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Madison Burgess decided to get serious about weight loss when the scale hit 91 kilograms (200 pounds). She began taking Ozempic. The medication worked better than she ever thought possible: even on the low starter dose, she lost more than 2 kg (5 lbs) within the first week.

Problems began, however, when Burgess, a 25-year-old healthcare administrator from Bloomfield, Michigan, ramped up her intake, as per the manufacturer’s guidelines. “The higher doses were rough on me,” she says. The constipation, nausea, diarrhoea and acid reflux hit hard and made eating difficult. That’s when she decided to drop back down to a lower dose and determine whether she could continue seeing benefits.

Burgess is just one of a growing number of people who are “microdosing” – a practice more typically associated with psychedelics such as LSD and psilocybin – by taking lower-than-standard amounts of weight-loss drugs such as Wegovy and Mounjaro (see “How they work”, below).

For some, the hope is to avoid side effects while losing weight, while others want to tap into the anti-inflammatory effect of these medications or reap their other benefits for the heart and the brain (see “A wonder drug”?, below). Microdosing the drugs has even been by ultra-wealthy elites like tech entrepreneur Bryan Johnson, and is rumoured to be the secret weapon of Hollywood stars wanting to look svelte for photo calls.

The question is, does this off-label, low-dose experimentation work?

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Medications such as Ozempic, Mounjaro and their ilk come in pre-loaded injectable pens. In conjunction with their healthcare provider, users typically follow a dosing regime that goes up. . In the first month, users take a low introductory dose of 0.25 milligrams a week. This then doubles, and then doubles again until a “maintenance” dose of either 1.7 or 2.4 mg per week is achieved, which is then taken long term. These standard doses are the only strengths that have been studied in large-scale clinical trials.

For this reason, microdosing these weight-loss medications isn’t approved by the US Food and Drug Administration (FDA) or by other health authorities. But that hasn’t stopped people from trying it, says at the Veterans Affairs St. Louis Health Care System in Missouri.

For Burgess, small doses of between 0.25 and 0.5 mg per week have been a success: she has lost 27 kg (60 lbs) and reached her goal weight without the problematic side effects. “At the lower doses, I don’t have symptoms,” she says. Burgess continues to take the drug to avoid regaining weight – an additional motivation for microdosing.

Inflammation

Another microdosing enthusiast, , a nurse practitioner who owns her own medical weight-loss practice in Golden, Colorado, says that low doses of tirzepatide have generally improved her quality of life. She takes 2 mg per week (the recommended starter dose is 2.5 mg) and contends that microdosing has reduced her inflammation, as evidenced by her having fewer aches and pains, given her more energy, and generally helped her choose a more wholesome diet. “Having less thoughts about food and less cravings makes it much easier to want to choose healthy foods,” says Sorensen.

Al-Aly’s identified a host of health benefits in addition to weight loss for those taking the medications, including a reduced risk of substance use disorders, Alzheimer’s disease, dementia, clotting disorders and many other conditions. But these were at higher doses and there is no data to show that similar results will occur in those who microdose.

“For most people, we need higher doses to see weight loss and diabetes results, but there are some exceptions,” says Carolynn Francavilla, an obesity physician in Denver, Colorado. The major clinical trials investigating semaglutide have found a large variability in response. Around , achieving weight loss in excess of 20 per cent; their sensitivity to the medication may mean that it takes far less of it for them to see results.

Longevity

Whether the drugs are indeed a fountain of youth remains unclear, but we do know that they can . “It is plausible that microdosing could provide some [anti]inflammatory benefits … but we just don’t know yet,” says Al-Aly.

Still, the medications shouldn’t be taken haphazardly. “There should be a medical problem that we’re improving if we’re going to use the medications at any dose,” says Francavilla. And it could be dangerous for some people, especially those with , some types of thyroid cancer and some gastrointestinal issues like , a condition that leads to delayed gastric emptying.

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In the US, many of those who microdose source their GLP-1 drugs from compounding pharmacies. These provide custom-made medications from pharmaceutical-grade ingredients when the branded medications are in short supply. This is a cheaper option than buying Wegovy and other brands at retail pharmacies, but comes with the risk of contamination and inaccurate dosages, as these injections aren’t FDA-approved for safety and quality. In the coming months, however, the compounding of semaglutide injections , as there is no longer a shortage of the brand-name versions. This will have knock-on implications for microdosers like Burgess, who had started using compounded injections rather than Ozempic in her bid to avoid regaining weight.

Still, Burgess isn’t planning to stop microdosing semaglutide anytime soon. “It’s a tool that helped me in my weight-loss journey,” she says.