Off-Label Uses and Microdosing of GLP-1s

Welcome to another edition of the Doctor's Note where we talk about what's on our minds when it comes to your health.

This week on the Common Sense MD, I explored a topic that’s creating a revolution in medicine: microdosing GLP-1 medications. While you might know the names Ozempic or tirzepatide, these drugs—originally meant for diabetes—are proving to do much more than regulate blood sugar. We’re now seeing their incredible effects on weight loss, cardiovascular health, neuroprotection, inflammation, and even conditions like PCOS and migraines. As I shared in the episode, I myself use a microdose of tirzepatide, even though I do not have diabetes or obesity, because of the broad wellness and preventative benefits.

There’s still a lot of misunderstanding out there. Many see GLP-1s strictly as diabetes or obesity drugs, underestimating their holistic potential. In my practice at Performance Medicine, we’re utilizing these medications off-label, tailoring doses to individuals and often using much smaller (micro) doses than FDA guidelines for diabetics. This means less cost, fewer side effects, and potentially life-changing results for a wider range of people. While insurance is playing catch-up and access can be a challenge (especially for off-label use), the landscape is changing rapidly as more options and competition emerge.

PODCAST NOTES 

• GLP-1s and GIPs Explained: GLP-1 (glucagon-like peptide 1) and GIP (glucose-dependent insulinotropic polypeptide) are hormones naturally produced in the gut when you eat. They play a key role in helping your body regulate blood sugar by stimulating insulin release and suppressing glucagon. While first developed to help diabetics control their blood sugar, it’s now clear these hormones—and the drugs that mimic them—impact the body in a variety of powerful ways beyond simple glucose management.

• Microdosing Works: The traditional approach to GLP-1 therapy involves using relatively high doses, primarily for those with diabetes or severe obesity. But research—and real-world experience—shows that even very small doses (“microdosing”) can provide substantial benefits, ranging from increased metabolic health to reduced inflammation, often with far fewer side effects. In my own regimen and my practice, we find that a low starting point allows for highly individualized treatment and can be safer, gentler, and more sustainable over the long term.

• Weight Loss Is Just the Start: One of the early surprises with GLP-1 medications was how much weight people lost—sometimes exceeding 15–20% of their total body weight. However, I've found—and studies confirm—the real value is how these drugs reset metabolism, decrease appetite, slow digestion, and help overcome underlying metabolic dysfunction that lifestyle changes alone can rarely fix. For many, these medications are a lifeline where standard approaches fall short and maintain the improvements for the long haul.

• Off-Label Use Is Widespread and Legitimate: Prescribing medications “off-label” simply means using them for a condition or at a dose not originally specified by the FDA. This is actually very common in medicine, with about half of all prescriptions in the US written for off-label use. Physicians have the expertise and autonomy to individualize treatment plans, and when done properly—as with microdosed GLP-1s—this approach can produce truly transformative health outcomes for people who would otherwise fall through the cracks.

• Heart and Brain Benefits: One of the lesser-known advantages of these medications is their impact on cardiovascular and neurological health. Studies show that GLP-1s can significantly reduce the risk of major heart events like heart attacks and strokes, lower blood pressure, and improve cholesterol. There's also emerging evidence they cross the blood-brain barrier, helping protect the brain from degenerative diseases like Alzheimer's and Parkinson’s by reducing inflammation and oxidative stress.

• Inflammation and Well-being: A substantial number of my patients—and I’ve experienced this myself—report reduced joint pain and less generalized inflammation after starting on these medications, often even before major weight loss is achieved. This reduction in inflammation seems to be one of the key reasons many people feel better overall, with improved energy and less daily discomfort, reflecting systemic improvement beyond what scales and lab numbers can measure.

• Other Conditions Helped: Beyond diabetes and obesity, GLP-1s are showing benefit for a spectrum of other health issues. They reduce fat in the liver (helpful for fatty liver disease), assist women with PCOS, decrease migraine frequency, and even help diminish cravings in patients with substance use disorders. Additionally, they can improve kidney function and sleep apnea, contribute to better mood and emotional stability, and support healthier bone and muscle composition when paired with the right diet and exercise.

• Affordability Is Increasing: One of the main barriers to accessing these drugs has been cost, especially for those without diabetes, since insurance rarely covers off-label use. However, by microdosing and sourcing medications from high-quality compounding pharmacies, the treatment becomes much more affordable and accessible. As more pharmaceutical companies enter the market, and as the medical and public understanding of these drugs expands, we’re likely to see even more competitive pricing and easier access in the near future.

As always, my goal at Performance Medicine is to give you the most up to date, practical, and individualized health strategies available. I truly believe GLP-1s are a game changer in medicine. If you’re interested in learning if microdosing or these therapies might be right for you—whether for diabetes, weight management, or a range of other health concerns—simply fill out this form and we will reach out to you.  

Stay educated. Stay healthy. 

Till next week.