| Today’s letter |
| The two questions that may take the nausea out of the prescription |
| In 1977, years after a drug called thalidomide caused birth defects in thousands of babies, the FDA decided to protect women by keeping them out of early drug trials. An eleven-page guideline banned every woman of childbearing age from early drug testing. Sponsors read the rule broadly and shut women out of later phases, too. By the time it was lifted, sixteen years later, most of the drug data doctors relied on came from men. |
| That was 1993. The ban went away, but its echo did not. Right now, one of the most prescribed weight loss drugs in the country is an injection most people know by name: Ozempic, or one of its relatives. The feeds are full of it this month, and so are the journals. Women were in these trials. And still… the side effects she is living with every week are nowhere on the label. |
| “Why can’t I just push through this?” |
| This is a woman who called three offices before she found a prescriber. She showed up, paid the copay, watched a nurse walk her through the injection pen. Every single thing the program asked, she did. |
| The advice she got sounded simple: the nausea passes, everyone feels it, give it a few more weeks. So she gave it a few more weeks. The nausea stayed. Her cycle changed. Then came the fatigue, the kind where the couch pulls you under by four in the afternoon. She stopped the medication and told herself she just could not handle it. |
| Here’s what gets me. |
| None of this was her failing. The drug’s own paperwork was missing half the story. |
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| Let me show you how I know. Not with my opinion, but with a study. |
| A team at the University of Pennsylvania collected more than 400,000 posts from Reddit, written by nearly 70,000 people taking semaglutide or tirzepatide, the compounds in the most widely prescribed weight loss injections. The posts covered more than five years. |
| They sorted through every reported side effect and compared the full list against what the drugs’ prescribing information actually says. |
| What they found |
| University of Pennsylvania, 2026. Sehgal et al., Nature Health. |
| The prescribing information (what it lists) |
| Nausea, vomiting, constipation and diarrhea, the stomach side effects the trials tracked. Menstrual changes and temperature complaints are not prominently featured.
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| The 67,000 users who posted (what they described) |
| Across 410,198 posts written over six years, 67,008 people said they were taking one of these drugs, and 43.5 percent described at least one side effect. Nausea led at 36.9 percent, fatigue came second at 16.7 percent, and about 13 percent described psychiatric symptoms such as anxiety or insomnia. Reproductive symptoms like irregular cycles came up often enough that the researchers named them as a signal worth investigating. |
| Reported, not proven. The authors say they cannot tell whether the drugs are causing these symptoms. |
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| In other words, the symptoms were not in her head. They just were not on the label. |
| She was not too weak to handle it. The prescription was not built for her body. Yours might not be, either. |
| So why would a drug that targets your appetite also change your cycle and leave you shivering? |
| The drugs are thought to work by engaging a part of the brain called the hypothalamus, which helps regulate a wide range of hormones. That region does not only manage hunger. It also has a hand in the menstrual cycle, in body temperature, and in mood, which is why the Penn team flagged the cycle changes and the chills as worth a closer look. The trials tracked weight and stomach trouble. Nobody was measuring the rest. |
| She never stood a chance against a label that was missing half the list. Neither did you, I’d bet. |
| That’s the part no one says out loud… |
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| Try this today |
| Before your next prescriber appointment, write down every side effect you have noticed: nausea past the first few weeks, changes in your cycle, feeling cold when the room is not, fatigue that does not match how you slept, anything with your mood or your sleep. Take it on paper. Then ask two things. Whether staying at this dose a few weeks longer before the next increase could ease the side effects, and whether the symptoms on your list are ones she wants to track. Do not change your dose or stop anything on your own. The list is for the exam room, and the decision is yours and hers. |
| Your symptoms are data. The list puts them in the chart. |
| Promise me you’ll try it today? Saying it out loud is half of what makes it stick. |
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| Nothing about that piece of paper changes the drug. It changes what the prescriber can see. A symptom mentioned over the phone slips by. Written on paper in the exam room, it becomes something a dose adjustment can be built on. |
| Sixty-seven thousand people were already doing a version of this, posting their symptoms online where someone might finally notice. Researchers at Penn did notice, and now the gap between what the trials tracked and what people described is in a peer reviewed journal. |
| Your next appointment is still ahead of you. There is still time to bring the list. |
| And the part where you blamed yourself for not being strong enough… |
| It was never your fault. |
| — Cole |
| P.S. If you ever stopped a medication because the side effects felt like your fault, hit reply and send the word SAME. |
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