Continued Treatment With Tirzepatide (SURMOUNT-4)
NAD First When: The primary complaint is fatigue, low energy, or feeling depleted for no identifiable reason Brain fog, difficulty with memory recall, or cognitive slowing that is affecting work or daily function Post-viral recovery (Long COVID, post-Lyme, or similar) where systemic cellular function feels compromised The patient wants a broad, foundational energy intervention before layering anything specific on top Peptides First When: The concern is specific and localized: hair thinning, skin laxity, tendon injury, gut inflammation, or body composition The patient wants to optimize performance in the gym, including muscle gain and fat loss (CJC/Ipamorelin, Tesamorelin, MOTS-C) The goal is targeted repair, for example post-procedure healing or scar reduction The patient is already energetic but wants to enhance a specific system or tissue Combination When: Fatigue AND difficulty concentrating: NAD + Semax addresses both the cellular energy deficit and the cognitive signaling layer Fatigue AND skin/hair concerns: NAD + GHK-Cu covers the systemic energy layer and the specific tissue signaling layer simultaneously The patient has multiple complaints that clearly fall into different categories Optimization patients who want to address cellular health comprehensively rather than one concern at a time What Patients Feel: NAD vs
NAC is absorbed within a few hours, but noticeable effects depend on what youre using it for and individual factors
Portion Control : Pay attention to portion sizes to help prevent overeating
These injectable medications can be used as monotherapy or in combination with metformin
Reimbursements would cover up to $500 per month in the first year of treatment, and up to $250 per month in the second year
