Hair falling out at month 4 - freaking out — my results so far

Short answer first, then the reasoning. Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts. Receptor-level tachyphylaxis to the delayed-emptying effect develops over weeks while the central appetite effect persists, so the same dose is materially more comfortable at week six than at week two. A slower ladder therefore reaches the same dose with less cumulative nausea, not the same nausea spread thinner.

kate.chem said:

Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts.

kate.chem has the substance of this right. The condition it depends on is worth stating. The meal advice is right and incomplete without the hydration point. People stop drinking because drinking makes them feel full, then attribute dehydration symptoms to the drug.

GraceAZ_72 said:

Nausea arrived on day two of each dose step, lasted about four days, and disappeared entirely by the second week — until the step where it did not.

Can confirm the pattern GraceAZ_72 describes. The line between titrate-through and stop is not severity, it is trajectory and what else is present. Nausea that peaks and improves within a week is the expected pattern. Nausea that is escalating, or that comes with severe upper-abdominal pain radiating to the back, or that prevents fluids for more than a day, is a different conversation and belongs with a clinician the same day.

From the other side of the consultation, briefly. The useful move here is to separate what is established from what is widely repeated. Those two sets overlap less than the confident tone of most write-ups suggests, and the second set is where nearly all the disagreement on this board comes from.

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