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F.A.Qs

Frequently asked questions

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How much do I pay for Semaglutide?

The total cost for the Low and Medium dose (up to 1.2 mg weekly) is $219 a month, includes provider visit, medication and shipping costs.
You will be on low and medium dose for the first 3 months of treatment.

What is the cost for High dose Semaglutide (2.4 mg weekly) ?

The total cost is $289 a month, includes provider visit, medication and shipping costs.

Do I need high dose Semaglutide (2.4 mg weekly) ?

Most patients usually only need low and medium dose to achieve the desired weight loss ( up to 15%)
The data from the study shows that most patients lose around 12% on medium dose (1.2 mg weekly) versus 14% on high dose (2.4 mg weekly)

How much weight do I lose on Semaglutide ?

Based on the trials, patients lost up to 15% from baseline. We expect you to lose betweeen 8-15% of the body weight. However, very few percent of the patients in the trials did not lose much weight.

How long can I be on Semaglutide?

Semaglutide is used as a treatment for obesity with the aim of promoting sustainable weight loss. The recommended duration of treatment with semaglutide for obesity may vary, but it is generally considered for longer-term use. In clinical trials evaluating semaglutide for obesity treatment, the treatment duration has typically ranged from several months to over a year.

What is the dosing schedule for Semaglutide?

We start you on low dose of 0.25 mg weekly for first 4 weeks. and increase dose every 4 week.
During next 4 weeks, 5th to 8th week you are on 0.5 mg weekly
If you tolerate the dose, it is increased to 1 mg weekly from 9th week onwards. The dose of 1 mg a week can continue as maintenance dose.
The highest dose of 2.4 mg is implemented only if you have not achieved the desired weight loss and can affordability the higher cost of the treatment.

How do I get Semaglutide ?

After you met with the prescriber, they will order the medication for you.
The medication is shipped directly to your home from the Compounding Pharmacy.

Once I have received Semagltudeo how do I store Semaglutide ?

We recommend for you to store Semaglutide in the refrigerator.

How do I take or inject Semaglutide ?

Semaglutide in an injection form. You need to draw the prescribed amount of medication from the vial.
Use proper sterile technique. Clean the site with alcohol swab before injecting.
The needle provided to you is for subcutaneous injection. The needle goes below the skin level.
It is safe to inject on abdomen, upper part of the arm or thigh. Use different sites every week to inject.

What is the recommended dose ?

The usual starting dose of semaglutide is 0.25 mg once a week. After four weeks, the dose is typically increased to 0.5 mg once a week.
In a study called the STEP trial (Semaglutide Treatment Effect in People with Obesity), which included individuals with obesity without type 2 diabetes, semaglutide was evaluated at a dose of 2.4 mg once a week.

How does Semaglutide work ?

GLP-1 Receptor Activation: Semaglutide activates the GLP-1 receptors in the body. GLP-1 is a naturally occurring hormone that is released from the intestine in response to food intake. It plays a crucial role in regulating blood sugar levels.
Glucose Regulation: By activating GLP-1 receptors, semaglutide increases insulin secretion from the pancreas in a glucose-dependent manner. This means that insulin is released when blood sugar levels are elevated, helping to bring them down.
Insulin Sensitivity: Semaglutide also improves insulin sensitivity in peripheral tissues like muscles and liver. This means that the body becomes more responsive to the action of insulin, allowing it to utilize glucose more effectively.
Slowing Gastric Emptying: Another effect of semaglutide is the slowing down of gastric emptying, which refers to the rate at which food leaves the stomach and enters the intestines. By delaying gastric emptying, semaglutide helps to control the rise in blood sugar after meals.
Reduced Appetite: Semaglutide also acts on the brain’s appetite centers, leading to a decrease in appetite and a feeling of fullness. This can contribute to weight loss, and that’s why semaglutide is also being explored as an obesity treatment.

Is Semagltuide Safe for me to use ?

It is FDA approved medication but can have side effects.
Common side effects of semaglutide can include:
Gastrointestinal Symptoms: The most frequently reported side effects are gastrointestinal in nature, such as nausea, vomiting, diarrhea, and constipation. These symptoms are usually mild to moderate and tend to improve over time.
Hypoglycemia: Semaglutide, when used in combination with other blood sugar-lowering medications like sulfonylureas or insulin, can increase the risk of hypoglycemia (low blood sugar). It is important to closely monitor blood sugar levels and adjust the dosage of other medications as needed.
Injection Site Reactions: Some individuals may experience injection site reactions, such as redness, itching, or swelling at the injection site. Proper injection techniques can help minimize these reactions.
Gallbladder Disorders: There have been rare reports of gallbladder-related adverse events, including gallstones and inflammation of the gallbladder.

It’s worth noting that the safety and side effects of semaglutide may vary among individuals, and some people may experience different or no side effects at all. It’s essential for you to call us, or email us if you experience any side effects. Incase of moderate to severe side effects please go to the nearby emergency room.

What is sequential weight loss treatment ?

After initial treatment with Phentermine/Topamax for few months the patient is swithced over to Semaglutide.
This approach helps patients to maximise weight loss by working different mechanism of actions of medications.

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    Phentermine

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    How much do I pay for Phentermine and Topamax?

    The total cost is $ 129 a month, includes provider visit, medication and shipping costs.
    If you plan to pick up medication from your own pharmacy the monthly cost is $109. Please let us know if you want this option.

    How much weight do I expect to lose on Phentermine and Topamax combination ?

    Patients in the randomized controlled trials lost between 9% – 12%
    My patients along with the dietary advice lose close to 15% – 20%. For someone who weighs close to 200 lbs, I expect them to lose 30 lbs

    Do I take both the medications ? Or just take Phentermine?

    The randomized controlled trials were done with both medications take together. In my practice we have seen a better response when the medication is taken together.
    As we know Phentermine can lead to jitteriness, high energy state and topamax balances this side effect out. Hence the combination works really well.

    How much does Phentermine and Topamax cost at the pharmacy? ?

    The total cost is usually less than $30 if you pay cash and use goodrx coupons.

    Who qualifies for Phentermine and Topamax ?

    If you have BMI > 30, or BMI > 27 with hypertension, diabetes or obstructive sleep apnea, and do not have any contraindications

    BMI Calculator Link https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

    How does Phentermine work ?

    It is classified as a sympathomimetic amine and functions as an appetite suppressant.
    Here’s how phentermine works:
    1. Appetite Suppression: Phentermine stimulates the release of certain chemicals in the brain, such as norepinephrine, which activates the “fight or flight” response. This activation leads to a decrease in appetite and an increased feeling of fullness. By reducing hunger and cravings, phentermine helps individuals consume fewer calories and supports weight loss efforts.
    2. Increased Energy Expenditure: Phentermine also stimulates the release of adrenaline, which can increase energy expenditure and metabolic rate. This effect may contribute to weight loss by burning more calories.
    3. Central Nervous System Stimulation: Phentermine acts on the central nervous system, specifically the hypothalamus, to reduce hunger signals and increase satiety. It affects certain neurotransmitters, such as dopamine and serotonin, which are involved in regulating appetite and mood.

    How Long can I take Phentermine ?

    It’s important to note that phentermine is typically prescribed for short-term use, usually a few weeks to a few months, due to concerns about potential side effects and the risk of developing tolerance to its effects

    Is Phentermine Safe for me to use ?

    It is FDA approved medication but can have side effects.
    Common side effects of Phentermine can include:
    1. Increased Heart Rate: Phentermine is a stimulant, and one of its effects is an increase in heart rate. Some people may experience a faster or irregular heartbeat while taking phentermine.
    2. Elevated Blood Pressure: Phentermine can raise blood pressure levels, and individuals with pre-existing hypertension should be cautious when using this medication. Regular monitoring of blood pressure is recommended during treatment.
    3. Insomnia: Phentermine is known to have stimulating effects on the central nervous system, which can lead to difficulty falling asleep or staying asleep. Taking phentermine too late in the day may exacerbate insomnia.
    4. Dry Mouth: Phentermine can cause a reduction in saliva production, leading to a dry or uncomfortable sensation in the mouth. Staying hydrated and chewing sugar-free gum may help alleviate this side effect.
    5. Gastrointestinal Issues: Some individuals may experience digestive disturbances such as constipation, diarrhoea, or stomach discomfort while taking phentermine.
    6. Restlessness or Nervousness: Phentermine’s stimulating effects can sometimes lead to feelings of restlessness, nervousness, or anxiety in some individuals.
    7. Dizziness or Headache: These symptoms may occur as a result of changes in blood pressure or the stimulant effects of phentermine.
    It’s important to remember that not everyone will experience these side effects, and the severity and frequency can vary among individuals. If experience any bothersome or persistent side effects, it’s recommended to stop the medication and contact us immediately.

    Is Topamax safe for me to use ?

    It is FDA approved medication but can have side effects.
    1. Cognitive and Psychiatric Effects: Topamax can cause cognitive difficulties, including difficulty with concentration, memory problems, and confusion. It may also lead to mood changes, such as depression, anxiety, or irritability. Some individuals may experience changes in thinking or behavior.
    2. Dizziness and Coordination Issues: Topamax can cause dizziness, unsteadiness, or problems with coordination, which may increase the risk of falls or accidents.
    3. Tingling or Numbness: Some people may experience a sensation of tingling or numbness, often in the extremities, such as the hands or feet.
    4. Fatigue or Sleepiness: Topamax can cause drowsiness or fatigue in some individuals, which may affect daily activities or alertness.
    5. Vision Problems: Topamax can affect vision and may cause blurred vision, double vision, or other changes in visual perception.
    6. Loss of Appetite or Weight Loss: Topamax is known to cause a decrease in appetite, which can lead to weight loss in some individuals.
    7. Digestive Issues: Topamax can cause gastrointestinal side effects such as nausea, diarrhea, or stomach pain.
    8. Kidney Stones: There have been reports of an increased risk of kidney stones in individuals taking Topamax. Maintaining adequate hydration and following a recommended fluid intake may help reduce this risk.

    What is sequential weight loss treatment ?

    After initial treatment with Phentermine/Topamax for few months the patient is switched over to Semaglutide.
    This approach helps patients to maximise weight loss by working different mechanism of actions of medications.

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    Testosterone

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    How much do I pay for Testosterone?

    The total cost is $ 99 a month, includes provider visit, medication and shipping costs.
    You will be paying for the lab work every 6 months. The cost of lab work at Quest is $200 cash price.

    How do I get the medication ?

    Testosterone vial with the supplies is send directly to your address.

    What dose Testosterone is sent to me ?

    You are sent a 10 mg Testosterone vial, 200 mg testosterone cypionate/ml. Hence a total of 2000 mg.
    This vial should last you for a total of 10 weeks if you inject 1 ml every week.

    How do I inject testosterone?

    Use proper sterile technique. Clean the site with alcohol swab before injecting.
    Testosterone injections are typically administered into the muscle tissue (intramuscular injection).
    For self injection you can target the middle and outer portion of the thigh muscle
    If someone can administer, you could chose the gluteal muscles (buttocks), specifically the upper outer quadrant of the buttocks, known as the dorsogluteal site.

    What is the usual dosing schedule for Testosterone ?

    Most patient needs between 1 ml (200 mg) ever week to 2 weeks depending on testosterone levels.

    What are the side effects of Testosterone treatment ?

    Testosterone replacement therapy (TRT) can have potential side effects, although not everyone will experience them. It’s important to note that side effects can vary depending on the individual, dosage, method of administration, and other factors. Here are some possible side effects of testosterone therapy:
    1. Acne: Testosterone can stimulate oil production in the skin, leading to the development or exacerbation of acne in some individuals.
    2. Fluid Retention: Testosterone can cause fluid retention, which may result in swelling or bloating, particularly in the hands, feet, or ankles.
    3. Increased Red Blood Cell Count: Testosterone therapy can lead to an increase in red blood cell production, which may contribute to a thickening of the blood. This can increase the risk of blood clots or other cardiovascular problems.
    4. Decreased Testicular Size: Exogenous testosterone can suppress the body’s natural testosterone production, leading to testicular shrinkage. However, this is usually reversible upon discontinuation of testosterone therapy.
    5. Gynecomastia: In some cases, testosterone can be converted into estrogen in the body, potentially causing breast tissue enlargement or tenderness (gynecomastia). Monitoring hormone levels and adjusting the dosage can help mitigate this side effect.
    “6. Mood Changes: Testosterone can influence mood and behavior. Some individuals may experience mood swings, increased irritability, or changes in aggression levels.

    7. Sleep Apnea: Testosterone therapy can worsen or exacerbate sleep apnea, a condition characterized by breathing interruptions during sleep.
    8. Prostate Effects: Testosterone therapy may cause an increase in prostate-specific antigen (PSA) levels, which is a marker associated with prostate health. Regular monitoring is crucial to evaluate any potential impact on prostate health.

    It’s important to remember that not everyone will experience these side effects, and the severity and frequency can vary among individuals. If experience any bothersome or persistent side effects, it’s recommended to stop the medication and contact us immediately.

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