One year ago today I took my first 0.25mg shot. I promised myself I'd write the full honest review at 12 months — including the things nobody wants to talk about. Here it is.

THE GOOD:

I feel like a different person physically. Knees don't hurt. I can tie my shoes without losing my breath. I sleep better. My apnea is gone — returned the CPAP machine. I went from a 3XL to a L.

THE BAD (and nobody talks about this enough):

• Loose skin. It's significant. Abdomen, inner thighs, upper arms. I'm a 47-year-old woman who lost 71 lbs in 12 months — there was no avoiding it. I'm considering abdominoplasty but it's $8-12K out of pocket.
• GI issues never fully resolved. I still get nausea about once a week, usually the day after injection. Constipation is chronic — I take Miralax daily. Acid reflux has gotten worse, not better. I'm on omeprazole now which I wasn't before.
• Hair thinning. Months 4-8 were rough. Telogen effluvium from rapid weight loss. It IS growing back now but my hair is noticeably thinner than before. I wish someone had warned me more strongly about this.
• Social weirdness. People treat you differently when you lose weight. Some relationships have changed in ways I didn't expect. A few friends have become distant. My mother-in-law made a comment about "taking the easy way out" at Thanksgiving that I'm still angry about.
• Muscle loss. I didn't start resistance training until month 6 (my fault). DEXA at month 9 showed I'd lost about 14 lbs of lean mass. I've been lifting consistently since and it's stabilized, but I regret not starting on day 1.
• Food relationship is complicated. I went from food being the center of my social life to sometimes dreading meals. The joy I used to get from food is mostly gone. My therapist says this is a grieving process and she's probably right.

Would I do it again? Absolutely, without hesitation. The benefits vastly outweigh the downsides. But I wish I'd been better prepared for ALL of it.

F/47, 5'7".

Thank you for this. The honesty about the downsides is so valuable. I'm at month 3 and the hair thing is starting and I was panicking. Knowing it stabilized for you helps.

Can I ask what you're doing for the hair? Any supplements?

For hair: biotin 5,000mcg, zinc 30mg, iron (I was slightly deficient — get yours checked), and a collagen peptide supplement. Honestly I don't know which of these helped or if the hair just recovered on its own as my weight loss slowed. The dermatologist said telogen effluvium from rapid weight loss typically self-resolves in 6-12 months as your body adjusts. Mine peaked around month 6 and has been improving since month 9.

The most important thing is making sure you're not nutritionally deficient. When you're eating 1,200-1,500 calories, it's very easy to be short on iron, zinc, B12, and protein — all of which your hair needs.

This is one of the most balanced and realistic accounts I've seen. A few clinical thoughts:

The GERD worsening is a known issue. GLP-1 RAs slow gastric emptying, which can increase the time acidic contents sit in the stomach and worsen reflux. If omeprazole is managing it, that's fine, but it's worth discussing with your GI doctor if it becomes a long-term need since there are concerns about prolonged PPI use (vitamin B12 absorption, bone density, kidney effects).

The lean mass loss of 14 lbs at month 9 out of 60+ lbs total lost is about 23% lean mass loss, which is actually right at the expected ratio for weight loss without resistance training. The literature shows that adding resistance training (which you did at month 6) typically reduces this to 15% or less of subsequent weight lost. You made the right call, just wish it had been earlier.

On the food relationship: this is genuinely underappreciated. Food serves emotional and social functions that go far beyond nutrition. Losing the dopamine response to eating can feel like losing a coping mechanism, and therapy is the right approach.

My mother-in-law made a comment about "taking the easy way out" at Thanksgiving that I'm still angry about.

If semaglutide is "the easy way out," then insulin is "the easy way out" of type 1 diabetes and glasses are "the easy way out" of poor vision. Nobody chooses obesity. Medication that treats a physiological condition isn't cheating.

Sorry you dealt with that. The stigma around these medications is real and frustrating.