Weight loss
Semaglutide and tirzepatide, answered in order.
You’ve seen the brand-name injections advertised everywhere. Here’s what the medication actually is, what it does to your body, what it costs, what happens after you order, and what it can’t do.
It’s long on purpose. This is a real decision, and you should be able to make it without a phone call.
1 of 14
What is it, actually?
Read it in
Same facts, two ways of saying them. Your choice is remembered on every page.
Short versionA lab-made copy of a hunger hormone your gut already makes — engineered to last a week instead of a few minutes.
Clinical versionSemaglutide is a GLP-1 receptor agonist: a lab-built version of GLP-1, a hormone your gut releases after meals, modified so it binds to a blood protein and stays active about seven days instead of minutes. Tirzepatide does the same job on two hormone receptors, GLP-1 and GIP. What you get here is a compounded version — the same active molecule, prepared by a licensed pharmacy for your prescription. It is not the FDA-approved brand-name product, and it hasn’t been tested head-to-head against it.
When you eat, your gut releases a hormone called GLP-1. It tells your brain you’re full, slows your stomach down, and helps your pancreas handle sugar. Your natural version breaks down within minutes.
Semaglutide is a copy of that hormone, rebuilt so it lasts about a week. It’s the active ingredient in the best-known brand-name weight-loss injections.
Tirzepatide is the same idea, except it copies two gut hormones instead of one (GLP-1 and GIP). Think of it as the newer generation. It’s the active ingredient in the newer brand-name injections.
What you’d actually be getting
Not the brand-name product. A compounded semaglutide or tirzepatide — the same active ingredient, prepared by a licensed compounding pharmacy against a prescription written for you. The injectable versions include vitamin B12.
Same active ingredient is a real thing. Same product is not.
A compounded preparation can differ from the branded one in concentration, inactive ingredients, packaging and storage. It isn’t FDA-approved, and it hasn’t been through the trials the branded drugs went through. I’ll come back to exactly what that means in chapter 2, because it changes how you should read the research.
If the branded product is within reach for you through insurance or a manufacturer program, that’s a legitimately better-evidenced option, and I’ll tell you so rather than talk you out of it.
Two ways to take it
Injection
Once a week. A small needle into the fat just under the skin — belly, thigh or upper arm. Nothing like a blood draw. Most people are more anxious beforehand than after, and I’ll walk you through the first one on the phone if you want.
Under the tongue
Once a day, a small dose held under the tongue. No needle at all. If needles are the only thing standing between you and starting, this is why it exists.
2 of 14
Why do people take it?
Short versionBecause diet and exercise alone hit a wall for them, and this is the first thing that made eating less feel possible instead of heroic.
It was built to treat type 2 diabetes. The weight loss was an accident nobody planned for — it showed up in the diabetes trials and was dramatic enough that researchers ran an entirely new set of studies just for obesity. Tirzepatide came from asking whether two gut hormones would beat one. The answer was yes.
Here’s why it works when willpower doesn’t: when you lose weight the ordinary way, your body fights back. Hunger hormones go up, fullness hormones go down, and you spend every day negotiating with yourself. This changes the signal itself. People describe the constant background chatter about food — the “food noise” — going quiet. That’s usually the first thing anyone reports, well before the scale moves.
What the research found
In the main obesity trial for semaglutide, average weight loss was around 15% of body weight over roughly 16 months. A separate large trial found it reduced heart attacks and strokes by about a fifth in people with excess weight and existing heart disease. That second finding matters — plenty of things move the scale, but very few have been shown to keep people out of hospital.
For tirzepatide, average weight loss at the top dose was around 21% over roughly 17 months — noticeably more. It also has a specific approval for obstructive sleep apnea in people with obesity. What it doesn’t yet have is semaglutide’s proven track record on heart attacks and strokes; that data is still maturing.
Now the part you need to read twice
Those results come from trials of the branded, FDA-approved products. What I can help you get is a compounded medication containing the same active ingredient. Compounded preparations are not put through those trials and are not FDA-reviewed for safety, potency or quality before they ship.
So I cannot honestly tell you a compounded version will produce the numbers above, and neither can anyone else. Averages also hide enormous variation — some people lose far more, some far less, and the ones who did best in every trial were also eating and moving differently. Your result will be your own. I’d rather you have that clear going in than find it out after you’ve paid.
If you want the honest version of “how much will I lose?” — it’s in chapter 13, and the answer isn’t a number.
3 of 14
How does it work?
Short versionThree things at once: it helps your pancreas handle sugar, it slows your stomach down so you stay full, and it turns the hunger signal down in your brain.
Clinical versionThree mechanisms working together. It helps your pancreas release insulin when blood sugar is high and turns down glucagon, the hormone that raises it. It slows how fast your stomach empties, so a meal keeps you full longer. And it acts directly on the appetite centres in your brain, lowering hunger signals and how rewarding food feels — the “food noise” effect. Tirzepatide’s second target, GIP, appears to make it better tolerated at the same strength and adds effects on fat tissue and insulin sensitivity. The dose steps up every four weeks or so, because that’s what keeps the nausea manageable.
The pancreas. It nudges your body to release insulin when your blood sugar is high, and to hold back a hormone that raises it. Steadier sugar, fewer crashes, fewer crash-driven cravings.
The stomach. Food leaves your stomach more slowly, so a normal meal keeps you full for longer and a big meal feels like too much. This is also where most of the side effects come from — more on that in chapter 5.
The brain. It acts on the appetite centers directly. Hunger gets quieter, food is less interesting, portions shrink without a fight. This is the one people actually notice.
Tirzepatide does all of that and adds a second hormone on top. Researchers don’t fully agree on why the second one helps — better insulin sensitivity and some blunting of nausea are two of the theories — but the weight-loss numbers in the trials were higher.
What it doesn’t do
It doesn’t burn fat by itself. It makes eating less easier. That’s the whole job. Protein, water, sleep and moving your body still matter — and they matter more once your appetite drops, because that’s exactly when people accidentally under-eat and lose muscle along with the fat.
Some of what you lose is muscle
In every trial, a meaningful share of the weight lost was lean mass, not fat. The fix is boring and it works: eat protein at every meal and lift something heavy a couple of times a week. Do that and you end up smaller and stronger. Skip it and you end up smaller and weaker. If you want help with that side of it, ask me — it’s the part I actually know something about, and it’s free.
4 of 14
When do you take it — and when will you notice?
Short versionInjection: once a week, same day each week. Under the tongue: once a day. Appetite changes in the first week or two; the scale follows over months.
The schedule
Injections are weekly — pick a day and keep it. The under-the-tongue version is daily. Either way, the dose starts low and steps up gradually over the first couple of months. That ramp is deliberate: moving fast is what makes people nauseated. The provider sets the schedule, not you and not me, and the pharmacy’s label and the clinical team give you the specifics for your prescription.
Miss a dose? Don’t guess and don’t double up. Message the clinical team — the right answer depends on how late you are and which medication you’re on.
When you’ll notice
- Week 1–2Appetite starts dropping
Most people notice this early, well before the scale moves. The food noise gets quieter. Portions shrink without you deciding they should.
- Month 1 onThe dose steps up
Each increase can bring a few days of queasiness, then it settles. If it doesn’t settle, the answer is usually to slow the ramp, not push through — that’s a conversation with the provider.
- Month 3–6Steady, visible loss
This is usually where people stop doubting it. Clothes first, then other people noticing.
- Month 12–18It plateaus
Weight loss levels off. Where you land depends heavily on what you built alongside it — the eating, the training, the sleep.
That’s the general shape from the clinical literature on the branded products. Your experience may look different, and nobody can tell you in advance what yours will be.
5 of 14
Who is it for? Who isn’t it for?
Short versionAdults with real weight to lose who can commit to a year, not a month. Not for anyone with a personal or family history of medullary thyroid cancer or MEN2 — that’s a hard stop, not a caution.
Points toward yes
- You have real weight to lose, not ten vanity pounds
- You’ve tried diet and exercise alone and hit a wall
- You can afford it for a year or more, not just a month
- You’re willing to eat protein and do some resistance training alongside it
- You’d rather have a clinician make the call than guess
Points toward wait
- The cost would strain you into quitting in six months
- You’re expecting a short course and then done — that isn’t how this works
- You’re pregnant, breastfeeding, or trying to conceive
- You have a history of an eating disorder — raise it; the provider needs to know
- You have surgery coming up — tell the surgeon and anesthetist if you start
Hard stops the provider will apply
- A personal or family history of medullary thyroid cancer or MEN2 (a rare inherited condition). There’s a boxed warning for thyroid C-cell tumors, seen in rodent studies. This is a no, not a maybe.
- Pancreatitis in your history needs a serious look and may be a no.
- Pregnancy, breastfeeding, or trying to conceive.
- Type 1 diabetes, or diabetes managed with insulin or certain other medications, needs the provider’s eyes before anything is prescribed.
Real risks, stated plainly
Nausea, vomiting, diarrhea and constipation are common, and worst in the week after each dose increase. Most people adjust. Beyond that:
- Gallstones become more likely, because you’re losing weight quickly.
- Pancreatitis is rare but serious. Severe stomach pain that won’t let up means call a doctor, not me.
- Some of what you lose is muscle. Lift weights and eat protein or you’ll end up smaller and weaker rather than smaller and stronger.
- Tell any surgeon or anesthetist that you’re taking it — delayed stomach emptying raises risk under anesthesia.
- Tirzepatide can make birth-control pills less reliable, especially when starting and after dose increases. The provider needs to know if you take them.
- The weight tends to come back when you stop. The studies are consistent on this. Plan for a long-term medication, not a course of treatment.
These are things to raise on your intake form and with the provider. I’m not screening you — I’m telling you what the provider will be looking at so nothing catches you by surprise.
6 of 14
Where does it come from, and where can it ship?
Short versionPrescribed by a licensed provider in your state, prepared by a licensed US compounding pharmacy, shipped cold to your door by FedEx.
Where it’s prescribed
By a licensed provider in DirectMeds’ network who is licensed for your state. Not a call center, not an algorithm. Chapter 11 is all about them.
Where it’s made
A licensed, FDA-registered compounding pharmacy in the US prepares it against your prescription, under real quality standards. That is not the same as the product itself being FDA-approved — compounded medications aren’t — and you’ve heard me say that three times now because it’s the thing people most often get wrong.
Where it ships
To a street address, by FedEx, with tracking. It ships cold, packed on ice, so use an address where someone can bring it inside reasonably soon after it lands. It can’t be delivered to a PO box.
Where it’s available
Availability varies by state, and so do the rules about whether a provider has to speak with you first. If you want to be sure before you pay, email me your state and I’ll check.
Where it lives at home
In the fridge, per the pharmacy label, away from anyone it isn’t prescribed to. The clinical team will tell you how long a vial is good for once it’s open.
7 of 14
What does it cost — really?
Short version$179 a month for semaglutide injections, $299 for tirzepatide. Under the tongue: $199 and $249. Each shipment is a 90-day supply paid in three monthly payments. No membership fee, no consultation fee, and the recurring price is locked.
Here’s how the billing actually works, because it’s the thing people ask me to repeat. After the provider approves you, the pharmacy ships a full 90-day supply. You pay for it in three monthly payments, starting with your first order — so $179 a month is $537 per 90-day shipment, and I’d rather you see that arithmetic here than on a statement. There’s no separate consultation or membership fee, and the provider review is included.
For comparison, the branded products list well above $1,000 a month before insurance.
The comparison I’d actually make
$179 a month is $5.88 a day. Before you decide whether that’s an added expense, look at what hunger already costs you: the DoorDash order, the second snack, the restaurant meal that happened because you walked in hungry, the groceries bought on an empty stomach. Most people on appetite medication find that spending drops — not because they’re disciplined, but because the urge quietens. I can’t promise you a number, and I won’t pretend the medication pays for itself. But run the honest comparison against your food spending, not against zero.
No membership fee, no consultation fee. The number you see is the medication. The provider review is part of it.
No long-term contract. It renews until you cancel, and you can cancel future shipments any time after your first order. The first-order price and the recurring price are printed side by side above, because you should see both before you decide.
Your recurring price is locked. I’m authorized to guarantee that the recurring price you start at will not go up.
First-order discounts come and go. If today’s number is better than what’s printed here, I’ll tell you when you email me. If it’s worse, I’ll tell you that too.
My link saves you real money, every month. The DirectMeds shop lists semaglutide at $297 a month; my link is $179 — $118 a month less, for as long as you stay on it. Tirzepatide is $100 a month less, the under-the-tongue versions $50. That’s the “lifetime discount” the order page refers to, and it’s the honest reason to use my link rather than the homepage.
The per-day number is there on purpose. A monthly figure and a daily figure are the same money and feel very different. Both are honest; use whichever one helps you decide clearly.
The six-month option through Affirm — this one goes through me
There’s a second way to pay that isn’t on the order page: prepay six months and let Affirm split it into monthly payments. Because Affirm sets the payment based on your approval, the monthly figure can land well below the standard price — which is why people sometimes see a much lower number advertised and then can’t find it at checkout. It isn’t a discount. It’s financing, and the terms, including any interest, are Affirm’s decision, not mine, so I can’t quote the number in advance.
How to make it happen: email me, say you want the Affirm option, and give me the okay to send you the Affirm link. You fill it out, Affirm shows you your monthly payment, and you decide. Nothing is committed until you say yes. I’m paid the same either way, so I have no reason to steer you one direction or the other — just be honest with yourself about a six-month commitment before you take a lower monthly number.
About the countdown timer on the order page
When you tap my link, the page says “Welcome back” and starts a clock. Ignore the clock. It’s a marketing timer, not a deadline, and it’s the single biggest reason people I’ve talked to abandon an order — they feel rushed and close the tab. The price on my link is the price I quote every day. If you ever come back and it’s different, email me and I’ll get you the number I promised. You are allowed to sleep on this.
If the provider says no, you get every dollar back
You pay before the review, and that sounds worse than it is. If you’re not approved, you’re refunded in full. You are never stuck paying for a medication you were never prescribed.
And the disclosure, because it belongs on the page with the prices: I earn a commission when you order through my link. It doesn’t change what you pay — the pricing on my link is the best available — but you should weigh everything I say against it.
8 of 14
How do I order?
Short versionTap my link, pick your option, create a login, pay, then fill in the health intake. About ten minutes, all on your phone.
The whole thing takes about ten minutes, and you do it yourself, on your phone, at whatever pace you like. Here’s each step so nothing surprises you.
- Tap my link1 min
It opens the DirectMeds order page for weight loss. My name rides along inside the link — that’s what attaches me to your account as your account manager. The link is in chapter 14, and in the button at the bottom of your screen.
Here’s what you’ll see so nothing surprises you: a “Welcome back” page with the lifetime-discount pricing — semaglutide $179 (was $297), tirzepatide $299 (was $399), and the under-the-tongue versions at $199 and $249 — a countdown timer you should ignore, and a “Claim this discount” button. You choose your medication on the next step.
- Pick your option1 min
Choose semaglutide or tirzepatide, and injection or under the tongue. If you’re not sure which, chapter 13 has how I’d think about it — and the provider has the final say on what’s appropriate for you, so it’s a preference, not a commitment.
- Create your login and pay2 min
Your email becomes your username for the DirectMeds patient portal, and payment is by card. Nothing on the checkout is a consultation or membership fee; the number is the medication.
- Complete the health intake10 min
In your portal, right after checkout. This is the medical part, and it’s what the provider uses to decide. It includes a quick ID check — a photo of you and a photo of your ID, taken with your phone camera (a QR code opens it) or a webcam. Nothing ships until the intake is submitted. The next chapter walks through every question on it.
- Wait — briefly, and usually quietly1–3 days
A licensed provider reviews your intake. Chapter 10 tells you exactly what that wait looks like, including the part where nobody calls and that’s normal.
Before you start, three things
- Have your photo ID next to you. The intake asks for a picture of it, and hunting for it mid-form is where people stall.
- Use a street address, not a PO box. It ships by FedEx and needs a doorstep where someone can bring it inside soon after it lands.
- Not sure it’s available in your state? Availability and consult rules vary by state. Email me your state before you order and I’ll check.
If anything at all goes sideways — a page won’t load, a card gets declined, you’re not sure it submitted — email me. Fixing it is my actual job, and it usually takes two minutes.
9 of 14
What’s on the health intake form?
Short versionAbout ten minutes. A photo of you, a photo of your ID, your basics, and your medical history — answered honestly, because it’s the only thing the provider has to go on.
Right after you pay, you complete the health intake. It replaces the office visit: it’s everything a provider would ask you across a desk, and it’s the only thing they have to go on. So it’s worth doing carefully.
What it asks for
- A photo of you — a clear, well-lit selfie. It’s an identity check, not a beauty contest.
- A photo of your government ID — driver’s license or passport. This is the upload that trips people up most; good light, flat surface, no glare.
- Date of birth, height and weight, and your state.
- Your medical history — conditions, past surgeries, allergies, and every medication and supplement you take. Yes, every one.
What to make sure is on it for weight loss
These are the things the provider specifically looks at for this program. None of them are automatic disqualifiers unless I say so — but leaving one off is the one way to make this go badly.
- Any personal or family history of medullary thyroid cancer or MEN2
- Any history of pancreatitis, or gallbladder problems
- Diabetes — which type, and what you take for it, especially insulin
- Pregnancy, breastfeeding, or trying to conceive
- Birth-control pills, if you’re considering tirzepatide
- A history of an eating disorder
- Kidney problems, or serious stomach or bowel conditions
- Any surgery scheduled in the coming months
- Every medication and supplement, including the ones that feel irrelevant
Honesty is the fast path, not the risky one
People sometimes leave things off because they’re worried about being turned down. Think about what that buys you: if something in your history genuinely rules this out, you get a full refund and you’ve avoided a medication that wasn’t safe for you. If it just needs a closer look, the provider adjusts around it. The form isn’t a test you pass by omitting things. It’s how the provider keeps you safe.
If you get stuck
Nine times out of ten it’s the ID photo. Email me. I’ll walk you through it or sort it from my side. Please don’t leave a paid order sitting because a photo upload wouldn’t cooperate.
10 of 14
What happens, and when?
Short versionPay and do the intake today. Provider review in a day or three, usually without a call. Ships cold about five business days after approval. Appetite changes in the first two weeks; the scale follows over months.
Here’s the whole thing laid end to end, from the moment you pay. Knowing the shape of it in advance is most of what makes the wait easy.
- Day 0You order and complete the intake
Ten minutes. Have your ID out. Email me if anything sticks.
- Days 1–3A licensed provider reviews it
Usually silently. If your state requires a consult, or something in your history needs a closer look, they reach out first.
- On approvalThe pharmacy compounds and ships it
About five business days, cold, by FedEx, with tracking. Bring it inside and into the fridge when it lands.
- Week 1First dose, at the starting strength
The clinical team gives you the how-to. If it’s an injection and you want a human on the phone for the first one, that human is me.
- Week 1–2Appetite drops
The food noise goes quiet. Eat protein anyway.
- Month 1 onDose steps up
On the provider’s schedule. A few queasy days after each step is normal; a lot of them is a reason to message the clinical team.
- Month 3Refill ships, bloodwork if ordered
Your next 90-day supply renews on the subscription. If the provider wants labs, this is roughly when.
- Month 3–6Steady, visible loss
Where most people stop doubting it.
- Month 12–18Plateau, and a maintenance conversation
The provider decides what long-term looks like — a lower dose, a slower cadence, or staying put. That’s their call and yours, together.
If it goes quiet, that’s the process working
Most people never speak to a provider at all. Your intake gets reviewed and approved without a call, and the first thing you hear is that your order has shipped. I’ve had customers cancel a perfectly good order a few hours after paying purely because nothing happened — they were waiting on a phone call that, in their state and with their history, was never going to be needed.
When you should actually get in touch
- You can’t finish the intake, or the site won’t take your ID photo
- You’re not sure whether the order went through
- Something on your card statement doesn’t look right
- It’s been longer than feels reasonable and you want a human to check
That last one is a completely legitimate reason to email me. You don’t need a better excuse than “where is this?”
11 of 14
Who’s the provider, and what do they decide?
Short versionA licensed clinician in your state who reads your intake and makes the call. Often without a phone call — that’s the normal outcome, not a shortcut.
A licensed clinician in DirectMeds’ network, licensed for your state. They read your intake the way a doctor reads a chart, and they make the decision. I don’t.
What they decide
Whether this is appropriate for you at all. Which medication — semaglutide or tirzepatide — and which form. Your starting dose and the step-up schedule. And, over time, how to adjust if side effects are getting in the way or the loss has stalled. You tell the form what you’d prefer; they decide what’s safe.
Will you actually talk to them?
Maybe not, and that’s normal. In many states the provider can review your history and approve without ever speaking to you. If something in your history needs a closer look — or if your state requires a consult before prescribing — they reach out first. A call is not a rejection. It’s a clinician doing the job properly.
If they say no
You’re refunded in full, and I’d rather that happen than have you take something that isn’t right for you. You’re welcome to ask what the reason was, and to take it to your own doctor.
After approval
The clinical team takes over the medical side: how to take it, what to expect, side-effect questions, dose changes, and check-ins. If the provider orders bloodwork, that typically lands around the 90-day mark. You reach them through your account, and if you ever can’t find the door, I’ll walk you to it.
Questions that go to them, not me
- Dosing — starting dose, changes, what to do about a missed one
- Whether it’s safe alongside something else you take
- What a symptom or side effect means
- Interpreting labs
- Whether this is right for you at all
I’m not dodging you when I send those over. They have your history in front of them and I don’t, and guessing at it would be a genuinely bad thing to do.
12 of 14
What do I do as your account manager?
Short versionI’m the person who answers when something goes sideways with your order — intake, billing, “where is it.” Not a doctor, and I’ll say so when a question isn’t mine.
I’m a patient onboarding specialist at DirectMeds. Which is a long way of saying: I’m the person who explains this, and the person who picks up when something goes wrong with your order.
What I’m good for
- Explaining what the medication is and how the program works, in normal language
- Telling you what it costs today, including the renewal price
- Getting you through the intake form when it’s being difficult
- Finding out where your order is
- Billing and account problems — fixing them, or getting you to whoever can, without leaving you on hold
- Making sure you’re on the best price I’m authorized to offer, and that your recurring price stays put
- Setting up the six-month Affirm option, by email, if you want it
And the food and training side. The medication makes eating less easier — what you eat, how you keep your muscle, how you sleep is what decides where you land. That part I actually know something about, and it costs nothing to ask.
What I’m not
A doctor. Anything clinical — dosing, side effects, interactions, whether this is right for you — goes to the provider or the clinical team. I’ll tell you out loud when a question is above my pay grade rather than guess at it.
The one condition
I’m only attached to your account if you order through my link. Order through a different link, or straight from the DirectMeds homepage, and the system assigns you to nobody in particular — I can’t see your order, and I can’t help with an order I can’t see. The link in chapter 14 is the only way I’m on it.
How to reach me
Email. Malcolm@DirectMeds.com. Tell me what you’re trying to do and I’ll give you a straight answer.
Why there’s no phone number on this site
Calls and texts to DirectMeds go to whichever rep is on shift. If that isn’t me, the person who picks up becomes your account manager — and I can’t take that back afterwards. Email lands with me and only me. So: my link to order, my email to reach me. That’s the whole system.
There’s a practical reason too. When I’m on shift I’m on the dialer and can’t always stop to take a call. Email I can answer any time, on or off the clock, and I can submit orders and send links from it 24/7. It’s the fastest way to actually get me.
Cancelling or changing an existing order
That goes through Customer Service rather than through me — the company keeps new orders and account changes separate so they don’t tangle. Tell me what you need and I’ll get you to the right people. You won’t be left holding.
And how I’m paid, one more time: commission on orders through my link. It doesn’t change your price. It’s stated on every page so you can weigh everything else against it.
13 of 14
What else do people ask?
Short versionThe things people actually ask, including the awkward ones — about weight loss, and about the whole setup.
Everything I get asked about weight loss that hasn’t already been covered, including the awkward ones. Tap a question to open it.
The medication
Is this the same thing as the brand-name injection?
Same active ingredient. The brand-name injections are the FDA-approved products. A compounded version is prepared by a pharmacy against an individual prescription and is not FDA-reviewed for safety, potency or quality before it ships. Those are meaningfully different things, and you should know which one you’re buying.
How much weight will I lose?
I won’t give you a number, and here’s why: the only numbers that exist come from trials of the branded products, they’re averages, and averages hide people who lost half as much and people who lost twice as much. What I can tell you is what those trials showed on average (chapter 2), that the people who did best changed how they ate and moved, and that your provider can talk about your specific situation in a way I can’t. Anyone who promises you a number is selling.
Which one should I take — semaglutide or tirzepatide?
That’s genuinely a provider decision. Tirzepatide showed larger weight loss in trials. Semaglutide has the stronger evidence on heart attacks and strokes, and costs less. Your history and your goals go on the intake form and the provider makes the call. You can state a preference; they decide what’s safe.
Injection or under the tongue?
If you can do a weekly injection, most people find it simpler — one thing to remember a week instead of one a day. If a needle is the thing stopping you, the under-the-tongue version exists for exactly that reason. Both go through the same provider review.
Will I be on this forever?
Possibly, and you should plan as though yes. When people stop, most of the lost weight returns. Some taper to a lower maintenance dose. Nobody has a reliable way to take the full benefit and then walk away, and anyone telling you otherwise is selling.
How bad is the nausea, really?
For most people: noticeable for a few days after each dose increase, then it settles. For a minority: bad enough to quit. Smaller portions, avoiding greasy food, and not rushing dose increases all help. If it’s severe, the answer is usually to slow down rather than push through — and that’s a conversation with the provider.
Do I have to inject myself?
Not necessarily — there’s the under-the-tongue version. If you do go with injections, it’s once a week with a small needle into the fat under your skin. I’ll talk you through the first one on the phone if you want.
What if I miss a dose?
Don’t double up and don’t guess. Message the clinical team through your account — the right answer depends on how many days late you are and which medication you’re on.
Can I drink alcohol on it?
Many people find they want it less. Beyond that, it’s a question for the clinical team, especially if you drink regularly — alcohol and a slowed stomach can interact in ways that vary person to person.
What about my birth control?
If you take birth-control pills and you’re considering tirzepatide, put it on the form. It can make the pill less reliable, particularly when starting and after each dose increase, and the provider may suggest a backup method for a while.
Does it include B12? Why?
The injectable versions do. B12 is commonly added to compounded GLP-1 formulations; some people feel it helps with the tiredness that can come with eating a lot less. It’s not the reason to choose one form over another.
Will I lose muscle?
Some, unless you actively defend it. Protein at every meal and resistance training a couple of times a week is the whole prescription. Ask me if you want help building that — it’s free and it’s the part I’m actually good at.
Do I need to change how I eat?
The medication will change it for you to a point — you’ll eat less without deciding to. What it won’t do is pick the right foods. Prioritise protein, drink water, go easy on greasy and very sweet things (they’re what set the nausea off), and eat slowly. That’s most of it.
Can I switch from injection to under the tongue later, or the other way?
Usually, through the clinical team and Customer Service. Tell me what you want and I’ll get you to the right people.
Does it ship cold? What if it sits on my porch?
It ships packed on ice by FedEx with tracking. Bring it inside and into the fridge as soon as you reasonably can. If it sat out longer than you’re comfortable with, email me the tracking and the timing and I’ll find out where you stand rather than have you guess.
How the 90-day supply works
Why is it a 90-day supply?
The program ships a full 90-day supply up front after approval, with the cost split into three monthly payments. It saves you placing a new order every month, and the provider can set your dose steps across the whole supply.
Can I just order one month?
No. The initial order is the full 90-day supply, paid monthly. There’s no long-term contract beyond that: you can cancel future shipments any time after your first order.
Why does the price change after the first order?
Where there’s a first-order discount, it’s there to get you started; after that it goes to the regular recurring price, which is printed next to it in chapter 7 and is guaranteed not to rise.
The company
Is this a scam?
No, and I understand why you’re asking. DirectMeds has been operating since 2024 with thousands of reviews. Prescriptions come from licensed providers, medications from licensed compounding pharmacies, and it ships by FedEx with tracking.
What throws people is the order of things: you pay, then you wait, and often nobody calls, because the provider can review your history without needing to. That quiet stretch is the process working normally.
Is it FDA-approved?
Not in the way a branded, mass-manufactured drug is. The active ingredients have established clinical use, but a compounded preparation is not individually FDA-approved or FDA-reviewed before it ships. It’s legal, it’s long-standing, and it’s prepared in FDA-registered pharmacies under real quality standards. But anyone who tells you it’s exactly the same as the brand is overselling.
Is compounded the same as generic?
No. “Generic” has a specific legal meaning and this isn’t it. Compounded means a licensed pharmacy prepares the medication against your prescription, with the same active ingredient as the brand you know. Same ingredient, not an identical product — it can differ in concentration, inactive ingredients, packaging and storage.
Why did I have to pay before a doctor saw me?
Because the model doesn’t charge a separate consultation fee. You pay for the medication and the provider review is part of that. If the provider decides you’re not a good candidate, you’re refunded in full. It’s a fair trade, and worth understanding going in.
Money
Is there a membership or consultation fee?
No. You pay for the medication.
Is it a subscription?
Yes. It renews until you cancel. The first-order price and the renewal price are both in chapter 7, side by side, because you should know both before you decide.
I saw a much lower monthly price somewhere. Why isn’t it at checkout?
Nine times out of ten that’s an Affirm monthly payment on a six-month prepay, not a discount — and it isn’t on the order page because it has to be set up through a rep. Chapter 7 explains it. Email me and I’ll send you the Affirm link with your permission; Affirm shows you your actual monthly figure and you decide.
How does the Affirm option work?
You prepay six months, Affirm finances it and splits it into monthly payments based on your approval. The terms are Affirm’s, including any interest, so I can’t promise a number. I set it up by email: you tell me you want it and give me the okay to send the link. I’m paid the same either way.
Will my price go up later?
The recurring price you start at is the one you keep. I’m authorized to guarantee that. First-order discounts do end after the first order — that’s printed in chapter 7 — but the recurring number doesn’t climb.
It’s more than I can afford right now.
Then wait. I mean that. The program isn’t going anywhere, and a bill that doesn’t fit turns into quitting at month two, which helps nobody. If it’s close, one honest data point: people on appetite medication often find their food and takeout spending drops, because the appetite does. That’s worth factoring in, but it’s a hope, not a line item — don’t budget on it.
Does using your link cost me more?
No. My link carries the best pricing available. I earn a commission on orders through it. I’d rather you know than not.
Does insurance cover it? Can I use my HSA or FSA?
It’s a cash-pay program and isn’t billed through insurance, which is also why there are no prior authorizations or waiting. HSA and FSA cards are accepted, and DirectMeds can provide receipts for reimbursement. If you have a specific question about that, email me and I’ll check rather than guess.
What if I want to cancel?
Changes to an existing account go through Customer Service rather than me. Tell me and I’ll get you to the right people instead of leaving you on hold.
The process
Will I talk to a doctor?
Maybe not, and that’s normal. In many states the provider reviews your intake and approves it without a call. If something needs a closer look, or your state requires a consult, they reach out before approving.
How long until it arrives?
Once the provider approves and the pharmacy fills it, shipping is about five business days by FedEx, with tracking. It can’t go to a PO box.
Is it available in my state?
It varies by program. As of this writing the weight-loss programs aren’t available in Mississippi or Louisiana, and hormone therapy and peptides aren’t available in Alabama or Mississippi. Consult rules vary by state too. Email me your state before you order if you want to be sure.
Do I have to talk to someone every month?
No. Once the first order and intake are done, shipments continue on the subscription. You don’t call anyone to reorder, and nobody needs to call you.
I’m nervous about starting.
That’s a reasonable response to starting a medication, not a problem to be talked out of. Here’s what’s actually protecting you: a licensed provider reviews your full history before anything is prescribed, nothing ships until you’ve completed the intake, the clinical team answers every question you have, and if the provider says no, you’re refunded in full. Nothing happens without your say-so.
I want to talk to my own doctor first.
Good. Do that. Send them this page — it has the ingredients, the risks and the hard stops written out — and ask what they think. A doctor who knows what you’re considering can catch things a form can’t. Nothing here expires while you have that conversation.
I’m comparing other companies.
You should. I won’t badmouth anyone; I’ll just tell you what to compare. Whether the price includes the provider review or there’s a consult or membership fee on top. Whether the recurring price is locked. Whether a licensed pharmacy prepares it. Whether a specific person is attached to your account, or a queue. And whether they’ll put their pricing on a page where you can read it at midnight.
Should I tell my regular doctor?
Yes. I’d encourage it, and I’ll give you whatever you need for that conversation. A good doctor will want to know, and the provider here would rather you have one more set of eyes on it, not fewer.
I got stuck on the intake form.
Email me. It’s the easiest thing in the world for me to fix and it takes two minutes. Don’t leave an order sitting because a photo upload wouldn’t cooperate.
Where can I read reviews?
DirectMeds on Trustpilot. Read the bad ones too; they’re usually about the quiet stretch after paying, which is the thing chapter 10 is for.
Why isn’t there a phone number on this site?
Because calls and texts to DirectMeds go to whichever rep is on shift, and whoever picks up becomes your account manager. If you want me specifically, it’s my link to order and my email to reach me.
If your question isn’t here, email me and ask it. An unanswered question is the main reason people don’t start, and I’d rather spend ten minutes on it than have you guess.
14 of 14
Ready?
Short versionThis link opens the DirectMeds weight-loss order page with my name attached. It’s the only link that makes me your account manager.
You’ve read the whole thing. If it’s a yes, here’s the link. If it’s a not-yet, that’s a good outcome too — nothing here expires.
Use this exact link
Ordering through it is what makes me your account manager. If you order through any other link, or straight from the DirectMeds site, I won’t be attached to your account — and I can’t help with an order I can’t see.
Same price either way. The only difference is whether you get a specific person. And once you’ve ordered, the way to reach that person is Malcolm@DirectMeds.com — not the main phone line, which goes to whoever is on shift.
One more time, because it matters: the order page will show a countdown. It isn’t real. Take the time you need.
Not ready?
Send this page to yourself and come back at midnight when the doubt shows up. Or email me the thing that’s stopping you. No countdown, no last chance.
You pay before the provider reviews you. If they decide you’re not a good candidate, you’re refunded in full. Subscriptions renew until you cancel. Compounded medications are not FDA-approved. Results vary.