WHAT ARE GLP-1 PEPTIDES?

• GLP-1 agonist medications are a genuinely revolutionary class of medications that put achieving a healthy body weight within reach for most people.

• The most well known of these medications, and the most affordable, is semaglutide (commonly sold under the brand names Ozempic® and Wegovy®).

• A second-generation medication called tirzepatide (brand name Mounjaro®) is also available. This medication binds to an additional receptor called the glucose-dependent insulinoptropic polypeptide (GIP), intensifying its treatment effect.

HOW DO THEY WORK?

• Both semaglutide and tirzepatide bind to the glucagon-like-peptide 1 (GLP-1) hormone receptor found in the human gut.

• This has many beneficial effects, but primary among them is extremely potent appetite suppression and dramatic slowing of emptying of the stomach—eliminating cravings and causing a rapid reduction in body weight.

• Tirzepatide binds to an additional receptor called the glucose-dependent insulinotropic polypeptide (GIP) receptor. This dual-receptor action results in even more dramatic results.

WHAT RESULTS CAN I EXPECT?

Semaglutide:

• An average patient taking semaglutide will lose 16% of their body weight—nearly 7x more than with lifestyle interventions alone.

• An average 200 pound patient can expect to lose 30-35 pounds or more.

Tirzepatide:

• An average patient taking tirzepatide will lose a remarkable 22.5% of their body weight—nearly 10x more than with lifestyle interventions alone.

• An average 200 pound patient could expect to lose 45 pounds or more.

Additional treatment effects:

• Patients taking GLP-1 agonists also show dramatic improvements in waist circumference, blood sugar and blood pressure levels, and overall level of physical function—as well as a significant reduction in risk of adverse cardiac events such as heart attack.

ARE THERE SIDE EFFECTS?

• Side effects of GLP-1 medications are generally mild, and most can be decreased or eliminated by careful adjustment of your diet under the supervision of Dr. Justl Ellis.

• The most commonly experienced side effects are nausea and diarrhea. Occasionally, moderately severe side effects such as stomach pain and vomiting may occur.

• Very severe or life-threatening side effects are very rare but can occur.

HOW ARE GLP-1 PEPTIDES ADMINISTERED?

• Semaglutide and tirzepatide are both administered via subcutaneous injection (under the skin).

CAN I AFFORD THIS?

• Yes, you can!

• We ship compounded semaglutide and tirzepatide directly to your door from our pharmacy partner at a fraction of the cost of “brand name” medications.

• You may use Health Savings Account (HSA) funds to pay for Voafit services.

WHERE CAN I LEARN MORE?

• Comprehensive information on GLP-1 medications written for patients, including efficacy data, contraindications, and potential side effects, may be accessed via this document from the Department of Texas Health and Services.

• FDA prescriber information data sheets for semaglutide and tirzepatide may be accessed here and here.

• Treatment effects for semaglutide were first described in this 2021 study in the New England Journal of Medicine. These findings were confirmed in the STEP 5 Trial published in Nature Medicine in 2022.

• Treatment effects for tirzepatide were first described in this 2022 study, also published in the New England Journal of Medicine.

• Multiple trials showing reduction in risk of adverse cardiac events such as heart attack in patients taking GLP-1 agonist medication may be reviewed here and here.

WHY SHOULD I GET MY TESTOSTERONE CHECKED?

• Testosterone is a critical hormone which plays multiple important roles in the body, such as the development of male secondary sexual characteristics during puberty, development and maintenance of muscle mass and strength, maintenance of bone strength, sex drive, and fertility and sperm production.

• As men age, testosterone levels drop very gradually, about 1% to 2% each year. More than a third of men over age 45 may have reduced levels of testosterone than might be considered normal. Testosterone levels have also been declining in otherwise healthy younger men over the last decades.

WHAT ARE THE SYMPTOMS OF “LOW T”?

• Symptoms of testosterone deficiency in adult men include reduced body and facial hair, loss of muscle mass, low libido, impotence, small testicles, reduced sperm count and infertility, irritability, poor concentration and depression, and brittle bones.

WHO IS ELIGIBLE FOR HRT WITH VOAFIT?

• All men without absolute contraindications who desire to optimize their testosterone levels are eligible for HRT with Voafit.

• Men with laboratory confirmed testosterone levels below the 50th percentile for age AND symptoms of testosterone deficiency are the most likely group to show benefit from testosterone replacement.

• Men whose testosterone levels are “normal” but who nevertheless wish to increase their testosterone levels may also use HRT to do so. However, the risk-benefit calculation in this population is uncertain.

• Whether an individual patient is eligible for HRT will be determined at the time of consultation with Dr. Justl Ellis.

WHAT KIND OF RESULTS CAN I EXPECT?

• Treatment with testosterone in a properly selected proper population should result in Increasing muscle mass, higher libido, improved sexual function, and improved mood may occur during treatment.

• Many symptoms that can be attributed to low testosterone could also be caused by other factors (such as clinical depression, other physiologic reasons for low libido, etc). Responses to testosterone replacement therapy are individual and positive results from treatment are not guaranteed.

WHAT SIDE EFFECTS MIGHT I EXPERIENCE?

• Testosterone replacement therapy may cause higher than normal red blood cell counts (polycythemia), which may increase the risk of heart problems or blood clots. While rare, when these complications occur, they may be serious or even life-threatening.

• Testosterone treatment may cause enlargement of the prostate, which may result in difficulty urinating or an increased risk of urinary tract infections. Testosterone supplementation may also decrease sperm production and decrease fertility.

• Minor side effects of testosterone therapy include gynecomastia (development of increasing breast tissue in males), acne, and depression.

• This list of side effects is not comprehensive. An FDA document fully describing the indications, risks, and benefits of testosterone replacement therapy with testosterone cypionate can be reviewed by clicking here.

ARE THERE ANY CONTRAINDICATIONS TO HRT?

• Testosterone replacement is contraindicated (not allowed) in persons with a known allergy to testosterone cypionate or any of its components and in men with breast cancer or prostate cancer.

HOW IS TESTOSTERONE THERAPY ADMINISTERED?

• For direct hormone replacement, we most commonly prescribe injectable testosterone cypionate, which is a long-acting form of testosterone typically administered by intramuscular or subcutaneous injection. Regimens are available ranging from once weekly (convenient but less stable levels) to daily (less convenient but much better stability and symptom control).

• Customized and alternative regimens (i.e., combining testosterone with nandrolone to improve the side effect profile) are available.

• Alternative regimens to increase natural production of testosterone are also available. Examples of medications used include enclomiphene, gonadorelin, and hCG. The route and frequency of administration of these medications depends on the medication and individual patient factors.

• For details about the medications we use, please refer to the individual medications listed under the “Men’s Hormone” section of the “All Medications” section of the homepage.

• Schedule a consultation with Dr. Justl Ellis to determine which regimen might be right for you.

WHY IS ENSURING MY HORMONES ARE BALANCED IMPORTANT?

• The hormonal system and monthly cycle in women is complex! Estrogen, progesterone, and other hormones all must be in balance to maintain female fertility and physiologic function.

• Most women are aware that menopause can cause significant and dramatic hormonal changes. Fewer are aware that there are many issues that can affect younger women’s hormones as well, such as polycystic ovarian syndrome (PCOS) to being obese or underweight, among others.

• If you are suffering from hot flashes, mood changes, poor sleep quality, low energy, or poor sexual function, abnormal hormone levels may be part of the cause. Hormone replacement therapy can be part of the solution!

WHICH WOMEN ARE ELIGIBLE FOR HRT?

• Most women with hormone levels outside of the normal range are potential candidates for hormone replacement or modulating therapy.

• Depending on the hormones involved, some patients may have conditions that prevent them from being candidates for treatment.

• HRT is an individual decision that each woman should make after a comprehensive discussion of risks and benefits with a qualified physician.

WHAT KINDS OF TREATMENTS DO YOU PRESCRIBE?

• Treatment regimens are individualized and depend on your own lab results and symptoms.

• Direct estrogen replacement with either estradiol or estriol (or a combination of both) is the most commonly used hormone replacement therapy. Estrogen is usually taken transdermally via a topical cream or patch. Injectable regimens are available but are seldom necessary.

• Progesterone replacement can be accomplished via dissolving troches, topical creams, and vaginal suppositories.

• Additional supporting medications such as DHEA, testosterone, and others may also be prescribed on an individual basis.

WHAT KIND OF RESULTS CAN I EXPECT?

There are many benefits of bioidentical hormone replacement therapy, including:

• Reduction in direct hormonally related symptoms such as mood swings, low energy, hot flashes, and night sweats

• Lowering of risk of heart attack, stroke, and blood clots

• Reduced risk of breast cancer

• Reduced risk of osteopenia and osteoporosis

• Improved sleep quality

• Improved mood

• Improved cognition and brain health

• Reduced all-cause mortality for under-60 women in their first 10 years of menopause

• Decreased anxiety and depression in certain populations

Responses to hormone replacement therapy are individual and results are not guaranteed.

ARE THERE ANY MAJOR RISKS TO FEMALE HRT?

• Risks of HRT vary with the type, dose, route of administration, duration of use, and age of initiation.

• You may be aware that treatment with oral estrogens in the past increases the risks of breast and uterine cancer, cardiovascular events, and blood clots.

• Modern HRT regimens significantly reduce or even eliminate these risks by reducing the doses used and using different methods of application (such as topical creams, and vaginal suppositories).

• We give the smallest doses needed of the safest possible preparations to achieve the patient’s desired treatment goals.

ARE THERE ANY CONTRAINDICATIONS TO FEMALE HRT?

Hormone replacement therapy with estrogens is absolutely contraindicated in women with:

• Unexplained vaginal bleeding

• Estrogen-sensitive breast and endometrial cancers or a genetically elevated risk of breast cancer

• A history of blood clots or blood clotting disorders

• A personal history of coronary artery disease or stroke

• A history of severely elevated triglyceride levels or severe gallbladder disease

• A history of liver disease.

Discuss your individual medical history with Dr. Justl Ellis during your consultation.

WHERE CAN I FIND MORE INFORMATION?

• Review the “Women’s Hormone” section under the “Medications” section of the Voafit homepage for detailed information on the medications we prescribe.

• An easy-to-understand PDF guide to HRT written by the Veteran’s Administration can be reviewed by clicking here.

• A comprehensive, peer-reviewed journal review of the topic of HRT in menopause can be reviewed by clicking here.

WHAT IS INCLUDED IN THE PEPTIDES+ MEMBERSHIP?

• Peptides+ is a special discount program wherein subscribers can access truly wholesale-priced peptides and other non-peptide wellness medications as well as at-cost on-demand laboratory testing.

• Peptides+ members also gain access to concierge-style care from Dr. Ian Justl Ellis and his team.

• Dr. Justl Ellis is a board-certified physician and certified personal trainer with decades of experience helping patients optimize their health and fitness via both medicinal and non-medicinal interventions.

WHAT ARE PEPTIDES?

• Peptides are large proteins composed of amino acid chains and regulate a wide range of biological functions. Peptides signal and trigger the body’s molecules and cells to perform specific healing tasks vital to our health and well-being.

• About 7,000 naturally occurring peptides have been identified, and medical treatment with natural or artificially created peptides is currently the focus of intense study.

• The first therapeutic peptide synthesized and used for human treatment was insulin in 1921. Since then, remarkable achievements have been made resulting in the approval of more than 33 peptide drugs worldwide since 2000. Many more are under current investigation.

• Advantages of large-molecule peptide therapy over other medication classes include very high specificity i.e., they typically do not bind to anything other than their intended receptor. This can result in significantly higher effectiveness and a generally lower side effect profile than other classes of medications.

WHAT CONDITIONS CAN BE TREATED WITH PEPTIDE THERAPY?

The field of peptide therapy is expanding rapidly, and a wide variety of conditions can be treated with peptides.

Conditions treated include:

• Boosting hormone levels

• Improving sleep quality

• Stimulating hair growth

• Enhancing cognitive function

• Treating sexual dysfunction

• Decreasing joint and muscle pain

• Increasing muscle mass

• Increasing weight loss

• Promoting immune function

• Increasing energy

Schedule a free virtual consultation with Dr. Justl Ellis to discuss your medical needs and to see if peptide therapy might be right for you!

WHICH PEPTIDES DO YOU OFFER?

• We offer a variety of individual peptide therapies, each with their own unique physiologic effects and mechanisms of action. Synergistic combinations of certain peptides are also available. For a full description of each peptide, please review the “Medications” section of the Voafit homepage.

HOW ARE PEPTIDE MEDICATIONS ADMINISTERED?

• Most peptides are refrigerated, short-shelf-life medications administered by subcutaneous injection. Some peptides may be taken by mouth.

WHAT KIND OF RESULTS CAN I EXPECT?

• Peptide therapy is a rapidly evolving field with a wide variety of newly available treatments.

• Certain peptides, such as the GLP-1 weight loss peptides, are FDA approved therapies have been studied extensively and have been conclusively shown to be tremendously effective in human treatment populations.

• Many other peptides show significant promise in animal studies and theoretical models and are being demonstrated anecdotally and in small human studies as being safe and effective. Most peptide therapies are not yet FDA approved and treatment with them should be considered experimental.

WHAT SIDE EFFECTS MIGHT I EXPERIENCE?

• Side effects of peptide therapy are generally mild but are usually related to their target receptor.

• A full discussion of the known side effect profiles of each peptide can be found by clicking on the individual peptide under the “Medications” section of the Voafit homepage.

WHERE CAN I FIND MORE INFORMATION?

• A comprehensive review article published in a peer reviewed journal discussing current applications and future directions for peptide therapies may be found here.

• For more specific information, refer to the individual peptides listed in the “Medications” section of the homepage.