---------|----------|--------------|----------|-------------|------------| | Ozempic | Semaglutide | Diabetes | 2mg | 10-15% | ~$950 | | Wegovy | Semaglutide | Weight loss | 2.4mg | 15-17% | ~$1,350 | | Wegovy Pill | Semaglutide | Weight loss | 25mg | 16% | $149-299 | | Mounjaro | Tirzepatide | Diabetes | 15mg | 18-20% | ~$1,025 | | Zepbound* | Tirzepatide | Weight loss, OSA | 15mg | 20-22% | ~$1,060 |
*Promotional pricing through Novo Nordisk programs
Understanding the Molecules
Semaglutide (Ozempic, Wegovy, Rybelsus): - Pure GLP-1 receptor agonist - Longest track record - Strongest cardiovascular outcome data (SELECT trial: 20% MACE reduction) - Available in oral form - Slightly higher GI side effect rates
Tirzepatide (Mounjaro, Zepbound): - Dual GLP-1/GIP receptor agonist - More weight loss (~5% more than semaglutide) - Approved for sleep apnea (Zepbound) - Cardiovascular trial pending (results 2027) - Possibly milder side effects
Efficacy Comparison
Weight loss (clinical trials): - Zepbound 15mg: 20.9% - Mounjaro 15mg: ~20% - Wegovy 2.4mg: 14.9% - Wegovy Pill 25mg: 16.6% - Ozempic 2mg: ~12%
Tirzepatide wins on pure weight loss. The dual mechanism produces consistently greater results.
Cardiovascular Protection
Semaglutide (SELECT trial): - 20% reduction in heart attacks, strokes, CV death - Proven in 17,604 patients over 4+ years - FDA cardiovascular indication
Tirzepatide: - SURPASS-CVOT trial ongoing - Results expected 2027 - Expected to show similar benefit (based on mechanism) - But not proven yet
If cardiovascular protection is priority: Semaglutide has the data. Tirzepatide is expected to match it but hasn't proven it yet.
Sleep Apnea
Zepbound: FDA-approved for OSA (first-ever drug approval) Others: Not specifically approved, though all produce OSA improvement through weight loss
If you have sleep apnea: Zepbound has unique regulatory backing and clinical trial data for this indication.
Oral Options
Currently available: - Wegovy Pill (semaglutide 25mg) — FDA-approved December 2025 - Rybelsus (semaglutide 14mg) — Diabetes only
Coming soon: - Orforglipron (Eli Lilly) — Oral GLP-1 with no food restrictions, potentially 2026
If you won't inject: Wegovy Pill is currently the only oral option approved for weight loss.
Side Effect Comparison
| Side Effect | Semaglutide | Tirzepatide |
|---|---|---|
| Nausea | 44% | 31% |
| Diarrhea | 30% | 23% |
| Vomiting | 25% | 12% |
| Constipation | 24% | 17% |
| Discontinuation rate | 7% | 4-7% |
Tirzepatide appears gentler. The GIP component may buffer GLP-1 side effects.
Insurance and Access
Easiest to get covered: - Ozempic (diabetes indication) - Mounjaro (diabetes indication)
Hardest to get covered: - Wegovy (weight loss, often excluded) - Zepbound (weight loss, often excluded)
Strategy: If you have any diabetes/prediabetes, the diabetes indication often has better coverage than weight loss indication.
Self-pay options: - LillyDirect: $549-550/month for Mounjaro or Zepbound - Wegovy Pill: $149-299/month (promotional)
Decision Matrix for Men
Maximum Weight Loss
Winner: Zepbound/Mounjaro (tirzepatide) 20%+ average weight loss is unmatched.
Proven Heart Protection
Winner: Wegovy/Ozempic (semaglutide) SELECT trial data is definitive. Tirzepatide CV trial ongoing.
Sleep Apnea
Winner: Zepbound Only medication FDA-approved for OSA.
Won't Inject
Winner: Wegovy Pill Only oral GLP-1 approved for weight loss.
Best Value (Self-Pay)
Winner: Wegovy Pill at $149-299 Promotional pricing undercuts all other options.
Easier GI Tolerance
Winner: Mounjaro/Zepbound (tirzepatide) Lower rates of nausea and vomiting.
Have Diabetes
Winner: Mounjaro or Ozempic Diabetes indication, often better coverage.
The Practical Decision
For most men, the choice comes down to:
Access: What can you actually get prescribed and covered? Priority: Weight loss (tirzepatide) vs. proven CV protection (semaglutide)? Administration: Will you inject or need oral? Cost: What can you afford long-term?
All four medications work. All produce significant weight loss. All will likely improve testosterone and metabolic health.
The "best" medication is the one you can access, afford, tolerate, and take consistently.
Starting Point Recommendation
If new to GLP-1s and have cardiovascular risk: Start with semaglutide (Wegovy or Ozempic). The SELECT trial data provides confidence.
If maximum weight loss is priority: Start with tirzepatide (Zepbound or Mounjaro). The efficacy advantage is clear.
If semaglutide side effects are intolerable: Switch to tirzepatide. It's often gentler.
If cost is the primary barrier: Wegovy Pill at $149-299/month (if eligible for programs) or LillyDirect at ~$550/month.
Related Articles: - Semaglutide vs Tirzepatide: Which Is Better for Men? - The Real Cost of GLP-1 Medications in 2026 - 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.