Ozempic Can Cause Major Loss of Muscle Mass and Reduce Bone Density(healthline.com)
healthline.com
Ozempic Can Cause Major Loss of Muscle Mass and Reduce Bone Density
https://www.healthline.com/health-news/ozempic-muscle-mass-loss
76 comments
Doesn't all weight loss schemes also decrease muscle mass if not done together with some sort of resistance training and adequate protein intake? From what I've heard, Ozempic mostly just decreases the appetite, so I would be surprised if the results were somehow magically much different from just eating less without any drugs.
from the article:
“Any time people lose weight, one-quarter to one-third of that weight can be muscle, and the faster we lose, the more likely we are to lose muscle. While 20% reduction in muscle mass seems normal for someone losing weight, the problem is the length of time in which this muscle loss occurs,” said Kumar.
“Any time people lose weight, one-quarter to one-third of that weight can be muscle, and the faster we lose, the more likely we are to lose muscle. While 20% reduction in muscle mass seems normal for someone losing weight, the problem is the length of time in which this muscle loss occurs,” said Kumar.
What a lot of people don't realize is that obese people are VERY muscular. It takes a ton of muscle and bone density to support that much extra weight. This is why exercise is important in any weight loss regimen. It isn't important because it burns calories, but because it maintains the condition of your body.
I don't understand why your first claim supports the second.
I agree obese people are very muscular. But since you won't need so much muscle and bone when you weigh less, why is it important to exercise any more than it is generally?
As you lose weight, you need to adapt to your changing body. You will lose a lot of muscle in the process which is okay! However, all that exercise you got from just standing and walking normally will go away too. Maintaining condition will require intentional effort, otherwise you will start to see injuries. Think of it like physical therapy while recovering from an illness.
There have been some studies that show that muscle loss is disapportionally higher than fat loss, which would lead to worse body composition after losing weight.
If I remember correctly, that happens because when on calorific deficit, by default people reduce their activity - this is the instinctual response. Body responds by losing muscular mass as energetically it is costlier to maintain than fat. This is why it is important to maintain or even increase the activity while losing weight.
This would surprise me since the primary reason a body stores excess fat is to be used for energy when needed. Then, the moment of need arrives and the body burns mostly muscle? Citation would be appreciated.
I always think of it as the difference between starving in a cave waiting for winter to end and starving while attempting to hunt down food in the summer. In the winter, reducing energy expenditure is important so you lose muscle first. In the summer it's more important to maintain condition so you can fight off competition and cultivate food sources.
By hunkering down on the couch and just losing weight you get the winter scenario. By exercising while you lose weight you get the summer scenario.
By hunkering down on the couch and just losing weight you get the winter scenario. By exercising while you lose weight you get the summer scenario.
Makes sense really. The fat stores will go a longer way with less muscle. I imagine that would work brilliantly during the cold winter months living in a cave, where theres less reason to move much. Unfortunately, this is dysfunctional in the developed world.
So that the body isn't burning too much muscle in an attempt to preserve the fat
[deleted]
Indeed. The fact that they (the drug’s sponsors) didn’t look at how much of the weight lost during the RCT was lean mass is very damning.
To your point, we know lifting weights specifically is crucial for maintaining bone mineral density[1]. I wonder if there’s a correlation between loss of lean mass and reduced bone mineral density.
[1] Crucial being a relative term with respect to the applicability of this study’s findings https://pubmed.ncbi.nlm.nih.gov/31797417/
Edit: for sourcing.
To your point, we know lifting weights specifically is crucial for maintaining bone mineral density[1]. I wonder if there’s a correlation between loss of lean mass and reduced bone mineral density.
[1] Crucial being a relative term with respect to the applicability of this study’s findings https://pubmed.ncbi.nlm.nih.gov/31797417/
Edit: for sourcing.
Evidence is mixed on weight lifting and bone density. Some studies see no benefit at all. The idea that it is "crucial" isn't supported by any evidence at all. Most people have bone density that is fine without any weight lifting.
On the other hand the evidence on running and bone density is very consistent.
On the other hand the evidence on running and bone density is very consistent.
You are incorrect. There is a consensus among scientists who study this subject that /skeletal/ muscle mass is directly associated with bone density. There are specific arguments and disagreements about what exercise is most beneficial for increasing overall skeletal muscle mass index efficiently, but the relationship between skeletal muscle mass, blood flow and nutrient distributions, the downstream effects on hormone regulation systems, and how all of those improve bone density are very well studied.
Neither you or the above commenter have provided sources.
AFAIK resistance training would beat aerobic sport (for this problem); the
correlation is right in the headline.
https://pubmed.ncbi.nlm.nih.gov/31797417/
https://pubmed.ncbi.nlm.nih.gov/31797417/
So for good bone density you need to pursue a high impact sport that might destroy your joints? Unfortunate if true!
Try taking a look at high intensity resistance training. It's the weight lifting equivalent to high intensity interval training. It's very effective, and it's low impact relative to the amount of time spent exercising.
There is a lot of evidence that high impact sports like running actually improve joint health. Especially if they practice appropriate resting and nutrition. I suspect that a lot of the injuries we associate with high impact activities are from people who have lost conditioning from inactivity, attempting to resume exercise without knowing their new limits.
https://www.nm.org/healthbeat/healthy-tips/fitness/is-runnin...
https://www.nm.org/healthbeat/healthy-tips/fitness/is-runnin...
same idea as building a callous on your hands or feet. lots of use tends to toughen your joints.
While I'm not sure about the connection between weight lifting and bone density, I do know that inactivity is a major cause of injury and lost physical fitness. A person who is obese is getting that exercise just by existing. Every time they stand up, lift an arm, bend over, or walk across the room, they are engaging in more exercise than a low body weight person does in the gym. Once that weight is gone, they will need to increase activity levels.
I would be surprised if the activity of moving you overweight body around could be classified as resistance exercise when it comes to any of the positive adaptation usually elicited by lifting bb
I imagine if you lifted bar bells 24/7 it would be way less healthy. I know that wearable weights are not recommended because it can cause health problems and injuries. I like this video by Phil Gaimon. Stuff like walking, standing, balancing and getting on his bike are much more difficult.
https://www.youtube.com/watch?v=Y6W2Hmy0Lzo
https://www.youtube.com/watch?v=Y6W2Hmy0Lzo
As an anecdotal comparison, over the last year or so, I have lost about 15% of my body weight through diet and exercise, going from 220 down to 190 today. I did this with exercise (walking exclusively for six months, then shifting to walking plus weight training with a coach twice a week). Nothing extreme.
I also use a scale that does body mass measurements (consumer grade). It says:
1. My fat-free body weight went from 148.6 down to 143.2.
2. My muscle mass is down from 142 down to 136 (see below)
3. I have had no bone loss of bone mass.
As I was walking, I seemed to consistently lose about 25% of the weight in muscle. My weight loss stopped as I started hitting the weights, but I started putting on about a pound per month in muscle, which is very visible on my core and arms.
Peter Attia has a nuanced medical take on the drug, based on interactions with his patients (short video https://www.youtube.com/watch?v=T6fhFLv2ERs). His take was that the drug works and there are very few side effects. He also uses it as a last resort, as he has seen his patients lose far more bone mass and muscle than he would like. However, it is a lifesaver for people who don't have success with other methods.
Personally, I don't want to use it, but don't judge others for making the right medical decisions for themselves.
I also use a scale that does body mass measurements (consumer grade). It says:
1. My fat-free body weight went from 148.6 down to 143.2.
2. My muscle mass is down from 142 down to 136 (see below)
3. I have had no bone loss of bone mass.
As I was walking, I seemed to consistently lose about 25% of the weight in muscle. My weight loss stopped as I started hitting the weights, but I started putting on about a pound per month in muscle, which is very visible on my core and arms.
Peter Attia has a nuanced medical take on the drug, based on interactions with his patients (short video https://www.youtube.com/watch?v=T6fhFLv2ERs). His take was that the drug works and there are very few side effects. He also uses it as a last resort, as he has seen his patients lose far more bone mass and muscle than he would like. However, it is a lifesaver for people who don't have success with other methods.
Personally, I don't want to use it, but don't judge others for making the right medical decisions for themselves.
Did I miss a study in the article? There's a bit about general muscle mass loss, a study about bariatric bypass surgery, and then some generic advice to take protein.
This looks a bit like a supplement ad.
This looks a bit like a supplement ad.
I agree, there was a recent funded-by-diet-shake-company study which found that current US recommendations for protein intake we're too low.
It would not surprise me at all if the makers of things like Ensure are scared of weight loss drugs and are trying to find a way to stay relevant.
It would not surprise me at all if the makers of things like Ensure are scared of weight loss drugs and are trying to find a way to stay relevant.
Why would they be scared, would the people who take them take less supplements than before?
I see this more as an opportunity? "Hey, this new drug is all great, but focus your reduced caloric intake on the proper macros, brozempic!"
I see this more as an opportunity? "Hey, this new drug is all great, but focus your reduced caloric intake on the proper macros, brozempic!"
the weight loss industry is huge in the US, and a reasonably fool-proof pill that works is a deadly threat to their profits.
These are two side effects of losing weight in general, and nothing special to Ozempic.
Isn't the weight-loss "feature" of Ozempic a side-effect, and not the original primary target of the drug? I could (and very well probably am) be wrong here, but I thought it's original purpose was to moderate blood sugar levels, not cause the user to drop large amounts of weight quickly.
If so, I'm honestly not surprised at all. Magic bullets don't exist. If they do, they usually come with unforeseen side effects.
If so, I'm honestly not surprised at all. Magic bullets don't exist. If they do, they usually come with unforeseen side effects.
The, er, male enhancement "feature" of Viagra is a side-effect of its original use: blood pressure medicine.
It's only a side-effect if it's secondary or undesirable.
[edit] Or (setting aside the birth defects) curing multiple myeloma was a side-effect of thalidomide, which was originally given for morning sickness. And life extension is a promising potential side-effect of metformin.
It's only a side-effect if it's secondary or undesirable.
[edit] Or (setting aside the birth defects) curing multiple myeloma was a side-effect of thalidomide, which was originally given for morning sickness. And life extension is a promising potential side-effect of metformin.
>It's only a side-effect if it's secondary or undesirable.
What is your point? that's the definition... A side effect of turning the light on is heat.
"A peripheral or secondary effect, especially an undesirable secondary effect of a drug or therapy."
What is your point? that's the definition... A side effect of turning the light on is heat.
"A peripheral or secondary effect, especially an undesirable secondary effect of a drug or therapy."
I'm currently on it and it was prescribed by my doctor for my diabetes. I just started it. Yes, the side effect may be weight loss for me, which will also directly help my diabetes in and of itself, but the weight-loss is only a side effect.
But since so many are using it JUST for weight-loss, which their insurance probably doesn't cover, I sometimes have to wait because it's sold out. So me, having a legit reason to be on it due to my diabetes, can't always get it because someone else wants it just to lose weight.
But since so many are using it JUST for weight-loss, which their insurance probably doesn't cover, I sometimes have to wait because it's sold out. So me, having a legit reason to be on it due to my diabetes, can't always get it because someone else wants it just to lose weight.
>just to lose weight
You mean they "just" want to reduce their blood pressure, reduce their cholesterol, reduce their glucose, reduce their chances of cancer, stroke, coronary heart disease, all the while moving easier, having more energy, and not feel embarrassed by their weight any longer.
You mean they "just" want to reduce their blood pressure, reduce their cholesterol, reduce their glucose, reduce their chances of cancer, stroke, coronary heart disease, all the while moving easier, having more energy, and not feel embarrassed by their weight any longer.
i think the parent's point would be that most people can achieve all those things without using a drug (the cholesterol and BP parts are often chronically high for non-obese people but there are other medications for those things that target them more directly)
>can achieve
The longterm success number for those that lose significant weight and keep it off for many years, are abysmal.
The longterm success number for those that lose significant weight and keep it off for many years, are abysmal.
sure, but my anecdotal hearsay unsubstantiated information on this is that people who are only a little bit over their ideal weight are using it so that they dont even need to apply modest efforts at staying healthy. People who are chronically morbidly obese are likely better off with the bariatric surgery approach.
There’s a huge cohort in between those two states.
and reduce their chance of developing into diabetes.
(There is high correlation between overweight to obese to be pre-diabetic or undiagnosed/untreated diabetic)
(There is high correlation between overweight to obese to be pre-diabetic or undiagnosed/untreated diabetic)
Those people could also lift weights and eat less. Ozempic works because it makes people feel full and stop eating, to lose weight without Ozempic.
eat less and move more.
eat less and move more.
Taking Semaglutide gives an adherence advantage (with diet and exercise) vs. just diet/exercise alone.
There was a 16% weight loss for those that received semaglutide/diet/exercise/counseling versus a loss of 5% for placebo those that received diet/exercise/counseling without semaglutide.
https://pubmed.ncbi.nlm.nih.gov/33625476/
There was a 16% weight loss for those that received semaglutide/diet/exercise/counseling versus a loss of 5% for placebo those that received diet/exercise/counseling without semaglutide.
https://pubmed.ncbi.nlm.nih.gov/33625476/
Spoken like someone who's never had an eating disorder. Thanks for the non-helpful "advice" that's obvious to everyone on the planet.
It's tantamount to people telling others with clinical depression to "just cheer up and stop feeling sorry for themselves. Have you tried not being depressed?"
You're talking about people who are medically obese, GP is talking about people who are consuming the limited supplies of a valuable drug because they want the optimal "beach body". They're not the same thing.
I don't think the medical bar for obesity is as high as you might think it is. A lot of people who you and I might regard as simply overweight if we saw them on the street are, in fact, obese according to the BMI criteria.
Moreover these drugs are not going to get people an "optimal beach body"; they might at best help to get weight in the range where work can start on that.
In fact for people at normal weight looking to improve their appearance these drugs would probably be counterproductive, for the reasons mentioned in the study. When the goal is to optimize for aesthetics a low body fat percentage is key. That requires a solid amount of muscle mass, and a drug regimen that catabolizes muscle is going to be counterproductive.
Moreover these drugs are not going to get people an "optimal beach body"; they might at best help to get weight in the range where work can start on that.
In fact for people at normal weight looking to improve their appearance these drugs would probably be counterproductive, for the reasons mentioned in the study. When the goal is to optimize for aesthetics a low body fat percentage is key. That requires a solid amount of muscle mass, and a drug regimen that catabolizes muscle is going to be counterproductive.
That is largely a sensible comment, but unfortunately none of what you're saying affects the actual demand for fad weight loss treatments. Look at the "alternative medicine" industry if you want to see how much demand there can be for products that literally have no effect on the body whatsoever. And there is certainly a very large demand for minor, purely cosmetic weight loss.
Over 2/3's of the American population falls in the overweight/obese category.
https://www.healthline.com/health/obesity-facts#statistics
It's probable that the demand is overwhelmingly coming from that large cohort. Which wouldn't be "cosmetic" weight loss.
https://www.healthline.com/health/obesity-facts#statistics
It's probable that the demand is overwhelmingly coming from that large cohort. Which wouldn't be "cosmetic" weight loss.
If you have a normal BMI, no diabetes, and want Ozempic for aesthetic reasons you first have to find a willing prescriber - not easy although I'm sure there are shady online services out there.
Then you have to pay for the drug out of pocket, that's a 5 figure sum annually. You can get a nutritionist, personal trainer, and meal prep for less in a lot of the country. Oh yeah and it also requires injections, a lot of people hate needles.
As another poster pointed out, 2/3 of the country are overweight or obese. There's plenty of medically qualified patients around, no need to assume some epidemic of already-thin people taking Ozempic to try to get six-pack abs.
Then you have to pay for the drug out of pocket, that's a 5 figure sum annually. You can get a nutritionist, personal trainer, and meal prep for less in a lot of the country. Oh yeah and it also requires injections, a lot of people hate needles.
As another poster pointed out, 2/3 of the country are overweight or obese. There's plenty of medically qualified patients around, no need to assume some epidemic of already-thin people taking Ozempic to try to get six-pack abs.
> If you have a normal BMI, no diabetes, and want Ozempic for aesthetic reasons you first have to find a willing prescriber - not easy although I'm sure there are shady online services out there.
You are wildly underestimating how many doctors are willing to prescribe medicines without a strong need. Have you heard of the opiod epidemic?
> Then you have to pay for the drug out of pocket, that's a 5 figure sum annually.
Unless you can convince your insurance company to pay for it -- say, with the help of a willing doctor. And even if you can't, there are a surprising number of people who will pay that kind of money for weight loss.
> You can get a nutritionist, personal trainer, and meal prep for less in a lot of the country.
You've been able to get those things for many years. They are not the same as an easy weight loss drug.
> As another poster pointed out, 2/3 of the country are overweight or obese.
The medical definition of "overweight" is quite broad, and clinically it's based on BMI, an extremely flawed measurement at an individual level. There are certainly plenty of people with a medical need for a weight loss drug! (I am one of them!) But there are also plenty of people who think they are ugly because they are 10-15 pounds over their "ideal" weight and have one little roll of belly fat. There is a strong tendency to medicalize this kind of problem. This is a pretty big part of American culture. Have you not encountered this before?
What I'm arguing here is that when a drug is in limited supply the people with an immediate need for it (diabetics) ought to take precedence over people who are worried about potential future health problems somewhere down the line (younger, mildly obese people), and that people who are mainly worried about cosmetics ought to wait for wider availability. I don't think that's controversial?
You are wildly underestimating how many doctors are willing to prescribe medicines without a strong need. Have you heard of the opiod epidemic?
> Then you have to pay for the drug out of pocket, that's a 5 figure sum annually.
Unless you can convince your insurance company to pay for it -- say, with the help of a willing doctor. And even if you can't, there are a surprising number of people who will pay that kind of money for weight loss.
> You can get a nutritionist, personal trainer, and meal prep for less in a lot of the country.
You've been able to get those things for many years. They are not the same as an easy weight loss drug.
> As another poster pointed out, 2/3 of the country are overweight or obese.
The medical definition of "overweight" is quite broad, and clinically it's based on BMI, an extremely flawed measurement at an individual level. There are certainly plenty of people with a medical need for a weight loss drug! (I am one of them!) But there are also plenty of people who think they are ugly because they are 10-15 pounds over their "ideal" weight and have one little roll of belly fat. There is a strong tendency to medicalize this kind of problem. This is a pretty big part of American culture. Have you not encountered this before?
What I'm arguing here is that when a drug is in limited supply the people with an immediate need for it (diabetics) ought to take precedence over people who are worried about potential future health problems somewhere down the line (younger, mildly obese people), and that people who are mainly worried about cosmetics ought to wait for wider availability. I don't think that's controversial?
> You are wildly underestimating how many doctors are willing to prescribe medicines without a strong need. Have you heard of the opiod epidemic?
Opioids don't cost $10k+ a year out of pocket.
> Unless you can convince your insurance company to pay for it -- say, with the help of a willing doctor.
Even with "good insurance", it's quite difficult to get Ozempic covered for weight loss, even if you are obese - let alone normal weight or just overweight. Not speculating here, I know people who meet the criteria and have tried.
> You've been able to get those things for many years. They are not the same as an easy weight loss drug
Yes, and that's one of the many reasons why obesity rates are lower among the wealthy. I don't think that paying over $1k a month and getting weekly injections is especially "easy."
> What I'm arguing here is that when a drug is in limited supply the people with an immediate need for it (diabetics) ought to take precedence over people who are worried about potential future health problems somewhere down the line (younger, mildly obese people), and that people who are mainly worried about cosmetics ought to wait for wider availability. I don't think that's controversial?
What evidence do you have that this is not occurring? I see a lot of evidence that insurance companies are aggressively rationing Ozempic for non-diabetic patients - both in the news media and in my personal life. Many of those paying out of pocket for semaglutide are getting it from compounding pharmacies because they can't get access to the brand name drug, either due to cost or supply constraints.
Opioids don't cost $10k+ a year out of pocket.
> Unless you can convince your insurance company to pay for it -- say, with the help of a willing doctor.
Even with "good insurance", it's quite difficult to get Ozempic covered for weight loss, even if you are obese - let alone normal weight or just overweight. Not speculating here, I know people who meet the criteria and have tried.
> You've been able to get those things for many years. They are not the same as an easy weight loss drug
Yes, and that's one of the many reasons why obesity rates are lower among the wealthy. I don't think that paying over $1k a month and getting weekly injections is especially "easy."
> What I'm arguing here is that when a drug is in limited supply the people with an immediate need for it (diabetics) ought to take precedence over people who are worried about potential future health problems somewhere down the line (younger, mildly obese people), and that people who are mainly worried about cosmetics ought to wait for wider availability. I don't think that's controversial?
What evidence do you have that this is not occurring? I see a lot of evidence that insurance companies are aggressively rationing Ozempic for non-diabetic patients - both in the news media and in my personal life. Many of those paying out of pocket for semaglutide are getting it from compounding pharmacies because they can't get access to the brand name drug, either due to cost or supply constraints.
I just went to the pharmacy and I am still unable to refill the prescription that I have been trying to get for a week to keep my actual diabetes under control, so you’ll have to pardon me if I don’t have the patience to argue this any more.
Same. My A1C went down 1.5 points (7.9 -> 6.5) after I went on Ozempic with minimal behavior changes. I've also had trouble getting prescriptions filled because it's the hot new weight loss drug.
You could always just stop eating sugar
Oh, good lord, why didn't I think about that?!?! WOW! Hey everyone, just stop eating sugar! CyberDildonics has solved it! Collect your Nobel Prize in medicine!
/s
/s
What is wrong with what I said? If you want to lose weight without a pill, stop eating sugar.
I highly doubt insurance would refuse to cover a medication that will almost certainly drastically lower their long term expenses
Yes, and its been turned into a seperate, identical drug, Wegovy, with different dosages to target weight loss.
Yes. Ozempic is a therapy for reducing A1C. The weight-loss and appetite suppression was a side effect. Generally speaking, weight loss is also good for lowering your A1C - so the side effect was a win.
lots of pills are used for uses different from their original uses, & it's fine. see Viagra, that was supposed to be heart medication
You mean, like any uncontrolled weight loss with an unbalanced diet/vitamin deficiency?
Ozempic basically decreases appetite. That's its main weight loss mode of action.
Ozempic basically decreases appetite. That's its main weight loss mode of action.
That's a drastic simplification.
Stomach stapling basically decreases appetite.
Ozempic acts with more precision by targeting your insulin release/sensitivity and addiction centers of the brain -- and making sugars/carbs harder to process.
Stomach stapling basically decreases appetite.
Ozempic acts with more precision by targeting your insulin release/sensitivity and addiction centers of the brain -- and making sugars/carbs harder to process.
Does it not slow down your stomach emptying into the gut so that you do not feel hungry because your tummy is telling your brain - hold on boss - still busy with lunch here for a late afternoon snack.
There seems to be some reports of folks suffering from rare stomach paralysis.
There seems to be some reports of folks suffering from rare stomach paralysis.
I wonder if this is caused directly by the drug or if it's just a side effect of the large caloric deficit. Because you lose a lot of muscle mass if you're in a large caloric deficit without taking any drug.
Basically, this is merely saying that as a function of losing weight rapidly, this happens. It doesn't seem to be specifically attributing it to Ozempic. In other words, Ozempic causes rapid weight loss which causes this.
That, however, might not be as attention-getting/click-baity a title.
That, however, might not be as attention-getting/click-baity a title.
What about the fact that people on ozempic don't change their eating habbits other than the amount they consume?
Eating all that garbage still had a negative effect on your health while if you want to loose that weight with this medication you need to change what you eat more than how much.
Eating all that garbage still had a negative effect on your health while if you want to loose that weight with this medication you need to change what you eat more than how much.
No, it can't. Losing weight by any means whatsoever can do this. There is nothing special or unique about losing it via Ozempic versus gutting it out and suppressing calories while still feeling hungry all the time.
I think the point being made is that this medical intervention, which has been approved to treat obesity via weight loss, is going to give people sarcopenia and ruin their bone mineral density. During the clinical trials, there was no analysis of body composition (via DXA or other means) which would have given patients more informed perspective about this issue.
It's a good shim considering the obesity rate in developed countries, but something superior would be a biological mechanism to inhibit the body's uptake of sugars. Instead of reducing appetite, which reduces intake of critical macros and minerals, you're then instead preventing the body from processing the worst offender in western diets. Eating healthy is challenging in the current macro (cost, access, time, etc).
Then perhaps the best treatment would be to combine a GLP-1 Agonist and sex-hormone replacement.
That would be expected if you stop eating too much also.
This is an reasonable tradeoff for many obese people in the short term. But it definitely implies long term ongoing use is not a good idea.
Peter Attia has talked about this issue at length.
Number one alarm-sounder on Sarcopenia as a problem for the elderly. And it's true. If "having a fall" can be fatal for you, you are far too weak. Boss up and get strong, at any age.
There's a pretty active black market for semaglutide. BBuilders usually offset catabolic effects of stuff like t3/t4/dnp/semaglutide with higher AAS.
It would be nice to know what `AAS` means.