✓You are likely a fit if
Most adults seeking metabolic or weight-loss benefit will pass screening. Specifically:
- Adult, age 18+, with a BMI ≥ 27 plus a weight-related condition (PCOS, prediabetes, hypertension, dyslipidemia, fatty liver, sleep apnea), or BMI ≥ 30 alone.
- Type 2 diabetes with A1c above target on lifestyle alone.
- Insulin resistance on labs (elevated fasting insulin, HOMA-IR > 2.0, low SHBG) even at lower BMI.
- You have stable medical history and can take a medication at home consistently.
- You're willing to start at the lowest dose and titrate slowly. We do not start at high doses.
×Hard contraindications, we will not prescribe
If any of these apply, GLP-1 therapy is off the table at OPTML. No exceptions.
- Personal or family history of medullary thyroid carcinoma (MTC), including a single first-degree relative.
- Multiple Endocrine Neoplasia syndrome type 2 (MEN2).
- History of acute or chronic pancreatitis, including alcohol-related pancreatitis.
- Active gallbladder disease requiring intervention, or symptomatic gallstones not yet treated.
- Severe gastroparesis or other significant gastric motility disorder.
- Pregnancy, planning pregnancy in the next 2 months, or active breastfeeding.
- Active eating disorder (anorexia nervosa, bulimia nervosa, or active restrictive pattern).
- Type 1 diabetes, we do not manage T1D telehealth.
- Known hypersensitivity to semaglutide, tirzepatide, or excipients.
!Conditions that require extra care
These don't disqualify you, but the physician will discuss risk, monitor more closely, or adjust the protocol.
- Diabetic retinopathy, rapid A1c reduction can transiently worsen retinopathy. We coordinate with your eye doctor.
- Severe renal impairment (eGFR < 30), not absolutely contraindicated but requires extra hydration and slower titration.
- BMI < 22, usually a sign GLP-1 isn't the right tool; we'll discuss alternatives.
- History of bariatric surgery, possible but requires nutrition planning to avoid muscle loss.
- Significant GERD, can worsen on GLP-1; manageable with timing and dose.
- On insulin or sulfonylureas, risk of hypoglycemia; doses of those medications often need to come down.
- Older adult (70+) with low muscle mass, we'll prioritize protein, resistance training, and slower fat-loss targets.
Pre-start labs we require
If you have these from the past 6 months, upload them. If not, we'll send a kit (Quest/LabCorp draw or in-home).
| Lab | Why |
|---|
| HbA1c, fasting glucose, fasting insulin | Baseline glycemic state and insulin resistance. |
| Comprehensive metabolic panel (CMP) | Renal and liver baseline. |
| Lipid panel (incl. apoB if available) | Cardiometabolic baseline. |
| TSH | Thyroid screen before any weight-loss intervention. |
| Lipase | Pancreatic baseline before GLP-1 initiation. |
| CBC | General health baseline. |
What to disclose at intake
Honest disclosure shortens the path. Hidden facts always surface eventually and they slow down or end care.
- Every prescription medication and over-the-counter you take, including dose.
- Any GLP-1 you've taken before, brand, dose, duration, why you stopped.
- Family history of thyroid cancer or MEN2.
- Any episode of severe abdominal pain, hospitalization, or pancreatitis, even decades ago.
- Your alcohol intake, honestly.
- Pregnancy plans within the next year.
- If you've ever had an eating disorder, even in remission.