To answer nancy_portland's question specifically:

From a clinical standpoint, Has anyone dealt with de novo is an area where we have good evidence.

The short answer: baseline labs + quarterly monitoring is the standard of care.

The longer answer involves understanding the mechanism of action at the receptor level, which I am happy to elaborate on if helpful.

Slightly tangential to Has anyone dealt with de but SteveThurs reminded me — has anyone else noticed changes in their alcohol tolerance?

I know it is not exactly on-topic but it seems related enough to ask here rather than starting a new thread. Apologies if this has been covered — I did search first.

OP here — wow, did not expect this much response! Thank you all for the thoughtful replies on Has anyone dealt with de.

To answer NurseLeah_Nash: I started tracking everything in a spreadsheet from day 1.

Quick update: I will post a proper update thread soon. Thanks again for the evidence-based discussion — this is exactly why I posted in a science-based community. 🙏

Want to share my personal experience related to Has anyone dealt with de novo since I think it might help others in a similar situation.

I started my GLP-1 journey in March 2025 at 277 lbs with metabolic syndrome. My telehealth provider prescribed semaglutide 0.25mg to start.

Now, 18 months later: I am down 52 lbs, my labs have normalized, and my sleep apnea has improved dramatically. The Has anyone dealt aspect specifically was something that made a big difference in my journey.

This forum was my go-to resource throughout.

Relevant to Has anyone dealt with de novo — here is my latest bloodwork comparison:

Key improvements: A1C 8.0% → 5.3%, triglycerides 223 → 93 mg/dL, hsCRP 6.0 → 1.1 mg/L. All on tirzepatide for 15 months.

The inflammatory marker drop is what impresses me most. Consistent with the SELECT trial's cardiovascular findings.