The original poster has lost 38 lbs on reta, reached maintenance, and now wants to reduce the 4 mg dose gradually to allow neutral calories without returning food noise or worsening fatigue. Participants suggest dropping 0.5–1 mg every 2–4 weeks and waiting for blood levels to stabilize, or switching to a low-dose combination with tirzepatide or semaglutide instead of lowering reta alone. Some report that fatigue may stem from the deficit itself, sleep issues, or low testosterone rather than the medication, and a few note that micro-dosing secretagogues can continue indefinitely.
What this discussion establishesWhether simply lowering reta is enough or whether adding semaglutide/tirzepatide is preferable; also whether fatigue is mainly from the deficit or from another factor such as testosterone.
Still openExact cause of the reported fatigue and whether micro-doses of secretagogues can be run indefinitely without issues.
Nothing here is advice.
Hi, I'm currently at 4 mg and an eight-month 300-calorie deficit is starting to wear on me. I'm looking for any standard approach people follow for stepping the dose down gradually. I already searched the forum.
Stepping down to what dose? Are you unable to eat? A bit more detail would help. You could try 2 mg or split 1 mg twice a week, but it's hard to know exactly what you're after.
Have you already lost more weight than you wanted and now can't eat enough, or do you still have weight to lose but the deficit is just getting tough after eight months? If the latter, maybe consider going up instead.
Sorry, was at work. Started at 2 mg late January and have now dropped 38 lbs. I don't need to lose any more. Moved up to 4 mg three months ago. The first six months I wasn't tired. My TDEE is currently 2400 and I average 2100 calories. I've stayed in roughly a 300-calorie deficit most days since January. Sleep was poor until I added tesamorelin. I think I may need a lower reta dose once I finish the tesamorelin cycle. Not sure if tesamorelin itself causes daytime fatigue. Sleep itself is good now. I'm in week six of 1 mg nightly. Goal is to reach a dose that lets me eat at maintenance without food noise returning. Maybe cagrilintide could help there. I was thinking of dropping 0.5 mg at a time but wasn't sure how long to stay at each step before going lower again. Diet is solid with macros and micros covered. Resistance training twice a week plus hiking, and I stay hydrated with electrolytes. The long deficit might just be catching up with me.
I'd probably drop a full 1 mg and hold there for two to four weeks to see how 3 mg feels. If food noise or undereating is still a problem, drop another 1 mg then.
The same rule applies going down as going up: levels stabilize after four weeks at a steady dose. I'd time any reductions around that window.
At lower doses reta often doesn't control food noise well. Consider lowering reta and adding a small amount of tirzepatide or even semaglutide.
I was leaning toward semaglutide or cagrilintide. What do you think about cagrilintide?
It leaves a lot of people quite tired. Some also seem to lose its effect fairly quickly, even after increasing the dose. I have an unused vial from early on but haven't been eager to try it, especially after the earlier discussion around fibrils.
I've had something similar—down 32 lbs since March and also on 4 mg for about three months. I was at 1800 calories from March into early September. Also run GH and sleep well. Dropping 0.5 mg per week feels more sensible to me than adding another compound. Less can be more. That said, I've been considering moving from 2 mg reta twice a week to 2 mg reta plus 2 mg tirzepatide once a week. How's your sleep routine? I'm in bed by 10–10:30 every night, weekends included. I've also been experimenting with SS-31, NAD+, and MOTS-c for the fatigue. Once you hit maintenance, recheck bloodwork. Keep updating as you go; I'll be curious how your results line up with mine.
Sleep routine is decent with the GH. I get seven to seven-and-a-half hours, 10 p.m. to 5 a.m. by choice. I use CPAP but numbers show almost no obstructions and I'm not on max flow. AHI is around 1 %. I'll keep everyone posted. Today's injection day; I'm going to 3 mg for four weeks to see if I end up raiding the freezer at night.
Good that the sleep schedule is consistent. The CPAP detail is useful; others might have input on that.
Can you eat more at your current dose? Not sure exactly what you're aiming for—lowering reta, adding cagrilintide? If you're already at goal weight, one option is to stay at the present dose and simply increase food intake. I did that and even gained a couple of pounds over a weekend celebration before dropping back down. I recently added a bit of semaglutide on top of my usual reta pin to help bridge the lower point in the week.
Main goal is to reduce the fatigue I suspect comes from staying in a deficit. Also planning ahead for when I come off tesamorelin, since 4 mg reta already disrupts sleep and I can't stay on tesamorelin forever. I'm in week five of a twelve-week cycle. I can eat more; yesterday I went about 100 calories over TDEE by adding whole-grain bread with peanut butter or extra banana with Greek yogurt.
Quick question on the semaglutide: do you use a small dose just to cover the lower point in the week?
My experience with these meds might be different from others. Once I take the dose my stomach feels full and I don't want much beyond a small piece of chicken, a protein shake or two, and maybe a handful of nuts. Weight comes off at a steady pace without much effort. I know some people follow elaborate diets and training plans, but the simple lack of interest in food has worked fine for me.
Yeah, that lines up. I split 5 mg tirzepatide and 5 mg reta. After adding reta the appetite control wasn't as strong as tirzepatide alone, so instead of raising the reta I pulled out a semaglutide kit and used 0.25 mg. It gave solid appetite suppression similar to when I first started tirzepatide. Seems like a useful way to bridge the gaps, and it's the cheapest option too.
I ran 0.13 mg semaglutide for eight or nine weeks and just moved to 0.25 mg on top of 3 mg reta and 10 mg tirzepatide. Also, you can probably run tesamorelin long-term. I'm considering staying on a very low dose of sermorelin indefinitely.
I picked up tesamorelin a couple of weeks ago and will probably try it after the new year.
A 300-calorie deficit isn't especially aggressive. I've maintained an average 1100-calorie deficit since December without fatigue. Like the other poster, I just eat what I want and let the medication handle the rest. No calorie counting. Yesterday it was three or four protein shakes plus three slices of pepperoni pizza.
Exactly my situation. I don't think the deficit is large enough to explain the fatigue, but it still seems worth checking. I'm looking into TRT with a clinician because I'm unsure if it's deficit-related or low testosterone. No other low-T symptoms though. I checked IGF-1 before starting the tesamorelin cycle and I'm currently at 1 mg. Micro-doses of these secretagogues seem workable.
I take 150 mg of testosterone cypionate per week. Started that mid-January. The main result of my deficit has been going from 282 lb down to 182 lb over 43.5 weeks.
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