I'm a Pathologist. The Ozempic & Mounjaro Cost You Can't Feel Yet (Long-Term Side Effects and Safety)

What are Ozempic and Mounjaro doing to your body that you can't feel yet? I'm a pathologist with obesity medicine training. I read the long-term trials, the FDA prescribing information and the newest safety studies on Ozempic, Wegovy, Mounjaro and Zepbound, so you can see what we know about semaglutide and tirzepatide apart from what lawsuits, headlines and social media make them sound like.

I sorted the long-term safety questions into 5 files: cancer, gut and kidneys, eyes, muscle and face, and brain and mood. That covers the thyroid cancer warning, pancreatic cancer, pancreatitis, gastroparesis, gallstones, kidney injury, anesthesia risk, diabetic retinopathy, NAION and sudden vision loss, muscle loss, "Ozempic face," depression and suicidal thoughts.

3 of the 5 files were more reassuring than the headlines suggest. 1 safety signal has become harder to dismiss. And we still don't have 10-year data at today's weight loss doses. Near the end, I cover a warning on the Mounjaro and Zepbound labels about birth control pills that many people on these drugs have never been told, plus what the labels say about pregnancy.

Chapters
00:00 What is this doing to me that I can't feel yet?
03:48 File 1: Cancer
07:43 File 2: Gut and kidneys
12:40 File 3: Eyes and vision
17:18 File 4: Muscle and face
18:59 File 5: Brain and mood
20:35 What we still don't know
22:57 Pregnancy and birth control

Where I landed
Cancer: reassuring, not closed. Tell your prescriber about any family history of medullary thyroid cancer or MEN 2.
Gut and kidneys: uncommon, and this is where the emergencies live. Tell your anesthesia team out loud before any procedure. Severe upper belly pain that goes through to the back is an emergency. Don't let vomiting turn into dehydration.
Eyes: emerging. The newer NAION signal is mainly linked to semaglutide, and a rapid drop in blood sugar can worsen existing diabetic retinopathy. Sudden vision loss in one eye is a same-day eye emergency.
Muscle and face: reassuring, with homework. Protein and lifting twice a week, guided by your prescriber.
Brain and mood: reassuring. Report a mood change that lasts more than 2 weeks after starting or raising your dose.

The GLP-1 Method: a 90-day program of short daily videos on the habits that hold your weight steady (protein, muscle, sleep and how you eat). Waitlist: getuninflamed.com
Watch on YouTube: @draminhedayat

References
SELECT, semaglutide 2.4 mg, 17,604 participants: Lincoff et al., NEJM 2023
FLOW, semaglutide and kidney outcomes, 3,533 participants: Perkovic et al., NEJM 2024
SUSTAIN-6, retinopathy complications: Marso et al., NEJM 2016
GI adverse events vs bupropion-naltrexone: Sodhi et al., JAMA 2023
Gallbladder disease, 76 trials, 103,371 participants: He et al., JAMA Intern Med 2022
French thyroid cancer cohort: Bezin et al., Diabetes Care 2023
Scandinavian thyroid cancer cohort, 145,410 users: Pasternak et al., BMJ 2024
NAION and semaglutide: Hathaway et al., JAMA Ophthalmol 2024
Suicidal ideation, 240,618 patients: Wang et al., Nat Med 2024
SURMOUNT-4, withdrawal and regain: Aronne et al., JAMA 2024
Tirzepatide 176-week data: Jastreboff et al., NEJM 2025

Disclosures: I have no financial relationship with Novo Nordisk, Eli Lilly or any pharmaceutical company, and this episode has no sponsor. I have no relationship with any seller of compounded or gray-market versions of these drugs, and I don't recommend buying them. I'm an independent educator. The major trials discussed were funded by the manufacturers, and I say so where it applies. This episode is education only, not medical advice. Decisions about starting, continuing or stopping a medication belong with you and your physician. If you have sudden vision loss, severe abdominal pain, or can't keep fluids down for more than a day, contact your prescriber or seek emergency care.