regression stat hit hard. For those of us locked out of Rezdiffra, this feels like the most promising alternative I've come across so far.

I’m not a doctor and this is absolutely not medical advice, just sharing what I found and what I’m doing. After talking to my hepatologist, I’m going on 2g/day of Meriva split breakfast/dinner (taken with fat). Importantly, this is NOT generic turmeric. Meriva is a specific branded phytosome by Indena—it’s the only formulation used in this trial. Standard turmeric or generic curcumin will not do this. Also, I stay far away from anything with piperine (black pepper) because combining it with a high-bioavailability curcumin can screw with liver enzymes and is linked to some liver injury reports.

Outside of this, my stack is just supportive stuff (omega-3, vitamin E natural 400IU, NAC, magnesium, etc.) but I honestly think the real players are the lifestyle change, tirzepatide, and hopefully this curcumin.

If anyone else has tried Meriva long-term or has updated info on Phase III trials, I’d love to hear. I’ll update this thread when I get my follow-up elastography and bloodwork.

Just wanted to put this on people’s radar because it gave me genuine hope, especially knowing Rezdiffra isn't an option for so many of us right now.

Stay strong everyone.

It’s not available at my location (middle eastern country) and I was told I am a good candidate for it so what is the solution?

So this was 6 months ago

CAP 374 with IQR of 49

KPA of 17.9 with IQR of 2.2 and IQR/median of 12%

Lost 24 kg maybe 15 of that is fat and took vitamin e 400 units but wasn’t consistent I literally took it for a few weeks on and off and ursodeoxycolic acid similarly and came back again and now it is

CAP is 262 with IQR range of 20

KPA is 17.9 with IQR of 0.8 and IQR/median of 7%

I am still morbidly obese but honestly when I did the last fibroscan my ALT/AST were not abnormal they were normalized for a while (before they weren’t) and my A1C was 5.9% before it wasn’t normalized.

Obesity specialized prop was used but nonetheless is it reasonable to conclude that my central obesity and my S2 liver is still showing inflated results ?

I am hoping that this is F2 not F3 so I can benefit from rezdiffra (which currently isn’t available in my country but I am fighting to get some) and I am currently on terziptide and using it with a plan to aggressively step up my doses and also started to take vitamin E and ursodeoxycolic acid again and plan to be consistent on it and take omega 3 as well.

I mean what are the odds of there ever being true F at all with this difference?

Can I reverse diverticulosis and regenerate my colon ???