NeuroNate 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. Posting only so the count is not one.

NeuroNate said:

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

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.

NeuroNate said:

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

NeuroNate said:

...the muscle loss concern with lean mass...

This is a legitimate and well-studied concern. Let me put some numbers on it:

In STEP 1, approximately 39% of weight lost was lean mass. However, the Lundgren 2024 study showed that structured resistance training reduced this to ~25% lean mass loss.

Context matters: at BMI 35+, you're carrying excess lean mass to support the extra weight. Losing some lean mass is expected and not inherently harmful if you maintain adequate muscle function through exercise.

The solution isn't avoiding the medication — it's combining it with proper exercise and protein intake.

Following on from NeuroNate — and this may be the naive question:

Did your prescriber agree with that reading, and if not what was their objection?

Dr.PathRoch said:

NeuroNate said: ...the muscle loss concern with lean mass...

This is where I part company with the consensus forming above. Pushing back on the consensus forming here. Consistency is not the same as correctness, and a board that agrees with itself quickly is usually agreeing with the first person who sounded certain.