Dr. Friedman’s Weight Loss Guide
The Changing Landscape for Compounded GLP-1s
Dr. Friedman only prescribes GLP-1s for established patients who is treating for hormone disorders.
The landscape for compounded weight loss medicines is changing rapidly. The good news is GLP-1s are becoming more available with new oral preparations commercially availability. The prices are going down, Lilly and NovoNordisk have expanded their direct-to-consumer marketing and seem to have reduced their efforts to litigate against compounding pharmacies that supply compounded GLP-1s. More telehealth companies have sprung up to prescribe compounded GLP-1s often at high cost and with little physician supervision. Dr. Friedman thinks the tide is turning in favor of personalized medicine using compounded preparations. Dr. Friedman uses various options summarized below to prescribe GLP-1s and is working with several reliable compounding pharmacies. Some availability depends on the state you live in. Hundreds of Dr. Friedman’s patients have benefited from these compounded GLP-1s which are available in syringes allowing individual dosing that is not possible with the commercial medicines. Compounded GLP-1s do not require insurance pre-authorization and overall are much more affordable. Dr. Friedman does not directly dispense these compounds.
Compounding Pharmacies that Dr. Friedman works with
Dr. Friedman works with several compounding pharmacies to provide affordable and safe GLP-1 drugs that have improved patients’ health and weight. Dr. Friedman has communicated with representatives from the three compounding pharmacies he works with (University Compounding Pharmacy(UCP)/Anazeo, RedRock and Strive Pharmacy) to determine recommended dosing as described below. Dr. Friedman’s philosophy is that compounded pharmacies are supplying “Tirzepatide” and “Semaglutide” and not “Ozempic”, “Wegovy”, “Zepbound” and “Mounjaro” and that they are supplying customized dosing that are not available with the fixed doses supplied by the pharmaceutical companies. Compounded GLP-1 allow for “microdosing”, in which the GLP-1 does is more physiological and has less side effects. Some compounding pharmacies such as Empower require in person visits, which makes no sense in this era of telemedicine and Dr. Friedman is unable to use them.
Clinic price:
Dr. Friedman has negotiated a clinic price at several compounding pharmacies that is substantially lower cost than pharmacy prices. Patients pay Dr. Friedman using the miscellaneous PayPal payment tab on his appointment tab (https://www.goodhormonehealth.com/appointment-booking/). Square is accepted but less preferred. His office will go over pricing with you by email.
Tirzepatide Vs Semaglutide
Overall, Dr. Friedman prefers Tirzepatide over Semaglutide as it gives more weight loss and less side effects but is currently available in CA only in the sublingual form. Many patients find sublingual Tirzepatide to be quite affective at appetite suppression and weight loss, while others find it less effective than subcutaneous injections. Dr. Friedman’s top recommendations are in red.
Strive Pharmacy
Strive Pharmacy, which compounds Semaglutide (brand name Ozempic, Wegovy), and Tirzepatide (brand name Mounjaro, Zepbound) is a 503B compounding pharmacy that offers GLP-1RAs to patients at a low price in 45 states including California-see https://catalog.strivepharmacy.com, but note that pricing Dr. Friedman charges will be different. The states they currently do not ship to include AR, IN, MN, SC and TX (Texas requires doctors to have TX license). For Strive pharmacy, patients pay Dr. Friedman directly at a discounted cost, that is lower than if they purchased from Strive. Open bottles are usable for at least 90 days after opening. There are several options available at Strive Pharmacy, with the common 6 options seen in this table (note that the price has decreased recently):
Those in red are popular doses. Other doses are available on request.
Red Rock Pharmacy is a good source of compounded injectable Tirzepatide or Semaglutide to California patients. This is currently the only source of injectable Tirzepatide for California patients. The prices are reasonable, and you pay Dr. Friedman. The caveat is an open bottle is only good for 28 days after opening. Dr. Friedman recommends B12 over glycine, unless you have a sensitivity or contraindication to B12. For all doses, glycine instead of B12 is available for the same price.
Tirzepatide Injections at UCP UCP has recently partnered with AnazoaHealth for compounded Tirzepatide/B12 injections. A 3ml vial of Tirzepatide/B12 at 20 mg/ml lasts 2 months and price includes shipping and syringes. Patients pay Dr. Friedman. They ship to all 50 states. This is a good choice for patients on higher doses of Tirzepatide or in states with less options.
Because the Red Rock Pharmacy is good for low doses and UCP is good for higher doses, one popular choice for California residents is to get one Tirzepatide/B12, 5mg-100 mcg/mL 1 ml vial from Red Rock Pharmacy and take 1 mg (0.2 ml) weekly for 3 weeks, 2 mg (0.4 mL) for 1 week, followed by one
Tirzepatide/B12, 8.5 mg-100 mcg/mL 1 ml vial, and take 2 mg (0.24 ml) weekly for 3 weeks and 2.5 mg weekly the next week. Those can be ordered at once. If the patient is doing well, a new order can be placed for a 20 mg/mL 3 ml vial from UCP and take 3 mg weekly for 2 weeks, 4 mg weekly for 2 weeks, 6 mg weekly for 2 weeks and 8 mg weekly for 2 weeks. The 60 mg bottle can be renewed with a dose of 10 mg weekly.
Sublingual Tirzepatide at UCP- is good choice for patients who don’t want a shot. Its effectiveness is more variable as some patients do well and lose weight and others find it ineffective. Patients pay UCP. Tirzepatide injections have been discontinued but they have sublingual (under the tongue) Tirzepatide (10 mg/mL). Recent information from UCP have recommended daily dosing for optimal weight loss. Recommended dose is 0.5 mL (5 mg) under the tongue daily. After 4 weeks, increase to 1mL (10 mg daily which is the final recommended dose. The price for the starter dose of 10 mL (lasts 20 days) is $180. The 30 mL vial which lasts about 2 months is $250 and a 60 mL vial that lasts about 3 months is $450. Patients pay UCP directly. It needs to be refrigerated and can be used for 90 days after opening the bottle. It comes with a syringe that can withdraw the liquid from the vial and put under the tongue, where it should
Zepbound Glass Vials For those patients who want a non-compounded FDA-approved preparation, Zepbound Glass Vials from Lilly Direct are an option, with the costs for different doses listed on the website. The cost for the 4 of the 10 mg vials is $499 for the first vial and $499 if renewed within 45 days or $699 if renewed after 45 days. Patients need to register on LillyDirect.lilly.com and purchase syringes for a small fee. Each vial is 0.5 ml, so the concentration is 2 mg/0.1 ml. Although the company discourages using the vial for multi-dosing (it doesn’t contain a preservative), one option would be to inject 1 mg (0.05 mL) weekly for 2 weeks, 2 mg (0.1 mL) weekly for 2 weeks, then 4 mg (0.2 ml) weekly. The box of 4 vials would last about 10 weeks. Dr. Friedman’s staff would send it to LillyDirect Self Pay Pharmacy Solutions.
Oral daily Wegovy- Oral daily Wegovy just became FDA-approved and is commercially available from Novo Nordisk. Commercial insurances are unlikely to cover it and MediCare and MediCal do not cover it. For cash-pay, the cost is $199/month for the 0.25 mg dose and $349/month for the 0.5 mg (it will be $199/month until March 31, 2026), 1 mg, 1.7 mg and 2.4 mg dose. Patients should sign up at wegovyprosavings.com and Dr. Friedman will e-prescribe it at NovoCare pharmacy.
Foundayo (orforglipron) is an oral daily GLP-1 analog related to semaglutide (prices should be compared to that of compounded semaglutide) that is available for self-pay through LillyDirect at https://www.lilly.com/lillydirect/medicines/foundayo. It can be taken with or without food. The price of the starting dose of 0.8 mg is $149/month, the 2.5 mg dose is $199/month, the 5.5 mg and 9 mg dose is $299/month and the 14.5 mg and 17.2 mg doses is $349 per month, or $299 per month if you refill within 45 days.
The Medicare GLP-1 Bridge program runs from July 1, 2026 until December 31, 2027. It allows eligible Medicare Part D beneficiaries to get specific weight-loss drugs for a $50 monthly copay. Covered drugs include Wegovy®, Zepbound® (KwikPen® only), and Foundayo®.
You must have Medicare Part D drug coverage. You cannot get a GLP-1 drug covered through your current Part D plan.
- Diagnosis: You must need the medication for weight loss and cannot have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease.
- Weight/Health Requirements: You must be 18 or older and meet specific BMI and health risk criteria: BMI ≥ 35: No additional conditions required.
- BMI ≥ 30: Must also have heart failure, uncontrolled high blood pressure, or chronic kidney disease.
- BMI ≥ 27: Must also have prediabetes or a history of heart attack, stroke, or blocked arteries.
Our office will complete the preauth for patients who qualify for a $50 processing fee. Please pay using the miscellaneous fees tab at https://www.goodhormonehealth.com/appointment-booking/. More information is available at https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge/information-pharmacies
What about Retatrutide? Retatrutide is an experimental triple-agonist weight-loss and diabetes drug developed by Eli Lilly that targets GLP-1, GIP, and glucagon receptors. In Phase 3 clinical trials, it produced unprecedented average weight reductions of up to 24% to 30% of body weight. Some providers are prescribing it even though it is not yet FDA-approved and probably won’t be FDA Approved until 2027. Due to safety concerns, Dr, Friedman only prescribes compounded GLP1s (Tirzepatide and Semaglutide ) that are FDA-approved.
Is Glycine/B12 helpful in compounded GLP-1s?
B12 may afford advantages: it has been studied for ameliorating nausea triggered by GLP-1 RAs. B12 may also optimize metabolic functioning, making it an adjunct in weight management goals. The glycine may help prevent loss of lean muscle mass in the context of caloric restriction.
What about loss of muscle mass with compounded GLP-1s?
Loss of muscle mass may occur on GLP-1s. Dr. Friedman does not recommend GLP-1s in patients with low muscle mass to begin with. He recommends making usre you have adequate protein intake, including plant-based protein. He also recommends increasing exercise, especially using the large muscles in arms and legs. He also recommends measuring a bioavailable and total testosterone lab every 3 months and going on compounded testosterone cream if bioavailable testosterone is less than 2.5 ng/dL. Because of the different options for compounded GLP-1s, Dr. Friedman is advising his patients to make a 10-minute followup appointment to discuss options. Compounding pharmacies do not give automatic refills; if you are on GLP-1s, make a 10 min appointment to discuss refills at least every 3 months. It is helpful to get labs before your appointment, including a bioavailable and total testosterone. For more information, please read about compounded GLP-1s, and listen to listen Dr. Friedman’s original GoodHormoneHealth Webinar on November 17, 2024 on compounded Tirzepatide vs Semaglutide for patients with endocrine problems https://www.youtube.com/watch?v=u9VbPDsJcPE,
https://www.facebook.com/goodhormonehealth, https://www.goodhormonehealth.com/webinars or on your podcast channel. Dr. Friedman discussed the updated situation for compounded GLP-1s at his most recent GoodHormoneHealth Webinar on Sunday March 23, 2025 at 6:00 PM after his talk on “How can Blue Zones and Maimonides’ principles be applied to lead a healthy life for patients with endocrine problems?” It is available on YouTube at or https://youtu.be/6q_zxNqu2uc
https://www.goodhormonehealth.com/webinars/ or
https://www.facebook.com/goodhormonehealth
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For more information go to Dr. Friedman’s website https://www.goodhormonehealth.com or contact his office at mail@goodhormonehealth.com.