From the other side of the consultation, briefly.

Back pain as a lean mass side effect: not from the medication itself, but from rapid body composition changes. Losing 44 lbs shifts your center of gravity and your core muscles need time to adjust.

Physical therapy has been essential. Core strengthening exercises (planks, dead bugs, bird dogs) daily for 10 minutes have eliminated my lower back pain. Your body is literally relearning how to carry itself.

quinn_sf said:

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: Food…

Body composition tracking via bioimpedance on lean mass (InBody scan every 3 months):

Note: skeletal muscle mass dipped initially then recovered with consistent resistance training + high protein. The visceral fat reduction is where the metabolic magic happens.

quinn_sf said:

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: Food…

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

Lumbar spine T-score: -0.10 → -0.8 (stable to slightly improved)
Femoral neck T-score: -0.9 → -0.9 (stable)

No significant bone loss despite 62 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.

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

What did you change at the same time, and can you separate the two now?

Moderator note: the sourcing question belongs in the vendor section and has been split out.