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c/tirzepatide·posted 11 months ago by u/blunt_coldbox29

SURMOUNT: what the trials say vs what this community says

Results Cold Box ×1 Slow Clap ×2 Receipts ×3

SURMOUNT: what the trials say vs what this community says. Change my mind, genuinely — I have no stake in being right about this.

Research-use-only material is not approved for human use. Anything in this thread about how a research vial "should" titrate is a discussion about chemistry, not a plan.

SURMOUNT-1 ran 72 weeks with the top arm around 21% mean body weight change. SURPASS is the diabetes programme and reports glycaemic endpoints, so quoting the two interchangeably is a category error.

The four-week interval in the label is a minimum. Nothing about the pharmacology requires you to step on schedule, and the trials stepped on a calendar because trials have to.

I will update this if the picture changes rather than quietly leaving it up.

4,344 up / 712 down86% upvoted36 commentsid pizgfg13 Aug 2025

36 comments

25 in this archive, depth 5

best — the order this archive was captured in

u/two_mil_or_one237 points·11 months ago

Weekly dosing again, half-life in the same neighbourhood as sema, so a step change takes about a month to reach steady state. Judging a new step at day five is judging noise.

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u/blunt_coldbox29OP163 points·11 months ago

Appetite effect for me is flat across seven days. On sema it was a wave. Same person, different molecule.

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u/blunt_coldbox29OP101 points·11 months ago

That percentage is body weight change, not body fat. Different measurement, and the distinction gets lost every time.

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u/blunt_coldbox29OP-6 points·11 months ago

Are you comparing yourself with the trial mean or with the people who post the most?

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u/hugo_bergstrom1 point·11 months ago

if 7.5 is working, 10 is not automatically better

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u/neha_falk0 points·11 months ago

Are you comparing yourself with the trial mean or with the people who post the most?

Saving this one. It is the clearest statement of the stall problem I have read here.

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u/copay_card_cc1 point·11 months ago

Same experience with the appetite effect being flatter across the week rather than front-loaded.

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u/mikkel_ogunleye213 points·11 months ago

Disagree with the conversion table. There is no validated equivalence between the two molecules and posting one as though there is does real damage.

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u/gustav_vermeulen172 points·11 months ago

Small fix: SURMOUNT is the obesity programme, SURPASS is the type-2 programme. They are different endpoints and the numbers do not transfer.

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u/quiet_moderatormod105 points·11 months ago·edited

Small fix: SURMOUNT is the obesity programme, SURPASS is the type-2 programme.

gustav_vermeulen is right that the two molecules are not interchangeable. There is no published conversion and the ones circulating are invented.

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u/priya_guerrero30 points·11 months ago

a lot of people plateau nicely at 10mg and never need 15

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u/ferritin_low10 points·11 months ago

stepping every four weeks is a ceiling on speed, not a schedule you must hit

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u/slow_logbook_ftw137 points·11 months ago·edited

Which week did the appetite change actually land for you?

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u/nz_unfunded81 points·11 months ago

Does constipation follow the day after the shot, or is it spread across the week?

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u/incretin_ivyMOD124 points·11 months ago

Left up, flair changed to Discussion. It is an opinion post and that is fine as long as it is labelled.

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u/piotr_nascimento86 points·11 months ago

What step are you on and how long have you been there?

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u/bastian_eriksen68 points·11 months ago

switching from sema is not a dose conversion, there is no clean equivalence

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u/fatima_wojcik92 points·11 months ago·edited

I would separate the two claims. That the GIP arm exists is uncontroversial; that it explains your muscle cramps pattern is a guess.

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u/cormac_pereira68 points·11 months ago

Vials and pens carry the same molecule; what differs is fill volume, device tolerance and whether you are doing your own arithmetic. Neither is inherently more accurate.

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[deleted]25 points·11 months ago

[deleted]

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u/mikkel_kimani19 points·11 months ago

It is a dual GIP and GLP-1 receptor agonist, and the GIP arm is the part that has no equivalent in the semaglutide threads. That is why the side-effect profile reads differently rather than just milder.

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u/kaia_cabrera32 points·11 months ago

This matches mine. Milder constipation than I expected, and what there was settled inside a fortnight of each step.

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u/aurel_lindqvist44 points·11 months ago

Sulphur burps for the first eight days after each step, then nothing. Predictable enough that I planned my week around it.

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u/dario_vermeulen14 points·11 months ago

Right. And the sema-to-tirz "conversion" people post is invented. There is no published equivalence.

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u/halima_boateng7 points·11 months ago·edited

Right.

Not sure about this bit. The GIP arm being real does not tell you that it is what caused your particular week.

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About c/tirzepatide

Tirzepatide-specific discussion: the dual-agonist pharmacology, the 2.5 → 15mg ladder, the appetite profile people describe as different from semaglutide, and the SURMOUNT/SURPASS trial programme. Comparisons with semaglutide are welcome as long as they are specific about dose equivalence being unknown.

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