The increasing prevalence of overweight and obesity has led to a surge in the demand for effective weight loss solutions. Hims & Hers, a telehealth company, offers a range of weight loss drugs, including oral medications, customizable pharmaceutical kits, and glucagon-like peptide (GLP-1) injectables, designed to help individuals achieve their weight loss goals. This article aims to provide a comprehensive review of Hims weight loss drugs, focusing on their benefits, potential side effects, and important considerations for individuals considering these medications.
Understanding GLP-1 Drugs and Their Mechanism of Action
GLP-1 drugs, also known as GLP-1 receptor agonists, have emerged as a highly effective treatment option for both type 2 diabetes and weight loss. These drugs mimic the action of glucagon-like peptide-1 (GLP-1), a naturally occurring hormone in the body that plays a crucial role in regulating blood sugar levels and appetite.
When you eat, your digestive system breaks down carbohydrates into simple sugars that travel through your bloodstream. GLP-1 agonists, trigger the release of insulin from your pancreas, which helps lower blood sugar levels. In people with type 2 diabetes, the body's cells are resistant to the effects of insulin, the body does not produce enough insulin, or both.
In addition to their effects on insulin release, GLP-1 drugs also act in the brain to reduce hunger and act on the stomach to delay emptying, so you feel full for a longer time. These effects can lead to weight loss, which can be an important part of managing diabetes. More recently, the FDA has approved several GLP-1 agonists for weight loss in people with obesity who do not have diabetes.
Ten GLP-1 drugs are FDA-approved to treat either type 2 diabetes or weight loss.
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Common Side Effects of Semaglutide
Semaglutide, the active ingredient in Ozempic® and Wegovy®, can cause gastrointestinal issues, and these typically get better with time as your body adjusts. The most common semaglutide side effects are gastrointestinal issues, like:
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Abdominal pain
These side effects are mostly mild to moderate in severity, and they usually get better with time.
Semaglutide Nausea
Nausea is the most common side effect of semaglutide. In clinical trials on Ozempic®, nausea was reported in about 20 percent of people taking a 1-milligram (mg) dose. The higher the dose, the more likely you are to experience nausea. In Wegovy® clinical trials, 44 percent of people reported nausea - participants were taking a 2.4-mg dose in this case.
Semaglutide may cause nausea because it slows how quickly food moves from the stomach to the intestines (gastric emptying). This helps you feel fuller, but it can also make you feel nauseous and bloated, especially if you overeat.
You can minimize semaglutide nausea by:
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- Eating smaller meals more regularly
- Avoiding fatty, greasy, and fried foods
- Drinking enough water (but avoiding drinks 30 to 60 minutes before and after eating)
- Taking prescription anti-nausea medications like ondansetron (Zofran®)
Semaglutide Diarrhea
You might experience diarrhea on semaglutide. Research shows that about 9 percent of people taking Ozempic® report it, and 30 percent of those taking Wegovy® report it. Semaglutide may cause diarrhea because the medication can change how food moves through the digestive system and how the body absorbs fatty compounds (lipids) and sugar (glucose).
You can treat semaglutide diarrhea by:
- Replenishing lost fluids by drinking plenty of water
- Avoiding dairy, coffee, alcohol, and carbonated drinks
- Eating foods that are easy to digest, like chicken, rice, carrots, and peeled fruit
- Taking over-the-counter (OTC) medications like loperamide (Imodium®)
Semaglutide Constipation
On the flip side of diarrhea, constipation is also common with semaglutide. In trials on Ozempic®, 5 percent of people reported constipation. About 24 percent of participants in Wegovy® trials reported it. Semaglutide may cause constipation because it can slow the movement of food through the digestive system and increase water absorption. Since semaglutide makes you feel fuller, you might also eat less fiber and drink less water - both of which can contribute to constipation.
To treat semaglutide constipation:
- Get more fiber by eating foods like fruits, veggies, brown rice, beans, and lentils
- Drink more water
- Do more physical activity
- Take OTC stool softeners
Semaglutide side effects tend to crop up when you first start taking the medication and when your dose increases. Doses typically increase every four weeks. Novo Nordisk-sponsored research found that semaglutide side effects tend to happen in the first eight to 12 weeks with Ozempic® and Rybelsus®.
Read also: Comprehensive Hims Weight Loss Program Analysis
Other Potential Side Effects
Losing weight can lead to many improvements in your health and well-being. But weight loss itself can also cause a few unwanted side effects, including:
- Fatigue
- “Semaglutide face”
- Muscle loss
Semaglutide Fatigue
Does semaglutide make you tired? It can. In Wegovy® clinical trials, 11 percent of people reported fatigue. You might feel tired because you’re eating fewer calories, exercising more, or experiencing dehydration due to side effects like vomiting and diarrhea.
To get more energy while taking semaglutide, try:
- Improving your sleep quality by cutting down on caffeine and keeping a consistent sleep schedule
- Doing regular physical activity and taking rest days
- Eating a variety of whole foods, including fruits, veggies, healthy fats, and lean proteins
- Drinking enough water
“Semaglutide Face”
“Semaglutide face” or “Ozempic® face” are terms used to describe the fat and muscle loss that can happen in the face with rapid or substantial weight loss. Losing fat and muscle in your face can change your appearance slightly or lead to sagging skin and more visible fine lines. This can happen with any type of weight loss - whether semaglutide is involved or not. Losing weight gradually and eating plenty of protein can help you avoid muscle loss. And you might find that your skin naturally retracts as you maintain your new weight. If weight is lost in a more gradual way, these changes may not be as noticeable.
Semaglutide Muscle Loss
There’s a risk you’ll lose some muscle as you lose body fat. Again, this can happen with any type of weight loss, whether you’re using semaglutide or not.
To avoid muscle loss:
- Eat plenty of protein. Go for lean protein sources like chicken, turkey, fish, eggs, and tofu.
- Strength train. Do bodyweight exercises, use dumbbells, or get on the resistance machines at the gym. Aim for at least two strength-training sessions a week.
Rare Side Effects
Hair loss may be a rare side effect of semaglutide. Participants in Ozempic® clinical trials didn’t report hair loss, but 3 percent of people in Wegovy® trials reported it. There are also anecdotal reports online of semaglutide hair loss. It’s not clear how semaglutide might affect your hairline. One theory is that the medication could disrupt the natural hair growth cycle. But there are also theories that semaglutide could improve hair health, so more research is needed. Hair loss could also come down to stress, aging, or rapid weight loss.
Currently, there’s no evidence suggesting that semaglutide negatively affects fertility. In fact, it may even improve fertility. How so? Obesity can negatively impact male fertility, and semaglutide can help you reach a healthy weight. More research is needed on this front, though.
Long-Term Side Effects
There are some potential long-term, serious side effects of semaglutide. Although rare, they’re worth knowing about so you know what to watch for.
For example, the long-term side effects of Wegovy® might include:
- Inflammation of the pancreas (pancreatitis)
- Gallbladder problems like gallstones and gallbladder disease
- Acute kidney injury - when the kidneys stop working properly
- Mental health issues
- Low blood sugar (hypoglycemia) when used with certain diabetes medications
- Complications with an eye condition called diabetic retinopathy in people with type 2 diabetes
There’s also a boxed warning from the FDA stating that semaglutide causes thyroid tumors in rodents. So far, research suggests semaglutide isn’t linked to an increased risk of cancer in humans, including thyroid cancer.
For many people, the health benefits of losing weight and treating obesity outweigh any potential long-term adverse events. But a healthcare professional can look at your current health and medical history to determine if semaglutide is safe for you to take long-term.
How Long Can You Stay on Semaglutide?
Semaglutide was originally a diabetes medication, meaning it’s designed for long-term use - or even life-long use. How long to stay on semaglutide for weight loss depends on:
- Your goals
- How well you’re tolerating the medication
- Whether you develop any new health conditions
- Your overall health
You might be able to stay on semaglutide to help maintain weight loss in the long run. A healthcare provider can give you personalized medical advice to help you decide if staying on semaglutide is the best choice.
Minimizing Side Effects Through Diet
Some foods can make the gastrointestinal side effects of semaglutide worse. To minimize side effects, limit or avoid:
- Spicy foods
- Fatty foods
- Fried foods
- Sugary foods and drinks
- Acidic foods like tomatoes and citrus fruits
- Garlic and onions
Bland foods may help when side effects like nausea crop up. Try rice, applesauce, plain toast, tofu, and cooked vegetables like carrots and spinach. Not sure what’s triggering side effects? Keep a food diary to track patterns. Of course, if nutritious foods like tomatoes and onions don’t trigger side effects for you, you can keep on eating them.
As for what to eat on semaglutide, prioritize whole foods, and aim to get a variety of nutrients. Go for:
- Fruits and veggies
- Lean proteins, like chicken, fish, and tofu
- Low-fat dairy products
- Legumes, including lentils, chickpeas, and beans
- Whole grains, like brown rice, quinoa, whole-wheat bread, and oatmeal
Semaglutide and Alcohol
You can technically drink alcohol on semaglutide. But if you drink regularly (or excessively), you might find it harder to stick to healthy habits. Alcohol can slow weight loss, and it may make semaglutide side effects worse. Consider drinking alcohol in moderation now and again, or cutting it out altogether.
Oral vs. Injectable Semaglutide
Semaglutide (Ozempic®, Wegovy®, Rybelsus®) comes in both injection and oral form. But beyond how you take it, what’s the difference? And which form is more effective for weight loss? Semaglutide injections and semaglutide pills work in similar ways, but injections are usually more effective for weight loss than pills.
So far, the Food and Drug Administration (FDA) has approved three semaglutide medications. Those include:
- Ozempic®
- Wegovy®
- Rybelsus®
You can also get compounded semaglutide injections.
- Ozempic® is FDA-approved to help people with type 2 diabetes control their blood sugar. It’s sometimes prescribed off-label for weight loss in people with overweight and obesity. It’s a once-a-week injection you take alongside making lifestyle changes, like eating more whole foods and doing more daily movement. As well as type 2 diabetes, Ozempic® is FDA-approved to reduce the risk of major cardiovascular events - like stroke and heart attack - in people with type 2 diabetes and cardiovascular disease. It’s also approved to reduce cardiovascular death and kidney risks in those with type 2 diabetes and chronic kidney disease.
- Wegovy® is also a once-a-week injection. It contains a higher dose of semaglutide than Ozempic®, and it’s currently the only semaglutide medication FDA-approved for weight loss. This drug is FDA-approved for weight reduction and chronic weight management alongside diet and exercise changes. It’s for people with obesity or overweight with at least one weight-related health condition, like: High blood pressure (hypertension), High cholesterol (dyslipidemia), Type 2 diabetes, Sleep apnea. Wegovy® is also approved to reduce cardiovascular risks in those with cardiovascular disease and either obesity or overweight. It can also be prescribed to treat a type of fatty liver disease called noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH).
- Rybelsus® is a daily semaglutide pill. Alongside eating more nutritious foods and doing more movement, it’s prescribed for people with type 2 diabetes to help manage their blood sugar. Like Ozempic®, healthcare professionals sometimes prescribe Rybelsus® off-label for weight loss when appropriate.
- Compounded Semaglutide is a weekly injection that contains the active ingredient semaglutide. Healthcare providers prescribe it when people have a unique need, like needing a personalized dosing schedule. Compounded semaglutide is a compounded product and hasn’t been approved by the FDA. The FDA doesn’t review compounded products for safety, effectiveness, or quality.
Research on Oral vs. Injectable Semaglutide
Research from 2021 looked at people with type 2 diabetes who made diet and exercise changes and took either 1 mg (milligram) of Ozempic® or 14 mg of Rybelsus®. Here’s what the results found:
- People taking Ozempic® lost about 10 pounds.
- People taking Rybelsus® lost roughly 8 pounds.
Wegovy® contains a higher dose of semaglutide than Ozempic® and may be even more effective for weight loss. One Wegovy® study found that those taking a 2.4-mg dose lost an average of around 15 percent of their body weight over 68 weeks.
Side Effects of Oral vs. Injectable Semaglutide
The side effects of oral semaglutide and semaglutide injections are mostly the same:
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Stomach pain
You may feel side effects when you first start taking semaglutide and when your dose increases. But you should start feeling better with time as your body adjusts.
Hims & Hers Semaglutide Injectables
Hims & Hers semaglutide injectables contain the same active ingredient as Wegovy and Ozempic, both of which are FDA-approved drugs commonly used for diabetes and weight loss. The injectable is designed to be used once a week as part of a broader weight-loss plan including dietary and lifestyle changes.
The $199 per month subscription to the Hims & Hers compounded injectable involves a close follow-up process and unlimited medical consultations with a licensed provider. The drug is not intended for diabetes management, according to Dr. Carroll.
Compounded Drugs: Safety Concerns
Compounded drugs aren’t FDA-approved. However, when drugs, such as semaglutide, are listed on the FDA shortage list, some restrictions-like those preventing companies from compounding copies of previously approved drugs-are relaxed.
The FDA is aware that some patients and health care professionals may look to unapproved versions of GLP-1 (glucagon-like peptide-1 (GLP-1) receptor agonists) drugs, including semaglutide and tirzepatide, as an option for weight loss. This can be risky for patients, as unapproved versions do not undergo FDA’s review for safety, effectiveness and quality before they are marketed.
FDA recommendations for health care professionals and patients:
Compounded drugs should only be used in patients whose medical needs cannot be met by an FDA-approved drug. Patients should obtain a prescription from their doctor and fill the prescription at a state-licensed pharmacy. Talk to your doctor if you have questions about your medicines.
Concerns with Compounded Versions of These Drugs
A compounded drug might be appropriate if a patient’s medical need cannot be met by an FDA-approved drug, or the FDA-approved drug is not commercially available. However, compounded drugs are not FDA approved. This means the agency does not review compounded drugs for safety, effectiveness or quality before they are marketed. The agency has identified some areas of concern for compounded GLP-1 drugs.
- Improper storage during shipping may lead to quality issues: Injectable GLP-1 drugs require refrigeration as indicated in their package inserts. FDA has received complaints that certain compounded GLP-1 drugs have arrived warm or with inadequate ice packs to keep the drug at recommended storage temperatures.
- Dosing concerns with compounded semaglutide and tirzepatide: FDA received multiple reports of adverse events, some requiring hospitalization, that may be related to dosing errors associated with compounded injectable semaglutide products. These dosing errors resulted from patients measuring and self-administering incorrect doses of the drug, and in some cases, health care professionals miscalculating doses of the drug. Additionally, the agency has received adverse event reports that may be related to patients prescribed compounded semaglutide or tirzepatide products in doses beyond what is in the FDA-approved drug label.
- Salt forms should not be used to compound semaglutide: The agency is aware that some semaglutide products sold by compounders may be the salt forms. These salt forms, including semaglutide sodium and semaglutide acetate, are different active ingredients than are used in the approved drugs. The agency does not have information on whether these salts have the same chemical and pharmacologic properties as the active ingredient in the approved drug, and we are not aware of any lawful basis for their use in compounding.
- Adverse events related to compounded versions of semaglutide and tirzepatide: FDA has received reports of adverse events related to compounded versions of semaglutide and tirzepatide. However, federal law does not require state-licensed pharmacies that are not outsourcing facilities to submit adverse events to FDA so it is likely that adverse events from compounded versions of these drugs are underreported.
- Illegal online sales of these drugs: FDA monitors the internet for fraudulent or unapproved drugs and has issued warning letters to stop the distribution of illegally marketed semaglutide and tirzepatide. These illegally marketed drugs: may be counterfeit, could contain the wrong ingredients or harmful ingredients, could contain too little, too much or no active ingredient at all.
Recommendations for consumers:
The agency encourages patients to be vigilant and know the source of their medicine. Carefully check labels of compounded GLP-1 drugs for warning signs such as spelling errors or incorrect addresses and ensure your medicine is provided by a licensed pharmacy and prescribed by a licensed health care provider. If you receive a product with a licensed pharmacy name on the label that you think might be fraudulent, contact the pharmacy to ask if it is their product. Talk to your doctor if you have questions about your medicines.
Other Weight Loss Medications
Besides oral semaglutide, other oral medications can promote weight loss. If eligible, Hims offers access to personalized oral weight loss kits. Kits combine oral medications in a formulation that best suits your body and needs.
Kits can include:
- Bupropion: Bupropion is an antidepressant that healthcare providers sometimes prescribe with other medications to promote weight loss.
- Metformin: Metformin is a diabetes drug that’s used off-label for weight loss. It can reduce appetite and change the gut microbiome to support weight loss.
- Naltrexone: Naltrexone can treat alcohol use disorder and opioid dependence. Providers sometimes prescribe it as part of a broader weight loss treatment plan.
- Topiramate: Topiramate is an epilepsy drug. It can also reduce appetite and change food-related reward pathways.
Some kits also come with vitamin B12, an essential nutrient.
Eligibility for Weight Loss Medications
Eligibility for weight loss medications is typically based on body mass index (BMI). For semaglutide or liraglutide, a patient must must be an adult or child age 12 or more, with a BMI of 30 or greater or with a BMI of 27 or greater with comorbidities such as high blood pressure, diabetes, or high cholesterol. People who have a BMI of 30 or above do not need to have a chronic disease associated with their BMI, because obesity is considered a chronic disease. Requirements are similar for many other weight loss medications, including phentermine, naltrexone-bupropion, and orlistat, although not all are FDA-approved for use in children. The more recently approved tirzepatide is approved only for adults with a BMI of 30 or greater.