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Consider semaglutide if: You prioritize lower cost and established safety data You have a history of GI sensitivity and prefer gradual titration You want to start with the more affordable option (semaglutide at $299/month) You're seeking 15-18% weight loss with solid cardiovascular benefit Consider tirzepatide if: You have more aggressive weight loss goals (20%+ reduction) You have type 2 diabetes or significant cardiometabolic risk Cost is not a primary barrier You tolerate GI side effects well or are willing to manage them Many patients find success on either medication

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