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These outcomes are documented, the backlash is real, and it deserves an honest response

The FDA removed semaglutide from its drug shortage list in March 2025, which means 503A pharmacies are no longer legally permitted to compound it for general use [3]

This adaptation is called tachyphylaxis, and it's a normal physiological responsenot a sign of medication failure

Metabolic and Hormonal Factors Underlying endocrine conditions can significantly impair weight loss efforts: Hypothyroidism : Untreated or inadequately managed thyroid dysfunction slows metabolic rate and may blunt Wegovy's effectiveness Polycystic ovary syndrome (PCOS) : Insulin resistance and hormonal imbalances can make weight loss more challenging Cushing's syndrome : Excess cortisol promotes weight gain, particularly central adiposity Sleep disorders : Obstructive sleep apnoea and poor sleep quality disrupt metabolic hormones (leptin, ghrelin) that regulate appetite NICE guidance (CG189) recommends investigating potential secondary causes of obesity when weight loss interventions prove ineffective

The medication reaches an equilibrium where the amount injected equals the amount eliminated weekly