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Tirzepatide (Mounjaro, Zepbound) Strengths: Highest efficacy for both glucose control and weight loss Dual mechanism (GLP-1 + GIP) may provide unique benefits Once-weekly dosing Generally well-tolerated Considerations: Higher cost than semaglutide Less long-term safety data (newer medication) Cardiovascular outcome trial not yet complete (though expected to be positive) Best for: Patients prioritizing maximum weight loss

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The pattern is reversed in males castrated as neonates or females treated with testosterone, which is readily aromatized to estradiol in the neonatal brain