----|------| | 1-4 | 2.5mg | | 5-8 | 5mg | | 9-12 | 7.5mg | | 13-16 | 10mg | | 17-20 | 12.5mg | | 21+ | 15mg (maximum) |
Flexibility: Not everyone needs the maximum dose. Many men stabilize at 10mg or 12.5mg. Discuss with your provider.
Titration matters: Rushing leads to severe side effects. Patience during titration leads to better long-term adherence.
Weight Loss Results
SURMOUNT trials: - SURMOUNT-1: 20.9% weight loss at 72 weeks (15mg dose) - SURMOUNT-2 (diabetic patients): 15.7% - Top responders: 25%+ weight loss
Real-world expectations: - Most men lose 18-22% of body weight - Superior to semaglutide by 5-6 percentage points - Highest approved efficacy available
For a 275 lb man, 20% loss = 55 lbs. That's the difference between obesity and normal weight for many.
Sleep Apnea: First-Ever Drug Approval
This is historic. Before Zepbound, sleep apnea had only two treatments: CPAP machines or surgery. No drug had ever been approved.
SURMOUNT-OSA trial results: - Up to 63% reduction in AHI (apnea-hypopnea index) - Many patients moved from severe to mild or below diagnostic threshold - Benefits beyond what weight loss alone would predict
Why this matters for men: - Men are 2-3x more likely to have OSA than women - CPAP compliance is notoriously poor (46-83% non-compliance) - Untreated OSA increases heart attack, stroke, and accident risk - OSA contributes to low testosterone and erectile dysfunction
Insurance implications: The OSA indication may provide a coverage pathway when weight loss indication is denied. If you have documented sleep apnea, Zepbound may be approved through that diagnosis.
Male-Specific Benefits
Greater Testosterone Improvement (Theoretically)
More weight loss = more visceral fat reduction = more aromatase reduction = more testosterone recovery.
No head-to-head testosterone data exists comparing semaglutide vs. tirzepatide. But the ENDO 2025 study included both medications, and testosterone improvement correlated with weight loss percentage.
If tirzepatide produces 5% more weight loss, it may produce proportionally more testosterone recovery.
Superior Sleep Apnea Treatment
The FDA-approved indication for OSA is unique to Zepbound. Men with sleep apnea have a specific, evidence-backed reason to choose tirzepatide over semaglutide.
Potentially Gentler Side Effect Profile
Comparative data suggests tirzepatide may have milder GI side effects than semaglutide: - Nausea: 31% (vs. 44% with semaglutide) - Vomiting: 12% (vs. 25%)
The GIP component may provide some buffering effect. For men who had intolerable side effects on semaglutide, tirzepatide might be better tolerated.
Side Effects
Common: - Nausea (31%) - Diarrhea (23%) - Vomiting (12%) - Constipation (17%)
Generally milder than semaglutide based on trial comparisons.
Serious (rare): - Pancreatitis - Gallbladder disease - Thyroid C-cell concerns (rodent studies)
Cost and Access
Retail: $1,000-1,100/month (slightly less than Wegovy)
LillyDirect: ~$550/month for self-pay patients. This is Eli Lilly's direct-to-consumer program — includes telehealth consultation and home delivery.
With insurance: Coverage varies. Prior authorization common. OSA indication may improve coverage probability.
Savings card: Zepbound Savings Card reduces copays for those with commercial insurance.
Zepbound vs. Wegovy Decision
| Factor | Zepbound | Wegovy |
|---|---|---|
| Weight loss | 20-22% | 15-17% |
| CV outcome data | Pending | Yes (SELECT) |
| Sleep apnea approved | Yes | No |
| Oral option | No | Yes (Wegovy Pill) |
| GI side effects | Milder | More common |
| LillyDirect pricing | $550/mo | N/A |
Choose Zepbound if: - Maximum weight loss is priority - You have sleep apnea - Semaglutide side effects were intolerable - LillyDirect pricing is attractive
Choose Wegovy if: - Cardiovascular protection is priority (proven data) - You want an oral option - Insurance covers Wegovy but not Zepbound
What to Expect: Month by Month
Month 1-2: Adjustment phase. Learning the injection process. Mild appetite changes. Possible GI effects.
Month 3-4: Appetite suppression strengthening. Weight loss accelerating. Reaching mid-range doses.
Month 5-8: Significant weight loss. Energy improving. Sleep apnea improving (if present). Approaching maintenance dose.
Month 9-12: Peak weight loss. Metabolic markers normalized or normalizing. Testosterone improvement likely measurable.
Year 1+: Maintenance phase. Ongoing medication needed to maintain results.
The Bottom Line
Zepbound is the most effective FDA-approved weight loss medication available. For men, it offers: - 20-22% weight loss (best in class) - First-ever drug approval for sleep apnea - Potentially milder side effects than semaglutide - Competitive pricing through LillyDirect
The main tradeoff: no cardiovascular outcome trial data yet (coming 2027). If you have significant CV risk and want proven protection, Wegovy has the SELECT trial data.
For most men prioritizing maximum weight loss or with sleep apnea, Zepbound is the leading choice.
Related Articles: - Semaglutide vs Tirzepatide: Which Is Better for Men? - The First Drug Ever Approved for Sleep Apnea Is a GLP-1 - GLP-1 Medications for Men: The Complete 2026 Guide
Last updated: January 2026
Medical disclaimer: This content is for informational purposes only and does not constitute medical advice.