Five Questions to Ask Before Starting a GLP-1, Especially If You Have Psoriasis or HS

GLP-1 prescribing has moved fast. Faster than the patient counseling has kept up with. A patient who five years ago would have had a full primary care workup before any weight loss medication now sometimes signs up on a phone, answers a brief questionnaire, and has a prescription on the way the same week. The medications work. The intake quality varies a lot.

If you are about to start a GLP-1, or if you are already on one and have wondered whether the intake covered everything it should have, these are the five questions worth getting answered. They are written with patients who have psoriasis or hidradenitis suppurativa in mind, because the skin angle changes some of the decision-making, but most of this applies to any patient considering a GLP-1.

Question One: Am I Actually a Candidate?

GLP-1 receptor agonists are FDA-approved for weight management in adults with a body mass index of thirty or higher, or twenty-seven or higher with at least one weight-related condition such as type 2 diabetes, high blood pressure, dyslipidemia, or obstructive sleep apnea. For patients with psoriasis or hidradenitis suppurativa, the disease itself is often what is driving the conversation, but the formal eligibility still runs through the BMI and metabolic criteria.

The intake should be reviewing your BMI, your prior weight loss attempts, your overall metabolic picture, and whether the medication is actually likely to help you. If you have a BMI of twenty-six and no metabolic comorbidities, you probably are not a candidate, regardless of how much you want to lose ten pounds. A clinician who prescribes anyway is taking a shortcut.

For HS and psoriasis patients specifically, the eligibility threshold is a guidepost, not a hard wall. A patient at BMI 28 with active moderate-to-severe HS, insulin resistance, and a strong family history of metabolic disease may be a reasonable candidate after a careful conversation. A patient at BMI 32 who has been stable on a biologic for years and never has flared since starting it may not need GLP-1 therapy at all. The decision is individual.

Our piece on weight and psoriasis covers the dermatology-specific case in more depth, and our HS-focused piece on GLP-1 evidence does the same for hidradenitis suppurativa.

Question Two: Are There Any Reasons I Should Not Take This?

The contraindications are not long, but they are absolute when they apply.

Personal or family history of medullary thyroid carcinoma rules out GLP-1 therapy. So does a personal or family history of multiple endocrine neoplasia type 2 (MEN 2). The FDA labels carry a black-box warning about thyroid C-cell tumors based on rodent studies. Whether the human risk is real remains debated, but the labeling is clear and the standard of care is to avoid these medications in patients with that family history.

A personal history of pancreatitis is the next major one. GLP-1 medications have been associated with pancreatitis at low but real rates, and a prior episode raises the bar. Some patients with remote, uncomplicated pancreatitis can still be candidates after careful evaluation, but the intake should ask the question and make a thoughtful call. A generic online intake that does not ask is missing something.

Severe gastroparesis is another. GLP-1 medications slow gastric emptying as part of their mechanism. In a patient who already has severely delayed gastric emptying, this can be a serious problem.

Pregnancy, planning pregnancy, or active breastfeeding rule these medications out for now. Lactation safety is not established. Patients who could become pregnant should be on reliable contraception while on therapy, and one detail matters here: tirzepatide can reduce the effectiveness of oral hormonal contraceptives because it slows gastric emptying. Its FDA label advises switching to a non-oral method, or adding a barrier method, for four weeks after starting tirzepatide and for four weeks after each dose increase. Semaglutide does not carry that specific labeled warning. If a future pregnancy is on your mind, the planning conversation belongs in the intake too: the semaglutide label advises stopping at least two months before trying to conceive, given its roughly one-week half-life.

A few other items deserve a careful conversation rather than an automatic exclusion. Active gallbladder disease. A history of significant depression that worsened with weight changes in the past. Eating disorder history. Severe diabetic retinopathy in patients with type 2 diabetes. None of these are absolute contraindications, but a good intake will ask and a good clinician will weigh them with you.

Question Three: Will I Be Able to Talk to a Real Clinician Once I Am on Therapy?

This is the question patients often forget to ask, because the intake is the part that feels visible. The intake is one decision point. The months on therapy after that are where the program does its real work.

A good GLP-1 program gives you direct access to a licensed clinician during treatment, not a chatbot, not a form, not an FAQ page. You should be able to message your clinician when a side effect shows up, when your dose feels off, when you have a question about food or hydration or what to do about nausea, when something on your skin or scalp surprises you, or when life happens and you need to pause for a stretch.

The platforms that ship the medication and then go quiet are not designed for that. The patient gets the prescription and then has to figure out what to do with everything that comes after.

Ask the question before you sign up. The answer tells you what the program will be like at month three, six, and beyond, not just on day one.

Question Four: How Does Dose Titration Actually Work?

GLP-1 medications are not started at the target dose. They are titrated up over weeks to months to minimize gastrointestinal side effects.

For compounded semaglutide, the typical starting dose is 0.25 milligrams subcutaneously once weekly. The dose increases every four weeks if the patient is tolerating it well, moving to 0.5 mg, then 1 mg, then 1.7 mg, then 2.4 mg as the maintenance dose. Some patients stop at a lower dose if they are getting good weight loss without escalation.

For compounded tirzepatide, the standard schedule starts at 2.5 milligrams weekly, increases every four weeks if tolerated, and steps through 5 mg, 7.5 mg, 10 mg, 12.5 mg, and a maximum maintenance dose of 15 mg weekly.

The titration matters because the side effect profile, especially nausea, is dose-dependent. Going too fast produces unnecessary suffering. Going too slow leaves weight loss potential on the table. A clinician who is paying attention will calibrate the schedule to the patient.

A platform that ships the maximum dose from week one is not doing the patient any favors. Neither is one that holds a patient at a low dose for months when they could be escalating safely.

Question Five: What Side Effects Should I Expect, and Who Handles Them?

This is the question that separates a serious intake from a checkout cart.

The common gastrointestinal side effects, nausea, constipation, occasional diarrhea, are most pronounced during the first few weeks at each new dose level. They usually settle within ten days. Eating slowly, eating smaller portions, avoiding fatty and very rich foods, and staying hydrated all help. Most patients work through them.

Beyond the GI effects, there are the dermatologic ones I see most often in my clinic. Telogen effluvium, the diffuse hair shedding that starts two to three months in and typically continues for six to nine months after the weight stabilizes before it stops. Facial volume loss, sometimes called GLP face, that becomes visible around month six and may need fillers or biostimulators to address. Loose skin in patients who lose more substantial amounts of weight, which may need procedural intervention if it persists after the weight stabilizes. Our piece on these side effects walks through what to expect.

The reason this matters for the choice of program is not the side effects themselves. It is who handles them when they show up.

A primary care intake will catch the medical side effects, the gallbladder symptoms, the pancreatitis warning signs, the metabolic shifts. A primary care clinician is generally not set up to manage hair shedding, facial volume loss, or skin laxity. Those are dermatologic conversations. A dermatology-led intake, in contrast, will anticipate the dermatologic consequences at the start, set expectations accordingly, and have a plan for each one when the time comes.

For HS and psoriasis patients specifically, the dermatology-led intake also asks about your current dermatologic therapy, coordinates with your dermatologist if needed, and watches for the changes in disease activity that often accompany weight reduction in these conditions.

If your weight is part of an inflammatory skin condition story, the right answer to "who handles the side effects" is "a dermatologist."

What Comes Next

If you have read this far and the questions feel familiar from your existing GLP-1 program, you are in good hands. If they feel new, that is worth raising with whoever is managing your care. In a dermatology-led model built around this kind of framework, GLP-1 candidacy is decided through a licensed clinician's individualized review, not an algorithm.

Important Information

Compounded medications are prepared by accredited US compounding pharmacies under a licensed prescriber and are not FDA-approved drug products in the way that brand-name medications such as Wegovy, Ozempic, Mounjaro, and Zepbound are. GLP-1 medications carry possible side effects including nausea, constipation, gallbladder issues, pancreatitis risk, and temporary hair shedding. GLP-1 therapy requires evaluation and prescription by a licensed clinician. This article is educational and is not medical advice.

Sources

• GLP-1 receptor agonists in inflammatory skin disease: a comprehensive review. J Eur Acad Dermatol Venereol. August 2025. doi:10.1111/jdv.20694. The dermatology-specific intake considerations.
• GLP-1 receptor agonists in dermatology: a clinical review. J Clin Aesthet Dermatol. 2025. PMC11932103.
• "GLP-1 in Dermatology" feature, Dermatology World, American Academy of Dermatology. January 2026.
• National Psoriasis Foundation primer on GLP-1 receptor agonists in psoriasis (advocacy organization summary).
• STEP-1: Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183
• SURMOUNT-1: Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038
• US Food and Drug Administration labeling for semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro).
• Drucker DJ. Mechanisms of action and therapeutic application of glucagon-like peptide-1. Cell Metab. 2018;27(4):740-756.
• American Gastroenterological Association. Clinical practice guideline on pharmacological interventions for adults with obesity. Gastroenterology. 2022;163(5):1198-1225.