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Athlete / performance · uptakeCommunity · convergenceNo approved clinical use

GLP-1 Foundation

Stack: Semaglutide · the licensed entry to the incretin class
"Unusually for this catalogue, the foundation here is a fully approved, clinically-proven medicine — not a research compound. The honest issue isn't whether it works; it's that it's prescription-only, and a large grey market runs it without supervision."
GoalWeight loss / glycaemic control
Compounds1 · Semaglutide
Human evidenceStrong — large RCTs (STEP / SUSTAIN)
StatusMHRA (UK): licensed medicine — prescription only (Wegovy / Ozempic / Rybelsus) · FDA (US): approved. Buying or possessing without a prescription, or sourcing research-grade, is outside the licensed supply chain
In this stack — snapshot; tap through for the full molecule file
Provenance & evidence layers — of the combination, not the parts
Approved clinical use
Where / who
Licensed and prescribed worldwide for type-2 diabetes and chronic weight management — Ozempic/Rybelsus (diabetes) and Wegovy (weight).
Status
A fully approved medicine with marketing authorisation, an SmPC and active pharmacovigilance — the opposite of a research compound.
Evidence it adds
Regulator-grade efficacy and safety — for the licensed product, used as directed.
Basis: MHRA / EMA / FDA marketing authorisations
Clinical trial evidence
Weight
The STEP programme: roughly 15% mean body-weight reduction at 68 weeks vs placebo in adults with obesity.
Glycaemic / CV
SUSTAIN (HbA1c) and SELECT (cardiovascular outcomes) — large, randomised, published in major journals.
Evidence it adds
Controlled human efficacy and safety data at scale — the strongest tier in this catalogue.
Basis: STEP, SUSTAIN, SELECT — peer-reviewed RCTs
Grey-market / unsupervised use
Where / who
Large numbers source semaglutide outside prescription — research-grade vials, overseas pharmacies, peer reconstitution.
What changes
The molecule is the same; the supervision, dose titration, sterility and product identity are not. Mis-dosing and counterfeit/under-dosed product are the documented real-world harms.
Evidence it adds
None on efficacy — this layer is about how unsupervised use diverges from the trials.
Basis: real-world sourcing patterns — not a trial tier
Regulatory — read carefully
MHRA (UK)
Licensed medicine — prescription only (POM). Legal to be prescribed and to possess with a prescription; supplying or buying outside that route is not lawful supply.
FDA (US)
Approved. Compounded semaglutide is only permitted under specific shortage/clinical conditions.
What it means
"Proven and licensed" is exactly why the supervised route matters — the safety record belongs to the prescribed product.
Basis: MHRA POM classification · FDA approval
Why this is the foundation

Semaglutide sits at the base of the incretin class because it's the most-studied, most-prescribed GLP-1 receptor agonist with the deepest outcome data behind it. Everything heavier in this section — dual and triple agonists — is measured against it. The honest framing here is unusual for the catalogue: the question isn't whether it works, it's whether it's being run the way the evidence was generated — prescribed, titrated and supervised — or sourced and self-administered outside that.

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Cycle shape — how it's typically structured, not a schedule to follow
Titration
step up slowly
Maintenance
effective dose
Review
continue / adjust
GLP-1s are titrated up gradually to manage GI side-effects — this mirrors the licensed schedule, not a prescription to follow.
What's worth monitoring

Unlike most of this catalogue, semaglutide has a defined clinical monitoring picture: GI tolerance during titration, and — for some — pancreatitis symptoms, gallbladder issues and significant muscle-mass loss alongside fat loss. The licensed product is monitored by a prescriber; outside that route, no one is. Baseline bloods and a clinician conversation are the sensible floor. General information, not medical advice.

Evidence
Human efficacy Strong

Large randomised trials (STEP / SUSTAIN) — ~15% mean weight loss at 68 weeks in obesity.

Outcome data Strong

SELECT showed cardiovascular benefit; regulator-grade safety record for the licensed product.

Unsupervised use Risk shifts

Same molecule, but dosing, sterility and product identity are no longer controlled.

The honest point

This one is proven. The harm-reduction question is about the supply route, not the science.

Fast facts
Compounds

Semaglutide

Brands

Wegovy · Ozempic · Rybelsus

UK strip

AMBER — prescription only medicine