My doctor says stay on 1mg but I feel like I need more — need advice

Answering the narrow version, because the broad one does not have a single answer. The trials generally allowed a step to be held or reduced and then retried, and people who did that mostly arrived at the same place a few weeks later. The end point of the ladder is set by tolerability, not by a schedule, and there is no evidence that reaching the top faster produces a better outcome.

Dr.RaviCardio said:

The trials generally allowed a step to be held or reduced and then retried, and people who did that mostly arrived at the same place a few weeks…

Agreed on the arithmetic, with one condition: holding indefinitely at a dose that is not doing anything is not patience, it is a stall with a nice name. The distinction is whether appetite has changed at all at the current step.

AmyNC_wife said:

I titrated faster than the label because I felt fine, hit a wall at the third step, and had to come back down — which I now think was the predictable…

Can confirm the pattern AmyNC_wife describes. Four weeks is the pharmacokinetics, not caution. With a one-week half-life you need four to five half-lives to reach steady state, so at two weeks you are dosing on top of a concentration that has not finished rising. Escalating then stacks exposure and you get the side-effect burden of the higher dose before you have seen the benefit of the current one.

From the other side of the consultation, briefly.

PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss. It's a titration dose to let your body adjust. Don't be discouraged if you don't lose much in the first month.

The therapeutic dose for weight management starts at 1.7mg (semaglutide) or 5mg (tirzepatide). Be patient with the ramp-up.