Semaglutide versus Tirzepatide
I’ve Been on Both. Here’s What I Actually Think.
I get this question constantly.
Semaglutide or tirzepatide -- which one is better? Which one worked better for you? Do you regret switching?
And honestly? I’ve been avoiding giving a direct answer because the direct answer is complicated. But I’ve been on both. Three years in. 75 pounds down. Still going. So let me just tell you what it actually looked like.
How I started
When I first walked into a weight loss clinic, I didn’t even know what a GLP-1 was. I went in looking for something called an RM3 program -- I don’t even know what that is to this day. They introduced me to semaglutide. I started on a compounded sublingual, no injection, just something I put under my tongue every morning.
I lost about 7 pounds that first month. And then I went home and fell down a TikTok rabbit hole for days trying to figure out what I had actually just started putting in my body.
That’s also when I started my social media -- because there wasn’t a lot of people sharing their real experience, and I wanted to document it for myself and for other people. Three years later, here we are.
By month two I was on injections. By month six I had lost 40 pounds.
The honest truth about my time on semaglutide
I felt terrible.
Not in a dramatic way -- but consistently, routinely terrible. Sulfur burps. Diarrhea. Exhaustion. And because of that, I was inconsistent as hell. If I had a vacation coming up, I’d skip my shot. If my period was starting, I’d skip it. If I had anything coming up that I didn’t want to feel sick for, I’d skip it.
I never got above a 0.75mg dose. I tried 1mg once and it wrecked me. And here’s the thing -- I’m a teacher. I have 28 kids in front of me every single day. I can’t have sulfur burps at school. I can’t run to the bathroom whenever I need to. I can’t put my head down when I’m exhausted. So the side effects that someone else might power through were just not an option for me.
By the time fall came around, I had stalled. I went to Hawaii, took three weeks off the medication, came back, dropped back down to the lowest dose, and the weight loss had stopped. I was frustrated. And then Zepbound came out.
Why I switched
I’m not going to pretend it was purely strategic. My ADHD brain saw everyone talking about tirzepatide and I had to have it. That’s the honest version.
But also -- I had stalled. The side effects weren’t worth it anymore. And I genuinely wanted to see if something would feel different.
I was already working with a telehealth company and I just asked if I could switch. They said yes, absolutely, and moved me over with no problem. I started tirzepatide at the end of November 2023 -- so I had been on semaglutide for about nine months, lost roughly 40 pounds, and then stopped losing those last three months because I kept skipping doses.
What tirzepatide actually felt like
The side effects were less. Not gone -- but less. Where semaglutide had me miserable, tirzepatide was more like... manageable. And because of that I was more consistent.
I hit Onederland in April -- about five months after starting. I went from around 215 down to 199. So that’s about 15 pounds in five months, which is slower than my semaglutide pace.
But here’s the thing I keep coming back to: on semaglutide, I couldn’t eat the things I loved without getting sick. Which meant I wasn’t eating them. Which maybe helped the weight loss -- but it was miserable. On tirzepatide, I can eat more normally. I have less restriction. Which means I’m also more in control of whether I actually make good choices, because the medication isn’t making bad choices feel terrible.
So did semaglutide work better? Maybe. But it also made me feel awful. And I don’t take B12 shots anymore just to get through the day, which I was doing constantly on sema.
Where I’m at now
I’m at 185 pounds. I’ve been inconsistent -- took months off in 2025 that I’m not proud of. Went from 180 back up to 200 at one point. Just took my first 9mg dose on Sunday and yesterday was rough -- headache, exhaustion, upset stomach. But no sulfur burps. No diarrhea. Not even close to what semaglutide did to me.
And today I’m eating normally. That alone feels like a win.
So which one is better?
I genuinely cannot tell you. And I’ve lived both.
What I can tell you is this:
If money is an issue -- semaglutide. It is so much more affordable out of pocket. That’s not even a conversation.
If you have a choice and cost isn’t the factor -- tirzepatide. Not because it works better, but because I think the side effects tend to be more manageable for most people. That means more consistency. And consistency is everything on this journey.
Both medications are good. Both can work. The one that works best for you is the one you can actually stay on.
I don’t regret switching. But I also don’t know for certain it was the right call. And after three years, I’m okay sitting in that uncertainty -- because I still feel better than I did at 277 pounds, and I’m still going.
If you’re trying to make this decision right now -- drop a comment. Tell me which one you’re on, how it’s going, whether you’ve tried both. Other people read these comments and they need to hear your story too.
See you next week. 💙
One more thing -- if you’re in the middle of figuring all of this out and you want a place to reconnect with why you even started, I’m running a 30-day May reset in my paid space here on Substack, starting May 1st. Every single day I’ll be posting -- you’ll read it, respond to it, and I’ll be in the comments with you. It’s called From Day One and it’s for anyone just starting a GLP-1 and anyone who’s been on it for a while and feels stuck.
Right now you can get your first year of paid Substack for $29 -- that’s the presale price and it goes away May 1st. If you’ve been on the fence, this is the moment. More details below.
I am not a medical professional. This is my personal experience only -- please talk to your provider before making any changes to your medication.
So you know I have a similar story . Did sema. Felt pretty bad and didnt lose till 3 mo in. I also wonder if lost more because I was so sick alot more then the med working. I decided to switch this past month to tirz and hoping after I move up to 5 mg I will see better results(. Weight loss and appetite suppression and food noise. ) I not feeling anything yet on 2.5 after being on a med for 4 mo that made it hard to even eat .I wonder if that is what I need for now but I also work with kids so hard to be able to manage side effects as well I was sad that I didn't ever enjoy anything anymore. I hope tirz will give me best of both worlds. I have not totally said no to going back on sema but wanna give this time bc its been nice not tofeel like I did for 3 months!!
I tried a compounded Sema and thought I was dying! Had very bad side effects that just prevented me from continuing. I stayed on it for about 2 months with no improvement and very little weight loss. I did nothing for a while. Trying to diet and exercise as I had in the past but that no longer worked for me. In December last year I was at my highest weight and talked with my provider about what I could do: she suggested I try Tirz. Since I didn’t want to be sick at Christmas, I started 2.5 mg on 12/26 and have stayed on that dose the entire time. I had side effects. Mostly nausea, fatigue, and chills! I quite literally freeze for about 24 hours after shot days. Which isn’t all that bad since I am a woman of a certain age! lol…I’ve been scared to increase the dose. I’ve continued to loose. Very SLOWLY. And I’m ok with that. To date I’ve lost a little over 30 pounds. I want to try to increase the dose but I really do not want the side effects. 😞