In many cases, yes microbiome repair, circadian alignment, SCFAs, exercise, and targeted nutrients strongly influence metabolic plasticity
Without these objective measures, the combination drifts into open ended use without ability to assess whether the addition of tesamorelin is doing anything beyond what the GLP-1 was already doing
Real-world outcomes can differ because people often change their normal behaviour in a research environment, whereas real-world settings give us a stronger indication of how effective medications are in the more unpredictable environment of peoples day-to-day lives
Interpretation is limited by the predominance of potentially overlapped retrospective data and minimal randomized evidence
In a recent NOTW, I shared what I believed to be the three reasons behind the weakness (in relevance order): The narrative around oral GLP-1s Schotts weak FY 2026 guidance (shared early in December) Stevanatos low float (80% or so remains in the hands of the Stevanato family) #3 is what it is and we cant do much about it
Tirzepatides exclusivity timeline will similarly shape Mounjaros future affordability.That said, generic entry does not instantly make the drug cheap everywhere