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Many patients arrive after reading about tirzepatide or semaglutide and wanting a local provider who will actually examine them, draw labs, and follow their case in person rather than issue a prescription through a questionnaire

Hormonal imbalance leading to uterine bleeding while taking semaglutide may be connected to rapid weight loss, changes in estrogen production, and effects on the HPO axis

PMID: 36602383

(AACE 2023 Obesity Guidelines, endocrine.org) The Obesity Society's position statement notes: "Pharmacotherapy for obesity should be considered an adjunct to, not a replacement for, behavioral intervention, and should be maintained long-term in patients who respond." This language directly supports Michigan Medicaid PA criteria requiring concurrent behavioral program participation