newstart_MO said:

Regarding lean mass: I accidentally injected my dose intramuscularly instead of subcutaneously last week (went in at wrong angle, too deep).

This is my experience too, for whatever a second data point is worth. I had assumed I was the exception until I read this.

Clinical perspective, offered as context rather than as advice.

Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.

Lumbar spine T-score: -0.9 → -0.6 (stable to slightly improved)
Femoral neck T-score: -0.11 → -0.7 (stable)

No significant bone loss despite 76 lbs of weight loss. Key factors: adequate calcium (1200mg/day), vitamin D (5000 IU/day), resistance training 3x/week, and adequate protein. Weight-bearing exercise is critical for maintaining bone density during rapid weight loss.

anders_CPH said:

Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.

Same pattern here, and in the same order.

anders_CPH said:

Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.

My endo's protocol for lean mass plateau: if weight loss stalls for 6+ weeks at current dose, we go through this checklist before titrating up:

1. Food diary review — is intake creeping up?
2. Protein check — minimum 100g/day
3. Activity audit — steps + resistance training
4. Sleep quality — poor sleep kills GLP-1 efficacy
5. Stress/cortisol management

Only after addressing all of these do we increase the dose. Often fixing one lifestyle factor restarts progress without needing more medication.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful. Thread quality here is what the rules are for. Keep it up.