GLP-1 Eligibility & Contraindications (Semaglutide / Tirzepatide), OPTML

✓You are likely a fit if

Most adults seeking metabolic or weight-loss benefit will pass screening. Specifically:

Adult, age 18+, with a BMI ≥ 27 plus a weight-related condition (PCOS, prediabetes, hypertension, dyslipidemia, fatty liver, sleep apnea), or BMI ≥ 30 alone.
Type 2 diabetes with A1c above target on lifestyle alone.
Insulin resistance on labs (elevated fasting insulin, HOMA-IR > 2.0, low SHBG) even at lower BMI.
You have stable medical history and can take a medication at home consistently.
You're willing to start at the lowest dose and titrate slowly. We do not start at high doses.

If any of these apply, GLP-1 therapy is off the table at OPTML. No exceptions.

Personal or family history of medullary thyroid carcinoma (MTC), including a single first-degree relative.
Multiple Endocrine Neoplasia syndrome type 2 (MEN2).
History of acute or chronic pancreatitis, including alcohol-related pancreatitis.
Active gallbladder disease requiring intervention, or symptomatic gallstones not yet treated.
Severe gastroparesis or other significant gastric motility disorder.
Pregnancy, planning pregnancy in the next 2 months, or active breastfeeding.
Active eating disorder (anorexia nervosa, bulimia nervosa, or active restrictive pattern).
Type 1 diabetes, we do not manage T1D telehealth.
Known hypersensitivity to semaglutide, tirzepatide, or excipients.

These don't disqualify you, but the physician will discuss risk, monitor more closely, or adjust the protocol.

Diabetic retinopathy, rapid A1c reduction can transiently worsen retinopathy. We coordinate with your eye doctor.
Severe renal impairment (eGFR < 30), not absolutely contraindicated but requires extra hydration and slower titration.
BMI < 22, usually a sign GLP-1 isn't the right tool; we'll discuss alternatives.
History of bariatric surgery, possible but requires nutrition planning to avoid muscle loss.
Significant GERD, can worsen on GLP-1; manageable with timing and dose.
On insulin or sulfonylureas, risk of hypoglycemia; doses of those medications often need to come down.
Older adult (70+) with low muscle mass, we'll prioritize protein, resistance training, and slower fat-loss targets.

If you have these from the past 6 months, upload them. If not, we'll send a kit (Quest/LabCorp draw or in-home).

Lab	Why
HbA1c, fasting glucose, fasting insulin	Baseline glycemic state and insulin resistance.
Comprehensive metabolic panel (CMP)	Renal and liver baseline.
Lipid panel (incl. apoB if available)	Cardiometabolic baseline.
TSH	Thyroid screen before any weight-loss intervention.
Lipase	Pancreatic baseline before GLP-1 initiation.
CBC	General health baseline.

Honest disclosure shortens the path. Hidden facts always surface eventually and they slow down or end care.

Every prescription medication and over-the-counter you take, including dose.
Any GLP-1 you've taken before, brand, dose, duration, why you stopped.
Family history of thyroid cancer or MEN2.
Any episode of severe abdominal pain, hospitalization, or pancreatitis, even decades ago.
Your alcohol intake, honestly.
Pregnancy plans within the next year.
If you've ever had an eating disorder, even in remission.