traveltech_sara said:

The trials generally allowed a step to be held or reduced and then retried, and people who did that mostly arrived at the same place a few weeks…

PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss. It's a titration dose to let your body adjust. Don't be discouraged if you don't lose much in the first month.

The therapeutic dose for weight management starts at 1.7mg (semaglutide) or 5mg (tirzepatide). Be patient with the ramp-up.

A narrower follow-up, since the general answer is now clear:

What the trials actually did with participants who could not tolerate a step, because that is the situation I am in and the protocol summaries skip it?

BiostatsBrad said:

PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss.

Dose escalation anxiety for titration: I was terrified to move from 0.5mg to 1.0mg based on horror stories in this forum. But my actual experience? Slightly more appetite suppression, zero additional side effects.

Remember that the people posting about terrible side effects are a biased sample. Most people titrate up without drama — they just don't post about it because it's uneventful.

OP back with an update, since a thread like this is useless without one.

Update — I came back down one step, held for a month, then went up again and it was uneventful the second time. Same ladder, slower.

LibrarianMeg said:

Dose escalation anxiety for titration: I was terrified to move from 0.5mg to 1.0mg based on horror stories in this forum.

That is right for the weekly injectables. For the daily agents the interval logic is different and the four-week convention does not transfer.