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Individuals on GLP-1 therapy express significant concern about muscle loss, prompting lifestyle changes and highlighting the need for informed primary care guidance.
A national survey of 1,000 adults currently taking GLP-1 receptor agonist (GLP-1 RA) medications reveals broad concern about the medications' side effects, including more than one-third who are leery of loss of lean muscle mass. More than half indicated they are making lifestyle changes to avoid the adverse outcome. The survey also highlights the central role for the primary care clinician to counsel individuals about benefits and risks associated with GLP-1 RA therapy before they begin. The survey was conducted in May by biopharmaceutical company Veru.
Among the most prominent concerns, 36% of respondents rated their perceived risk of muscle loss or weakness as moderate to very high. This trailed only gastrointestinal side effects (rated as moderate to very high by 50%) and neurologic symptoms such as fatigue or dizziness (44%).
While only 15% of respondents reported actually experiencing muscle loss, that number rose to 32% among those aged 60 and older—more than twice the overall rate. With 82% of all respondents under the age of 60, the survey notes that early-stage muscle mass decline "can continue for months or years before younger, stronger patients ever take notice."
Many respondents reported adopting new behaviors aimed at preserving muscle mass. When asked about diet, 36% said they follow a high-protein diet, while 55% reported eating more whole foods like fruits, vegetables, and lean proteins. In terms of physical activity, 63% engage in regular cardio, and 38% perform strength or resistance training—both shown to help prevent lean mass loss. Another 33% practice low-impact or flexibility-based exercise like yoga or stretching. Only 14% reported no meaningful physical activity.
“It is evident that patients are aware of the substantial risk that GLP-1 RAs pose to their muscle mass and physical function,” Mitchell Steiner, MD, Veru CEO said in a statement. “While diet and exercise are instrumental in combating lean mass decline, there is a mounting need—especially among the senior population—for treatments that can address the muscle loss which accompanies GLP-1 RAs. It is imperative that patients are presented with all the measures at their disposal to protect their long-term wellbeing.”
The rates at which respondents experienced GI, neurologic, and muscle loss side effects were roughly correlated the level of concern about each noted earlier. Overall, 25% reported nausea, constipation, or diarrhea; 22% reported fatigue, dizziness, or headaches; and 34% overall indicated they had experienced some form of side effect while on a GLP-1. However, two-thirds reported no side effects at all.
Before starting GLP-1 RA therapy, respondents turned to a range of sources for information. The majority (61%) consulted their general physician or primary care clinician, far outpacing other sources like friends and family (30%), pharmacists (25%), and online health portals such as Mayo Clinic or WebMD (24%). Only 6% said they consulted government agencies such as the CDC or NIH, while twice that proportion, 13%, reported using generative AI tools such as ChatGPT or Claude.
The findings also underscore the potential for pharmacologic adjuncts to GLP-1 RA therapy such as enobosarm, an investigational selective androgen receptor modulator Veru is currently developing. As previously reported on Patient Care,2 participants in a phase 2b study taking enobosarm along with semaglutide (Wegovy; Novo Nordisk) experienced a significantly smaller decline in lean mass (1.2% vs. 4.1% semaglutide alone) and greater total fat loss (10.9% vs. 8.6%). A follow-up maintenance study showed that enobosarm “completely prevented fat regain and preserved lean mass in both enobosarm dose groups compared to placebo” 12 weeks after Wegovy discontinuation. Veru has scheduled a meeting with the FDA to plan a Phase 3 trial.3
As GLP-1 usage expands in obesity and cardiometabolic care, these findings suggest that informed, ongoing dialogue between clinicians and patients will be essential—not only to manage expectations and side effects but to preserve long-term physical function.
