In this interview Dr. Charles Mok and an interviewer discuss the expanding role of GLP‑1 receptor agonists such as semaglutide and tirzepatide beyond simple weight loss. They explain that clinical trials in people with diabetes have shown a significant reduction in heart attacks and an estimated 1.5‑year increase in lifespan after three to four years of therapy, leading to FDA approval for cardiovascular protection in overweight or obese patients with comorbidities. The conversation then moves to practical prescribing challenges: many physicians are unaware of these benefits because insurance policies restrict use to obesity or diabetes, and the drugs are not marketed for micro‑dosing. Dr. Mok describes observed tachyphylaxis (rapid tolerance) at higher doses and proposes cycling (12‑week on/off) or micro‑dosing (lower dose every 1‑2 weeks) as strategies to maintain efficacy while minimizing side effects, noting the lack of formal studies due to limited commercial incentive. A patient anecdote illustrates how a rapid “quick win” in weight loss after breast‑cancer treatment boosted mental health and motivated lifestyle changes, underscoring the psychological impact of visible results. Finally, Dr. Mok outlines his clinic’s business model that blends cosmetic, wellness, and hormone‑replacement services, targeting an average patient age of 47.5, and emphasizes that improving appearance can reinforce adherence to health‑focused interventions. Throughout, the speakers stress the need for broader clinician education, insurance flexibility, and patient motivation to fully realize GLP‑1’s cardiovascular and quality‑of‑life benefits.
Chapters
Everybody says it's just a weight loss drug, it's just a weight loss drug. But you're saying that it is approved for cardiovascular use.
They found that people with diabetes who took GLP1 had less heart attacks and after three or four years probably get about one and a half years of additional lifespan. So it's significant. It's not trivial. You see things happening with people.
It's that little win, it's that little incentive that somebody can see the light at the end of the tunnel.
That's by no means a miracle, but it's the closest thing we've had foreign. We're getting studies now saying that somebody that's overweight, if they go on a GLP drug, they'll have less cardiovascular events. Enough that I got FDA approved for cardiovascular protection.
When I saw my doctor after I had gotten my blood work, because it was independent of him, he was not very well versed on the GLPs and what those cardiovascular benefits could be. And when you talk openly about GLP1, everybody says it's just a weight loss drug, it's just a weight loss drug. But you're saying that it is approved for cardiovascular use.
Yes, certain criteria. So let's talk like, why is your doctor not aware of it? Well, your doctor, generally speaking, works within the confines of what an insurance company dictates. And they're not going to approve microdosing at all, and certainly not for something other than obesity or overweight with comorbidities or diabetes. So when they did these trials, they found that people with diabetes who took GLP1 had less heart attacks. Then they said, what about people who are overweight with comorbidities or obese? They also have less cardiovascular risk. Probably after one year of use, get a certain number of months of health extension, and after three or four use, probably get about one and a half years of additional lifespan. So it's significant, it's not trivial. Significant reduction in cardiovascular events. When we're talking about microdosing, there's a couple ways to microdose it. One is to take a smaller dose, and the commercial available product does not have such a thing. So we sell it by a little bottle and you can draw it up yourself and you take a lower dose. The other thing that happens is your body gets its medical condition we call tachyphylaxis. So we've heard of anaphylaxis, allergic reaction, tachy rapid phylaxis. So tachyflaxis, where your body rapidly gets tolerant to the drug. Classic example, OPIOIDS okay, so you take a narcotic and take it for two months and all of a sudden it's not working anymore. You got to take more. And then if you stop the narcotic, it might take a month or two, but those phantom pains you had go away and they start working again. Now, it doesn't have the negative consequences with glp, but they have a rapid tachyphylaxis. And we look at the studies for semaglutide or tirzepatide, the maintenance dose was 10 times higher than the starting weight loss dose because of tolerance. So this led to the concept of can we cycle through it? We've been cycling people through it, going for 12 weeks, stop going. And you don't get that tachyphylaxis. And we discovered probably, I guess in 22, was that the women that were significantly overweight, that would have qualified for taking this all the time. They take their 12 or 13 weeks and then they'd just go on it periodically, a much lower dose, and they kept losing the weight, or they go on a second shorter cycle and lose the weight. This led to the idea about what about microdosing it? Because we see with the higher doses, you get the weight loss, but you also get the side effects. But if you keep that tolerance from happening, what happens? So when somebody takes their first dose of semaglutide, they'll generally notice a little lower appetite, a little less inflammation. If they have Crohn's disease, it might get a little better. If they have psoriasis, might get a little. All these autoimmune things get a little bit better. But then you need a higher and higher dose. Well, if you separate it out, if you take the starting dose and do it like every two or three weeks, you never get the tolerance that could be microdosing. The other way to microdose would be taking a smaller than starting dose every week. And they both kind of work as what's practical for you. I like the every other week because it's easy to draw it up that side, that way. But those are effective. And we don't have any studies on microdosing of semaglutide. So some based on some logic, and we call evidence based medicine, we see things happening with people, but there's no clinical studies and there's probably not any rationale for clinical studies. There's no money to be made by a drug company for it. You make a lower dose because that's
what a lot of people say. Well, there's no studies. Well, that doesn't mean there couldn't be studies done. It's just that people aren't necessarily doing them.
And we can use like sacritarian logic. So if a person that is obese takes a high dose of semaglutide, has a lower heart attack rate, the person that's normal weight, if they take low dose semaglutide and their labs get better, their lipids get better, their C reactive protein gets better, we know they're going to have a lower risk because we can actually stratify them. So that has occurred. We're seeing these things. But again, they're not going to do a double line rabbit control trial because there's not going to be a product made from it. We treat people that are not obese with tirzepatide because if we look at even like blood pressure, if you're saying optimal blood pressure is below 130 and below 85, well, it's better to be 120 over 70 and it's better be 11868. There's no question about that. This is proven that it's better to be lower. And there's certainly a point where it's too low, that's extraordinarily rare. Somebody's got a disease where it's too low. But you can't get too low of a blood pressure under normal circumstances. Okay, can you be too thin? Well, yeah, obviously, but in general you cannot. In fact, the only predictable way to extend life in every species is to undernourish it. Okay, this flies in the face of eating all this fricking protein. But I'm not an anti protein advocate, but I think it is leading to overeating if you try to get the recommendations from these people are suggesting. But people that fast or a little bit underweight live longer and people that are a little bit overweight, they have a lower short, you know, shortened lifespan.
I think that women need a quick win, some kind of a quick win. Well, here's an example. My best friend had had breast cancer. She had the estrogen blocker. She was gaining weight rapidly because she was in menopause and not able to treat it. Or so she didn't think. She, I don't know exactly what she gained, but it was a lot. She's a petite woman, she gained a lot and her mental state went right in the toilet along with it. She was, you know, she thought she was eating right, she was exercise or trying to exercise, but at some point she kind of just gave up. She would literally flat out just say, I'm miserable. And you could tell, like, it was almost rock bottom. She finally got her doctor to agree to put her on some form of semaglutide or tirzepatide, I don't know which. And within weeks, she was losing a little bit of weight. She was already starting to feel better mentally. So that prompted her to get into working out more, eating better, dressing better again, because now she was starting to feel good in her clothes again. It was like that little shift where she could see light at the end of the tunnel. That, to me, is why. Well, both HRT and peptide therapy, if it's appropriate, are two tools that can completely transform a woman's life.
We have a mission that we kind of do internally, and I'll talk about that. But outwardly, it's helping people look and feel better with less risk. That's really the core strategy of what we approach. And we have a cosmetic division and a wellness division, and we have some other businesses as well, like some plastic surgery. But our main goal is cosmetic and wellness, and they are the same people. Our average patient comes here is 47.5 years old, younger and older. And what I'm thinking about it from being in business is that we can add potential healthy years of lifespan to people's lives.
And it's kind of like, you look good doing it.
Look good doing it, right. And if you look good doing it, you're more motivated to keep it going is an outward thing. And it's kind of like that. You can lead a horse to water, but can't make her drink. So if we say, well, you have the opportunity to start hormone replacement therapy, now it's up to you to. To continue it and then to do the other things. Start going to the gym again, start having sex again, start being energetic again, start interacting with more people. So these all kind of tie together, and we're not really in the wellness space. We're working on coaching people on lifestyle. We don't do that. We do medical procedures. But it's the first step towards getting that life back the way you want it.
It's that little win. It's that little incentive that somebody can see the light at the end of the tunnel.
And the beautiful gift we've gotten recently is these GLP drugs. They are a gift. This is something that since 2016, every quarter, I worked on some innovation for obesity, and it was a struggle. And my thought was, if I gave myself enough time, this could be tackled. And then, boom, this new drug comes on the market, that's by no means a miracle, but it's the closest thing we've had. And the HRT, you know, I've been doing this since 2003, since the black. That's when we started our business. And the FDA admitting their mistake was just a gift because it gives us more ability to let our patients know that when their doctor says, well, that causes cancer, like, well, did you read the FDA said they made a mistake? It does not. It just changes the dialogue. And I think now it's really going to reverse 20 years of damage to women's health. It'll happen quick enough.
