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The 72-week STEP UP trial was a randomised, double-blinded, parallel-group, placebo-controlled, superiority trial designed to evaluate the efficacy of semaglutide 7.2 mg with semaglutide 2.4 mg and placebo as an adjunct to lifestyle intervention
Based on my experience and conversations with other athletes, here is a decision framework: Microdosing may be right if you: Only need to lose 3-8kg to reach your target race weight Train at high volume (10+ hours/week) and cannot afford to compromise fueling Have a history of GI sensitivity during exercise Are preparing for a specific race and cannot risk GI disruption Want to use GLP-1 as a tool alongside an already-disciplined nutrition plan Standard dosing may be more appropriate if you: Have significant weight to lose (15kg+) and are not currently in peak training Are in an off-season or base-building phase with lower fueling demands Have tried microdosing without meaningful results after 8-12 weeks Have metabolic health concerns (pre-diabetes, insulin resistance) that require therapeutic doses The key principle: find the minimum effective dose for your situation
This keeps endotoxin contamination from happening, which is especially dangerous for diabetics
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