I'm so tired of the narrative that GLP-1 medications inevitably cause devastating muscle loss and there's nothing you can do about it. Here are my three DEXA scans over 9 months on tirzepatide:

Read that again: lean mass went from 144.2 to 144.6 lbs while I lost 38 lbs total. Appendicular lean mass (arms + legs — the best proxy for actual skeletal muscle) INCREASED by 2.6 lbs.

My protocol:

• Progressive resistance training 4x/week (PPL + extra leg day)
• Protein: 180-200g/day (1g per lb of GOAL body weight)
• Creatine: 5g/day
• Sleep: 7-8 hours strictly
• Caloric deficit was moderate — roughly 500-700 cal/day, not the extreme deficits some people end up in

M/36, 5'11". I was not a total beginner to lifting but I was detrained — hadn't lifted seriously in about 3 years before starting this.

This is compelling data. The appendicular lean mass increase is particularly noteworthy because ALM is less confounded by water/organ weight changes than total lean mass. A 2.6 lb ALM increase during a 38-lb weight loss is genuinely impressive.

A few caveats for scientific rigor:

1. Creatine supplementation can increase intramuscular water retention, which DEXA reads as lean mass. Estimated effect: 2-4 lbs. Were you taking creatine before the baseline scan?
2. DEXA has a coefficient of variation of about 1-2% for lean mass measurements, so small changes should be interpreted cautiously.
3. That said, even accounting for both of these, you almost certainly maintained your baseline muscle mass, which is itself an excellent outcome during significant weight loss.

Fair points. To address #1: no, I started creatine at the same time I started tirzepatide, so the baseline scan was pre-creatine. That means some of the lean mass "preservation" could be creatine-related water. If we assume 3 lbs of that is intramuscular water, I'd be at 141.6 lbs of "real" lean mass vs. 144.2 baseline — still only a 2.6 lb loss during a 38 lb weight loss, which is exceptional by any standard.

Re: DEXA variability — all three scans were done on the same machine, same facility, same time of day, fasted. I tried to control as many variables as possible.

How did you manage 180-200g protein per day while on a GLP-1? I'm struggling to hit 100g. The appetite suppression makes it really hard to eat enough, and protein is the most satiating macro so it's a double whammy.

It's a genuine challenge. Here's what works for me:

• Protein shake first thing in the morning (40g) — liquid calories are much easier when appetite is suppressed
• Greek yogurt + protein powder as a snack (35g)
• Two meals centered around lean protein (chicken, fish, lean beef) — about 40-50g each
• Casein shake before bed (25g)

Some days I still fall short and land around 150g. But consistency over perfection. I also time my biggest meal about 2 hours after training when appetite is slightly higher.