I’ve spent most of my adult life in gyms, surrounded by people chasing strength, aesthetics, or just that feeling of being at home in their bodies. Weight training and bodybuilding taught me discipline, but it also taught me how common it is for people to quietly lean on “extras” while presenting their results as the product of clean diets and long hours under a barbell.
If you’ve been around fitness culture for a while, you’ve probably seen it too. The influencer who insists they’ve never touched a steroid but somehow got stage-ready in twelve weeks. The bodybuilder who attributes impossible conditioning to chicken and rice. Or the “natural” athlete who doesn’t admit to fat burners, clenbuterol, or growth hormone cycles. There has always been a gap between what people say got them results and what they actually used.
That’s why the explosion of ads in my feed for drugs like Ozempic, Wegovy, Mounjaro, and Zepbound feels so familiar. These products, marketed as near-miracle fixes for weight loss, are suddenly everywhere. Social media companies are pushing them aggressively, influencers are quietly using them without saying so, and meanwhile the science is still catching up, especially for transgender people balancing hormone replacement therapy (HRT).
This is not just about hype. It’s about how a medical trend, with real benefits but also serious risks, is being packaged for mass consumption. And when trans people, who already navigate unique medical and social challenges, are caught in that wave, the stakes are even higher.
So let’s slow things down. Let’s pull back the curtain on what these drugs are, where they came from, what the data says, and what it all means if you’re trans and watching your feed fill up with promises of effortless transformation.
From Diabetes Treatment to Weight-loss Phenomenon
Ozempic (semaglutide) wasn’t created as a weight-loss drug. It was approved in 2017 to treat type 2 diabetes, a condition where the body struggles to regulate blood sugar. By mimicking a gut hormone called GLP-1, the drug improved insulin sensitivity and stabilized glucose.
Then something interesting happened. Patients on the drug started losing weight, and not just a little. They were reporting noticeable drops in body mass. That “side effect” was quickly recognized as a market opportunity, and by 2021 the FDA had approved Wegovy, a higher-dose version of semaglutide, specifically for chronic weight management.
Other players soon entered the space. Saxenda (liraglutide) had already been approved for weight loss in 2014, but Wegovy took things mainstream. In 2022, Mounjaro (tirzepatide) hit the market for diabetes, followed by Zepbound in 2023 for obesity. Tirzepatide is sometimes called a “twincretin” because it mimics not just GLP-1 but also another hormone, GIP. The combination leads to even stronger appetite suppression and weight reduction.
These medications don’t burn fat directly. What they do is slow gastric emptying, suppress appetite signals, and keep blood sugar from spiking and crashing. The net result is that you feel full faster, eat less, and have steadier energy levels.
And the results, on paper, are staggering. Clinical trials showed Wegovy patients lost around 15 percent of body weight in about 68 weeks. Zepbound users shed between 15 and 21 percent depending on the dose. By comparison, older diet drugs often only produced 3 to 5 percent reductions. For doctors who had watched patients struggle for years, these new medications seemed revolutionary.
But that’s only part of the story.
The Catch: Results Only Last if You Stay on Them
Like blood pressure medication or cholesterol pills, GLP-1 drugs only work as long as you continue taking them. In studies where patients stopped, much of the weight came back within a year.
That rebound effect is important to understand because it changes the narrative. These aren’t twelve-week transformations. They are long-term commitments. They are not designed for short-term cosmetic goals but for chronic use, possibly for life.
That means the side effects, costs, and long-term unknowns also extend indefinitely.
Side Effects the Ads Rarely Mention
The commercials you see on television or the polished reels on Instagram rarely show the uncomfortable parts. Yet anyone who has been on these drugs or worked with patients who use them knows the side effects can be intense.
Nausea and vomiting are the most common, sometimes lasting weeks or months. Constipation or diarrhea is also frequent. For some, these side effects are manageable. For others, they lead to ER visits, IV fluids, or discontinuation.
There’s also the risk of gallbladder problems, especially with rapid weight loss. The drug labels warn about pancreatitis, a painful and dangerous inflammation of the pancreas. And for people with diabetes, there’s a risk of eye problems worsening if blood sugar improves too quickly.
Perhaps most concerning, the labels include warnings about possible suicidal thoughts or behavior. The FDA has not found clear evidence that GLP-1 drugs cause this, but they consider the potential serious enough to monitor.
Nowhere in those glossy ads do you see any of this.
The Influencer Illusion
Here’s where this intersects with the culture of body transformation online.
If you scroll social media, you’ll notice an uncanny number of influencers suddenly looking leaner, tighter, and more “effortless” in their progress. They often chalk it up to a “new diet” or “a change in workout routine.” What they don’t say is that they may have started weekly injections of semaglutide or tirzepatide.
This isn’t a conspiracy theory. It’s the same pattern that played out for decades in bodybuilding with steroids. It’s happening now with weight-loss injections. And the silence around it creates harm.
For trans people, the harm is amplified. We already face heightened body image struggles, dysphoria, and social pressure about how we “should” look. Watching influencers shrink while claiming it’s just kale and cardio feeds the toxic idea that our struggles are failures of willpower.
Transparency matters. If someone is using a powerful prescription medication, they should say so. Pretending it’s all discipline and clean eating is misleading at best and cruel at worst.
Why Trans Bodies Require Special Caution
Almost no clinical research has been done specifically on transgender patients using GLP-1 drugs while on HRT. That means we are left to connect the dots between what’s known in cisgender populations and what’s likely relevant for us.
- Estrogen and gallbladder risk: Oral estrogen already raises the risk of gallstones. GLP-1 drugs and rapid weight loss raise it further. That means transfeminine people need to take abdominal pain seriously, especially if it comes with fever, nausea, or jaundice.
- Oral estradiol absorption: Tirzepatide (Mounjaro/Zepbound) is known to reduce the effectiveness of oral contraceptives because it slows stomach emptying. While there isn’t direct data on estradiol, the same mechanism could affect absorption of oral HRT. That could lead to unstable hormone levels or reduced efficacy. Switching to patches or injections may be safer.
- Spironolactone and dehydration: Many transfeminine people take spironolactone, a diuretic anti-androgen. Add vomiting or diarrhea from a GLP-1 drug, and the risk of dangerous dehydration or electrolyte imbalances skyrockets.
- Muscle and bone health: Rapid weight loss often reduces lean muscle mass. For transmasculine individuals building muscle on testosterone, this undermines progress. For transfeminine individuals, it can reduce bone protection and overall strength. Resistance training and protein intake are essential safeguards.
- Eating disorders and mental health: Trans people already experience higher rates of eating disorders. A drug that suppresses appetite can unintentionally reinforce restrictive patterns. For some it may help reduce binge cycles, but for others it can worsen body image struggles. Careful screening and mental health support are essential.
The Silence Problem in Healthcare
One of the challenges trans people face is that even supportive providers may not have all the answers. Clinical trials didn’t include us in meaningful numbers. There are no published studies yet on how semaglutide or tirzepatide affects estradiol or testosterone dosing.
That means if you are considering one of these medications, you need a provider who is willing to experiment with you, not on you. That means checking hormone levels after significant weight loss, re-evaluating dosing if absorption seems off, and monitoring side effects with a trans-specific lens.
Unfortunately, many providers simply don’t know to ask these questions. Which is why being an informed patient is critical.
Practical Steps if you’re Considering It
If your doctor suggests a GLP-1 medication, don’t panic, but also don’t say yes without a plan.
Talk openly about how you take your hormones. If you’re on oral estradiol and starting tirzepatide, ask about switching to transdermal or injectable routes. Flag your use of spironolactone or finasteride so your doctor knows to monitor electrolytes if side effects hit. Ask about gallbladder risks and how to recognize early warning signs.
And just as importantly, think beyond the number on the scale. Protect your muscles and bones by lifting weights and eating adequate protein. Track your mood, your energy, and your relationship to food. If you notice disordered thoughts creeping back, pause and get support.
The Bottom Line
The arrival of Ozempic, Wegovy, Mounjaro, and Zepbound has changed the conversation around weight and health. For many people, they’re genuine breakthroughs. For others, they’re a source of side effects, financial stress, and unmet expectations.
For trans people, the calculus is more complicated. We have to consider hormone interactions, gallbladder risk, muscle health, and mental well-being in ways that cisgender patients often don’t.
What makes this moment frustrating is how much of it is being filtered through influencer culture and marketing campaigns rather than honest conversations. The ads show glowing smiles and easy weight loss. The reality is that these are serious medications, meant for chronic use, with unknowns for people on HRT.
So here’s the bottom line. If you’re trans and thinking about these drugs, go in with your eyes open. Ask the uncomfortable questions. Demand labs and monitoring. Protect your mental health as fiercely as your physical health. And remember that your value, your strength, and your identity are not defined by a number on the scale.
Because at the end of the day, the real goal isn’t to fit a filtered before-and-after photo. It’s to feel safe, strong, and whole in your own skin.
