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“I’m really conflicted,” she admits

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Strong indications for microdosing: Prior discontinuation of a GLP-1 agonist (semaglutide, liraglutide, dulaglutide, tirzepatide) due to nausea or vomiting History of gastroparesis, cyclic vomiting syndrome, or severe GERD Age over 65 with polypharmacy (higher baseline nausea risk) BMI under 27 (lower body mass may correlate with higher side-effect sensitivity, though evidence is mixed) Patient-reported high sensitivity to medication side effects across drug classes Weak or no indication for microdosing: First-time GLP-1 use with no prior GI issues (start at 0.25 mg per standard protocol) Impatience with weight-loss pace (microdosing delays therapeutic dosing and won't accelerate results) Misunderstanding that "lower is safer" (semaglutide's serious adverse events, pancreatitis and gallbladder disease, are not dose-dependent in the therapeutic range) A 2024 survey (Thompson et al., Obesity Science & Practice ) found that 34% of patients requesting microdose starts had no clinical indication