Most telehealth sites approve nearly every intake that clicks through. We don't. About one in five GLP-1 intakes gets routed elsewhere - thyroid history, pancreatitis, pregnancy plans, or a medication interaction that would put you in the ER. Here's the real criteria before you spend $299 on a service that shouldn't take you.
What GLP-1 medications actually do
GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) slow gastric emptying and suppress appetite by mimicking the hormone your gut releases after meals. Tirzepatide (Mounjaro, Zepbound) adds GIP receptor activity, which pushes average weight loss from ~14.9% (STEP-1) to ~20.9% (SURMOUNT-1).
They are not stimulants. The mechanism is satiety, not metabolism - which is why nausea, reflux, and constipation concentrate in titration weeks and fade once your body stabilizes at each dose step.
They work best as the medication layer on top of 0.7-1.0 g protein per lb lean mass, consistent training, and 25-35 g daily fiber. Skip the foundation and you lose roughly 25-40% of the weight as lean mass - the worst possible body composition outcome.
Standard eligibility criteria
FDA labeling covers BMI 30+, or 27+ with a metabolic comorbidity like HbA1c 5.7-6.4%, hypertension, or dyslipidemia. In practice, fasting insulin above 10 uIU/mL or HOMA-IR above 2 strengthens the case even when BMI is marginal.
Hard stops: personal or family history of medullary thyroid carcinoma, MEN2 syndrome, active pancreatitis, severe gastroparesis, pregnancy, breastfeeding, or planned conception inside the next two months.
Drug interactions worth flagging: insulin and sulfonylureas raise hypoglycemia risk during titration; oral contraceptives need dose-timing adjustments around semaglutide. Every intake screens for these explicitly.
Start the Advanced panel early - ApoB, HbA1c, fasting insulin, TSH, and a lipid panel decide whether GLP-1 is even the right lever.
Why intakes get declined
Roughly one in five GLP-1 intakes doesn't clear. The usual reasons: a first-degree relative with MTC, active pancreatitis risk factors, pregnancy plans inside the window, or a thyroid pattern that needs work-up before any GLP-1 conversation.
Decline is spelled out with a reason and an alternative - thyroid evaluation, coaching-first metabolic care, or a different class of medication. "No" is part of good medicine, not a failure mode.
If a service approves everyone who clicks through, walk away. That isn't telehealth; it's drop-shipping.
Book the assessment - if GLP-1 fits, we'll titrate; if it doesn't, we'll tell you why and route you.
What happens if you qualify
Titration follows FDA labeling: semaglutide 0.25 mg for four weeks, stepping toward 2.4 mg; tirzepatide 2.5 mg for four weeks, stepping toward 15 mg. Each step waits on GI tolerance, not the calendar.
Labs get retested at 3 and 6 months - HbA1c, lipid panel, liver enzymes, and CBC. Dose holds or drops if tolerance fails; switches between GLP-1 molecules happen under provider review.
State rules govern compounded vs branded access. If you're in a state where compounded GLP-1 is restricted, we'll say so during intake - before any payment.
What to do now
If BMI, lab values, and intake clear the criteria above, book the assessment and let a provider run the titration plan. If you're unsure on eligibility, start with the Advanced lab panel first - ApoB, HbA1c, and fasting insulin decide more than BMI ever will.
If you're in an excluded group (MTC history, pregnancy, active pancreatitis), stop shopping for GLP-1 from any service and route through coaching plus labs - the metabolic work can still move meaningfully without the medication.