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Semaglutide May Be the Better Starting Point If: You are new to GLP-1 therapy and want to start with the more established option You have strong cardiovascular risk factors (SELECT trial data is robust) You are sensitive to GI side effects and want to titrate conservatively Cost is a primary concern (compounded semaglutide is widely available) Tirzepatide May Be the Better Choice If: You have been on semaglutide and have plateaued You have type 2 diabetes or significant insulin resistance You want to maximize total weight loss potential You tolerated semaglutide well and are ready for a more potent option The right choice depends on your labs, your health history, your previous medication experience, and your goals

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