The Rise of Ozempic Microdosing

Much like those who opt for “baby Botox” or “MicroTox” to smooth wrinkles subtly without a totally frozen face, many people are now microdosing Ozempic to shed a few pounds, while minimizing unpleasant side effects. And now, with new research pointing to broader health benefits—including potential Alzheimer’s protection—losing weight isn’t the only reason people are lining up to ask their doctors about these ‘miracle’ drugs called GLP-1s (glucagon-like peptide 1 receptor agonists).

So is microdosing—or taking less than the standard dose—of GLP-1 weight loss drugs (which include Ozempic, Wegovy, Mounjaro, and Zepbound) a legit practice?

Beverly Tchang, MD, an endocrinologist and obesity specialist at NewYork-Presbyterian and Weill Cornell Medicine in New York City, has been instructing her patients to microdose long before the current GLP-1 revolution. When Ozempic (generically known as semaglutide) was approved by the FDA for adults with type 2 diabetes in 2017, it became clear that even the lowest doses were effective for weight loss, she says.

Yes, microdosing is considered off-label—it’s not in the package instructions—but it’s still evidence-based, Tchang says. For example, while the standard starting dose of Ozempic is 0.25 milligrams, studies have shown that a dose of 0.05 milligrams per day is both safe and effective in people with obesity. Lowering the dose can also help people who are struggling with certain side-effects find relief: “Microdosing really helps with GI side effects, like nausea and constipation and reflux,” Tchang says. Anecdotally, people have shared that smaller doses have also helped them avoid other less common symptoms like brain fog.

Tchang believes that tailoring doses to the individual just makes sense. “It’s the same concept as personalized nutrition.” The mission of the doctor is to treat the patient with the lowest therapeutic dose, she says. “Why go beyond that? Use the lowest dose that works for you. That’s the crux of microdosing.”

Before “microdosing” entered the lexicon, it was called “click counting” and could be done only with the GLP-1 drugs Ozempic and Wegovy, which come in multidose injectable pens, Tchang explains. But now, the rise of GLP-1 compounded medications—custom-made and available through online pharmacies at a fraction of the cost—has broadened access to these drugs and also sparked controversy. Unlike their brand-name counterparts, compounded medications aren’t FDA-approved.

“The landscape is riskier than if you were to get that prescription from your doctor who writes an FDA-approved medication that is evidence-based, that has had clinical trials, and it comes directly from the manufacturer,” says Tchang, who consults with both Ro, a telehealth pharmacy that offers compounded semaglutide, and Ozempic’s maker, Novo Nordisk.

Nevertheless, many people are seeking out microdoses of compounded GLP-1 drugs through med-spas or plastic surgeon’s offices to lose weight without going to more drastic measures. And while not recommended by doctors, some are even buying online courses from influencers and injecting themselves at home.

But as convincing as the marketing can be, when it comes to people who don’t have obesity, we simply don’t have the data to support microdosing, says Elizabeth Sharp, MD, a board-certified internal medicine physician, an assistant professor at Mount Sinai Hospital, and the founder of Health Meets Wellness, a concierge medical practice in New York City.

With less information about how those at a lower weight will respond, there’s intrinsically a higher risk, Tchang says. For example, it’s possible that taking weight loss medications at a low dose long-term could lead to loss of bone density and skeletal muscle mass, Sharp says—changes that are hard to reverse, especially as you get older.

Despite the lack of data, the buzz is hard to ignore. “A lot of my patients are asking about it,” says Sharp, who is hopeful about the idea of prescribing microdoses of GLP-1 medications for her nonobese patients in the not-so-distant future. “I just think we don’t know right now what that right dose is. And so it is a gray area where people are really experimenting. There isn’t an exact science to it.”

The medical community is also grappling with the idea that current definitions of obesity might be wrong—and leaving out people who can benefit from these drugs, Tchang says. “We’re recognizing that the disease of obesity is far more complex than just a number on the scale,” she says. “Obesity really is a problem with energy metabolism. It has to do with how your body handles those calories, whether the body chooses to store them or to burn them. And if it chooses to store them, how does it decide whether to store it in fat or muscle, for example?”

In other words, factors like your family history, cholesterol profile, body composition, and how you carry weight should be considered in addition to your weight. Even your ethnicity can play a role, Tchang says: Data shows that some ethnicities start to have metabolic problems like heart disease and diabetes at a relatively lower weight.

As Tchang points out, some people may not fit this evolved view of obesity but still want to lose a few pounds to feel their best—or to prevent future health problems. For example, beyond weight management, emerging research suggests that GLP-1 drugs have the potential to prevent heart attacks and strokes and even support people with addiction to quit smoking or drinking.

A newly published study found that people prescribed the drugs had a reduced risk of not just substance-abuse disorders, but also suicidal ideations, schizophrenia, and other psychotic disorders—as well as clotting problems, infections, liver failure, fatty liver disease, and liver cancer, says Ziyad Al-Aly, M.D., a physician-scientist at Washington University in St. Louis and an author on the study. “Very importantly, we also saw a reduced risk of Alzheimer’s disease and dementia,” Al-Aly says. “And that’s really a significant breakthrough because currently there are no good treatments for [them].”

Still, the study was observational and conducted in people with type 2 diabetes, so the findings may not apply to people without diabetes who are taking GLP-1s, Tchang says. It’s tempting to assume a cause-and-effect relationship, but the truth is, these types of studies are really meant to generate more questions than answers, she adds.

Another question that remains is whether microdosing would offer similar benefits. “We don’t know because what we studied is the therapeutic, FDA-approved doses,” Al-Aly says. Still, it’s possible that someone looking to lose a little bit of weight and also kick a smoking habit could kill two birds with one stone by talking to their doctor about off-label microdosing, Al-Aly says.

Until we get prevention trials—which our healthcare system isn’t incentivized to invest in—we just don’t know whether people who are fairly healthy and don’t have a lot of weight to lose can benefit from taking these medications, Tchang adds. For now, the debate around microdosing Ozempic mirrors that of microdosing psychedelic substances like LSD or psilocybin—some believe it’s a way to tap into mental health perks without a full-blown trip, while others say it’s under-researched or placebo.

For the Ozempic-curious, navigating the world of GLP-1 medications can feel like the Wild West. If you’re considering exploring microdosing, your first best step is to consult with your doctor to discuss the benefits and risks.

This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.