GLP-1 Treatment Informed Consent

1. Purpose of Treatment

You are being offered treatment for obesity or overweight with related health conditions. Your clinician may recommend GLP-1- based medications as part of a comprehensive weight-management program that includes lifestyle changes (diet, exercise, and behavioral counseling).

2. TYPES OF GLP-1 MEDICATIONS

A. FDA-Approved GLP-1 Medications

These are medications that have been reviewed and approved by the U.S. Food and Drug Administration (FDA) for weight management in adults. Examples include semaglutide (Wegovy) and tirzepatide (Zepbound). These products have undergone rigorous clinical trials demonstrating their safety and efficacy.

B. Compounded GLP-1 Medications

Compounded GLP-1 medications are custom formulations prepared by state-licensed compounding pharmacies based on a valid prescription.

3. How GLP-1 Medications Work

GLP-1 (glucagon-like peptide-1) receptor agonists work by:

• Slowing gastric emptying, which helps you feel full longer
• Reducing appetite and food intake
• Improving blood sugar control (in people with diabetes)

These medications are administered by subcutaneous injection, typically once weekly.

4. WHO IS ELIGIBLE FOR GLP-1 TREATMENT?

GLP-1 medications are generally considered for adults who have:

• A body mass index (BMI) of 30 or greater, OR
• A BMI of 27 or greater with at least one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol)
• Not achieved adequate weight loss with diet and exercise alone

Your clinician will determine whether you are a candidate based on your individual medical history, current health status, and treatment goals.

5. POTENTIAL BENEFITS

Possible benefits of GLP-1 treatment may include:

• Clinically signiðcant weight loss
• Improvement in weight-related health conditions (such as blood sugar, blood pressure, cholesterol)
• Reduced risk of cardiovascular events (in some patients)

Results vary among individuals and no specific amount of weight loss is guaranteed.

6. Potential Risks and Side Effects

BOXED WARNING: RISK OF THYROID C-CELL TUMORS

GLP-1 receptor agonists cause thyroid C-cell tumors in animal studies. It is not known whether they cause thyroid tumors in humans. Do not use GLP-1 medications if you or any family members have ever had medullary thyroid carcinoma (MTC) or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN2). Tell your clinician immediately if you develop symptoms such as a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath.

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Abdominal pain
• Headache
• Fatigue

Most side effects are mild to moderate and tend to improve over time, especially when the dose is increased gradually.

SERIOUS RISKS:

GLP-1 medications may cause serious side effects, including:

• Pancreatitis (inñammation of the pancreas): Stop using the medication and seek medical attention immediately if you have severe abdominal pain that does not go away
• Gallbladder disease: Including gallstones and inñammation of the gallbladder
• Kidney problems: Including worsening of chronic kidney disease; stay well-hydrated and report symptoms such as decreased urination or swelling
• Hypoglycemia (low blood sugar): Especially if you are also taking insulin or other diabetes medications; monitor your blood sugar and report symptoms such as dizziness, shakiness, or confusion
• Allergic reactions: Seek immediate medical attention if you develop rash, itching, swelling, difficulty breathing, or severe dizziness
• Changes in vision: Report any vision changes to your clinician
• Depression or suicidal thoughts: Report any mood changes to your clinician

This is not a complete list of side effects. Your clinician will discuss all risks and benefits with you.

7. CONTRAINDICATIONS – DO NOT USE GLP-1 MEDICATIONS IF YOU:

• Have a personal or family history of medullary thyroid carcinoma (MTC)
• Multiple Endocrine Neoplasia syndrome type 2 (MEN2)
• Have had a serious allergic reaction to semaglutide, tirzepatide, or any GLP-1 receptor agonist
• Are pregnant or breastfeeding (GLP-1 medications are not recommended during pregnancy or breastfeeding)

8. Monitoring and Follow-Up

GLP-1 treatment requires ongoing medical supervision, including:

• Regular follow-up visits to monitor your progress, side effects, and overall health
• Dose adjustments based on your response and tolerance
• Laboratory tests as clinically indicated
• Continued lifestyle modification (diet, exercise, behavioral counseling)

You must attend scheduled follow-up visits and report any side effects or concerns to your clinician promptly.

9. DURATION OF TREATMENT

GLP-1 treatment is typically long-term. Stopping the medication may result in weight regain. Your clinician will discuss the appropriate duration of treatment based on your individual response and health goals.

10. ALTERNATIVES TO GLP-1 TREATMENT

Alternative treatments for weight management include:

• Lifestyle modification alone (diet, exercise, behavioral counseling)
• Other weight-loss medications
• Bariatric surgery (in eligible patients)
• No treatment at this time

Your clinician will discuss these alternatives with you.

11. NO GUARANTEE OF RESULTS

Weight-loss results vary among individuals and depend on many factors, including adherence to medication, lifestyle changes, and individual metabolism. No speciðc amount of weight loss or other health outcome is guaranteed.

12. COST AND INSURANCE

GLP-1 medications may be expensive, and insurance coverage varies. Compounded formulations are typically not covered by insurance. You are responsible for understanding your coverage and any out-of pocket costs before starting treatment.

13. QUESTIONS AND CONSENT

Your clinician has explained GLP-1 treatment to you and has answered your questions. By proceeding with treatment, you acknowledge and consent to the following:

• I have read and understand this GLP-1 Weight-Loss Treatment Consent
• I have had the opportunity to ask questions about GLP-1 medications, including both FDA-approved and compounded options
• I understand the potential benefits, risks, side effects, and contraindications
• I understand that compounded GLP-1 medications are not FDAapproved and may carry additional risks
• I understand that results vary and no speciðc outcome is guaranteed
• I agree to attend follow-up visits and report any side effects or concerns
• I voluntarily consent to GLP-1-based weight-loss treatment as recommended by my clinician

You may withdraw your consent and discontinue treatment at any time by contacting your clinician.

14. CONTACT INFORMATION

If you have questions or concerns about your GLP-1 treatment, contact us at:

AgeReverse-RX

[email protected]

Email: [email protected]

Phone: (Phone number coming soon — see contact page for current options)

If you experience signs of a severe allergic reaction (difficulty breathing, swelling of face/throat), severe abdominal pain, or signs of pancreatitis, seek emergency medical care immediately and contact our clinical team at [email protected] or (Phone number coming soon — see contact page for current options).