Food noise again

You're already below standard titration levels because you want to avoid higher amounts, yet the noise is returning. Your own words laid out both the issue and the likely fix.

A few quick checks: did the vial just get opened or did the source change? Are you hitting roughly a gram of protein per pound of goal weight? How is sleep, water, and electrolytes? Tirz worked well for me at first. When I tried RETA the noise took weeks to settle even after reaching 3 mg, so I added a small daily amount of Cagri. If the basics are covered that might be worth considering.

Staying lower than usual is fine when it works, but it does not appear to be working here. Moving the dose up makes more sense than layering on extra compounds right away.

Could be worth trying Cagri alongside.

No need to match the EL schedule. Testing 6 mg next and adjusting from there if needed is reasonable.

The noise came back for me around the middle of the week on 5 mg. I now inject 5 mg on Fridays and add a 500 mcg dose on Tuesdays. That small extra keeps levels steadier and controls the noise. If needed I can raise the Tuesday amount to 1 mg later.

The straightforward step is to raise the dose. Being at only 5 mg after six months makes a return of appetite likely. If you still prefer not to increase, split dosing or adding Cagrilintide are the other options people mentioned.

Raising the tirz amount is the direct answer. If significant weight remains, holding at low doses works against progress. A 1-2 mg top-up on a hungry day can test whether more is needed without committing to a full higher weekly dose. Side effects are unlikely when hunger is present. At 58 and having already lost 24 lb the medication is probably helpful overall, so staying under-dosed while still hungry offers little benefit.

I have not used Cagri but sema has always controlled appetite well for me and is inexpensive. I recently added 0.75 mg weekly after skipping the lowest starter weeks. After two and a half years on GLP-1s I find the combination effective at that low sema amount.

Are you still dropping weight despite the noise? If loss continues there may be no need to increase yet. Once the noise stops progress I would go up, but only by 0.5 mg each time to keep changes gradual.