Guys are taking massive risks by combining testosterone and semaglutide, the main ingredient in Ozempic and Wegovy, to lose weight and build muscle. And nothing will stop them from doing it—not a drug shortage or even the possibility of death.
HE REFERRED TO it as his “little science experiment.” Once a week, Bill, 45, would wash his hands, sterilize his desk, and lay out the syringes he bought from Amazon as he prepared to inject his drug cocktail. He filled one syringe with off-script testosterone, the other with semaglutide, the active ingredient in the type 2 diabetes drug Ozempic and the weight-loss drug Wegovy. Testosterone Enanthate
Bill, who’s using only his first name to protect his privacy, doesn’t work in a pharmacy. He works in finance. But he would mix the semaglutide himself, adding sterile water to the powder he purchased from a website—no prescription, medical history, or insurance required. He was confident he knew what he was doing, since he’d prepared drugs in a similar way when taking human growth hormone in the past. And besides, the risks were nothing compared with the promise of supercharging his “cut,” allowing him to burn as much fat as possible and getting him ready to compete as a bodybuilder—a lifelong aspiration.
If you’ve ever tried to get cut—or “lean” or “shredded” or any of the words we associate with the ideal male form—then you know it’s hard to build muscle and lose fat simultaneously. The former requires consuming more calories than you burn, while the latter requires consuming fewer. Attempting to accomplish both goals at the same time may cause a slower rate of change in both, according to Lee Boyce, C.P.T., a Men’s Health advisor. That’s why most trainers will tell you to bulk first and then reduce fat. But what if there were a magical way to do both things at once?
Go to YouTube and you’ll find bodybuilding influencers, some with hundreds of thousands of followers, promoting businesses that sell testosterone and semaglutide, claiming the combo is a miracle concoction for a man who wants to lose weight but preserve or gain muscle. Thanks to the longstanding use of testosterone as a muscle-building hormone and the inescapable Ozempic hype, there are subreddits, TikToks, and Facebook groups full of guys who believe that this is the key to achieving their dream body.
Except experts are warning that the combination of testosterone and semaglutide can be dangerous when taken without a doctor’s supervision. What’s more, the online stores claiming to carry them might not be selling the real thing. This means guys like Bill are risking serious side effects—up to and including death.
Bill would learn that the hard way.
“HAS ANYONE USED TRT and Ozempic?"
The simple question on the r/Testosterone subreddit was tinder for a wildfire of opinions. This past January, a user who combined TRT (testosterone replacement therapy) and semaglutide replied enthusiastically, “Experience has been wonderful. I’ve dropped from 210 to 180 lbs in 6months. Feel and look great. Easier to lose weight and maintain muscle mass in the gym. The best combo imo.”
Discussions occurred on the r/PeptideForum subreddit, too, with guys wanting to up their doses to see even better results. “I’ve been on Semaglutide and TRT for 7 weeks and am down 18lbs. Happy with the results but as I start increasing dosage . . . I want to make sure I am maintaining the muscle mass I have at the very least.”
But what nobody was talking about was that there’s little to no research on the health impact of combining testosterone and semaglutide. And each one can have side effects of its own.
Semaglutide can cause patients to experience “intractable vomiting,” says Jesse Mills, M.D., director of the Men’s Clinic at UCLA. It can also cause bowel issues and gastroparesis. (That’s the stomach paralysis you read about in semaglutide horror stories; it involves indigestion, constipation, and other not-so-fun stuff.) Meanwhile, TRT carries a somewhat paradoxical risk of infertility and can result in a high concentration of red blood cells, which increases the possibility of blood clots, heart attacks, and strokes. Both can also cause pancreatitis, a painful inflammation of the pancreas that could put you in the hospital. In serious cases, it can require surgery and even be fatal.
These possible side effects can be easy to ignore when the potential fat-burning, muscle-building outcome is so irresistible. But the reality is that guys may be risking their health for no reason. Semaglutide is such a powerful appetite suppressant that it’s difficult for those taking it to eat enough food to gain or even maintain muscle mass. And that’s even with a muscle-building boost from TRT, says Priya Jaisinghani, M.D., an endocrinologist and obesity-medicine expert at NYU Langone Health.
Dr. Jaisinghani notes that Ozempic and Wegovy on their own are “life-changing” for patients who qualify for them. They can improve stubborn health issues like fatty liver disease and high blood pressure. However, they are “intended to be taken weekly, for the long term, and not in a cyclical manner,” she says. In other words, these are not “quick fix” weight-loss medications that you can use to lose 20 pounds in a few months and then quit. You’ll likely just gain all of the weight back.
If you’re taking semaglutide or testosterone, and especially if you’re taking both, you should really be monitored by a doctor. But many of the guys doing this aren’t being monitored by a doctor. Even worse, they probably aren’t even taking the real thing.
AS BILL AND others have found, real semaglutide is difficult to get. Demand is so great that Ozempic and Wegovy are on the FDA’s drug-shortage list. And since both drugs are expensive, insurers have strict requirements about who qualifies for coverage. Even if you could get a prescription and pay at least $900 out of pocket for a four-week supply of Ozempic or $1,300 for Wegovy, you might show up at the pharmacy and find they’re all out.
To meet the demand, alternative drug shops have emerged. First up: compounding pharmacies. Drug compounding is essentially combining, mixing, or altering ingredients to create a personalized medication (for example, if a patient is allergic to a certain ingredient in a drug). Some of these compounding pharmacies are legit. They follow FDA regulations and have state licenses. They’re actually allowed to make alternative versions of Ozempic and Wegovy to fill the need amid the drug shortages.
But many of the businesses advertising “compounded semaglutide” are not real compounding pharmacies at all. There are med spas selling semaglutide, and telemedicine services where getting a prescription is as easy as filling out a form. “Most of the time, these drugs are being prepared in nonsterile environments, which could lead to contaminants and cause harm to the body,” says Lemrey “Al” Carter, Pharm.D., a pharmacist and the executive director of the National Association of Boards of Pharmacy (NABP).
Beyond illegitimate compounding pharmacies, though, is a “worst-case scenario” that Carter is even more concerned about: websites, like the one Bill purchased from, that label semaglutide a “research chemical” not intended for human use and that also sell anabolic steroids and other drugs illegally. These sites have been around for years; semaglutide just happens to be their hot new product, and it’s much less expensive than the brand-name drugs. The research-chemical site Bill purchased from charges $124.99 for “semaglutide” in a quantity about five times higher than you could get from an FDA-approved seller.
According to several men who spoke with Men’s Health about buying semaglutide from these sites, the drug often comes as a powder. Based on this, Dr. Mills believes they’re selling the salt form of semaglutide, whose dangers the FDA has warned about. This untested version of the drug isn’t the same as the active ingredient in Ozempic and Wegovy and requires the user to mix it at home—making it easy to screw up the math and inject the wrong dose. The product could also contain life-threatening contaminants.
“You have the risk of not receiving the drug and worsening your health condition,” Carter says. “You have the risk of receiving something that could be laced with some type of poison that could kill you.” That makes research-chemical sites “an even greater risk than what you’re seeing at these med spas and some of these other clinics,” he adds.
To help people vet online retailers, the NABP has created a tool called Safe.Pharmacy, where you can paste a URL to check whether the site you’re considering purchasing from has engaged in any fraudulent activities. The FDA has also issued warning letters to many of these online pharmacies making clear that they’re violating federal law. But it’s a game of whack-a-mole: New sites pop up all the time, and neither the NABP nor the FDA has reviewed them all. Legislation proposed in Congress and supported by the NABP that might have made it harder for sites to resurrect themselves after being taken down never made it past committee hearings.
KEVIN, 43, HAS been on TRT for six years. He buys his testosterone legally with a doctor’s prescription, but he wanted to get leaner. When his doctor wouldn’t give him a prescription for semaglutide, he turned to research-chemical sites.
He isn’t trying to become a bodybuilder. “I’m more into just maintaining a ‘Hey, he goes to the gym’ kind of look,” he says. “Nothing crazy, just looking fairly big in a dress shirt.”
First, in 2021, Kevin tried liraglutide, an earlier-generation drug of the same class as semaglutide. He lost 35 pounds. But then he stopped taking it and gained a lot of the weight back. So in early 2022, he decided to try semaglutide. He says it made him depressed—a relatively rare but reported side effect.
“It made me feel like garbage mentally.”
He stopped taking the semaglutide, and about a month later he felt normal again. But Kevin didn’t quit altogether—he went back to combining liraglutide with his usual testosterone injections. And he’s been honest with his doctor about what he’s doing. “She would prefer I don’t use it, since there’s no way to really know what it is,” he says.
When Bill first spoke with Men’s Health in July, he acknowledged the risk he was taking, but he said he was pretty confident that he was doing things safely. At the time, he’d been taking testosterone and semaglutide together for seven weeks. He had lost about 16 pounds and, according to a DEXA scan, 3 percent of his body fat while maintaining most of his muscle.
On paper, this sounds great. However, Bill might have lost the weight and preserved his muscle even if the semaglutide he bought wasn’t real. Shedding 16 pounds in seven weeks is reasonably achievable without pharmaceutical help, especially since Bill was simultaneously working with a trainer and following a careful diet plan. But even if it was the real thing, Dr. Jaisinghani says everyone responds to these medications differently, losing body mass at different rates.
Ultimately, though, Bill took semaglutide for only a fraction of the time he intended. His original plan was to stay on the drug for a few months and then cycle off to reenter a muscle-building phase. He had it all laid out in an Excel spreadsheet! But things escalated quickly.
Following one of his weekly semaglutide injections, Bill broke out in a rash near the injection site. That week, he had also climbed down into a ditch to help a truck driver who’d been in an accident, so he thought the reaction might have been related to that somehow. He took some Benadryl and moved on.
The next week, he injected a larger dose, according to his schedule. Within 24 hours, he’d broken out again. This time, the rash was accompanied by an almost grapefruit-sized lump around the injection site. The lump was red, splotchy, and swollen, and the swollen area felt much harder than the fat tissue he’d injected the semaglutide into. “I probably should have gone to the ER,” he says sheepishly.“Needless to say, my semaglutide journey is done.”
IF WHAT YOU want is to get a little leaner but stay ripped, the dramatic weight loss associated with semaglutide isn’t what you’re looking for. In fact, according to Dr. Mills, there’s something out there that is safer and probably better: metformin, an earlier-generation diabetes drug. Metformin works by reducing insulin resistance and lowering blood sugar, but its weight-loss effect is more modest. In combination with TRT, “it’s a great way to get shredded,” he says. Plus, metformin has a good safety profile and is easier to start and stop, without such a huge rebound effect. Unlike semaglutide, metformin also isn’t likely to cause a loss of lean muscle tissue.
Dr. Mills suspects the TRT/semaglutide hype stems from the decades-long practice among bodybuilders of taking metformin in combination with either testosterone or an anabolic steroid. “It doesn’t surprise me that there are a lot of men who want to take it to the next level,” he says. But while Dr. Mills has no problem with supporting patients who have aesthetic goals, he’d prescribe both Ozempic and TRT only to a man who actually has type 2 diabetes and other health issues. (Interestingly, recent research has shown that TRT alone may help prevent or even reverse type 2 diabetes.)
Dr. Jaisinghani says that all drugs have risks and that the benefits of taking a drug should always outweigh those risks. For example, she tells Men’s Health she has a transgender patient who is taking testosterone along with Ozempic or Wegovy, but only with careful monitoring by her and a second doctor who’s in charge of transition-related care. Aside from that, she’d prescribe TRT only to a man with clinically low testosterone.
If you don’t have low testosterone and generally aren’t into risking your health, the nonpharmaceutical route to losing weight and building muscle is still a viable option. While it’s challenging to do both simultaneously, it’s not impossible. It takes patience and typically requires the help of a doctor, a dietitian, and an exercise physiologist, says Dr. Jaisinghani.
In a society that loves a good quick fix, though, that won’t stop an increasing number of websites from advertising this testosterone/semaglutide cocktail. Considering all the unknowns of taking them together (even if you’re getting the real deal), guys like Bill are lucky things didn’t turn out worse. But now he’s worried about the men out there who aren’t being careful, especially as they come across these sites.
“I’ve talked to my son about it,” Bill says. “You know, he’s 20, and this stuff is all over the place. I’ve told him there’s no reason to take this path. Whenever I hear it being talked about, I always try to be really careful and say, ‘Make sure you understand the costs, because they are real.’”
At the same time, Bill understands the temptation. “Everybody wants to look better, right?” he says. “Most of us do, anyway.” As a cautionary tale, he points to the recent death of the bodybuilder known as “Joesthetics,” who previously admitted to using performance-enhancing drugs and died at age 30 from an aneurysm.
“If I would’ve had when I was 20 what I have access to today . . . who knows if I’d be here?”
Garnet Henderson is an award-winning journalist in New York City. She is the senior multiplatform reporter at Rewire News Group and the host and producer of Access: A Podcast About Abortion. She is also a certified personal trainer with more than a decade of experience in the fitness industry.
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