PurityPaulOR said:

One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.

The regain framing needs pushing back on. Two thirds regained means one third did not, and the trial provided no ongoing support to either group. Treating regain as pharmacologically inevitable is as unsupported as treating maintenance as automatic.

Adding the numbers, since they settle part of this. If you are tracking this properly: same scanner, same time of day, same hydration, at least six months apart, and read grip strength or a lift number alongside it. Function is the outcome; the scan is the proxy.

Dr.GastroMayo said:

The regain framing needs pushing back on.

Adding the part of the answer the thread has not reached. The honest range is roughly 20 to 40% of total loss as lean mass without deliberate resistance training, and roughly 10 to 20% with it plus adequate protein. Both numbers need a caveat that matters: "lean mass" on a DEXA is not muscle. It includes water, glycogen and the lean fraction of organs, and glycogen alone carries about three grams of water per gram. A large early lean drop is mostly the glycogen and water going, which is why the first scan flatters and the second is the honest one.

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

Whether extending the interval works as well as reducing the dose, since they are not the same intervention pharmacologically?

Reporting back.

I went to a lower dose rather than a longer interval on the strength of the trough argument in this thread, and the difference in how even it feels is obvious.