Has anyone dealt with my 18-month semaglutide journey?

Dr.ObesityMed said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.

The figures, for anyone assembling their own picture. For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and subcutaneous bioavailability near 89%. Those four numbers explain most of the questions people ask about timing.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

Dr.GastroMayo said:

I will push back on the "any working dose is fine" framing.

There is a second half to this that has not been said yet. Worth answering the question that was asked rather than the one behind it. The narrow version usually has an answer; the broad version usually does not, and answering the broad one is how a thread stops being useful.

Following on from alex_tucson — and this may be the naive question:

Did your prescriber agree with that reading, and if not what was their objection?

Closing the loop on my own question.

Update. I did go to 2.4mg in the end, and the honest report is that it bought me less than the step before it and cost me two bad weeks. Worth knowing rather than worth repeating.