Creatine monohydrate + GLP-1 — looking for input

Dr.NateNeph said:

DEXA scan update relevant to lean mass: Scanned at months 0, 6, and 12.

Dr.NateNeph said:

...the muscle loss concern with lean mass...

This is a legitimate and well-studied concern. Let me put some numbers on it:

In STEP 1, approximately 39% of weight lost was lean mass. However, the Lundgren 2024 study showed that structured resistance training reduced this to ~25% lean mass loss.

Context matters: at BMI 35+, you're carrying excess lean mass to support the extra weight. Losing some lean mass is expected and not inherently harmful if you maintain adequate muscle function through exercise.

The solution isn't avoiding the medication — it's combining it with proper exercise and protein intake.

laura_annarbor said:

Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution.

Bookmarking. The distinction being drawn above is the one nobody else makes. Printing the relevant bit and taking it with me.

Dr.NateNeph said:

DEXA scan update relevant to lean mass: Scanned at months 0, 6, and 12.

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.

hyun_seoul said:

Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.

Sharing my comprehensive lab data relevant to lean mass:

Protocol: Tirzepatide 10mg/wk, resistance training 5x/week, protein 1.5g/kg/day.

The improvements in lean mass are clearly reflected in these numbers. The inflammatory marker reduction (hsCRP) is particularly striking.

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