Comparison guide. Reviewed by Alina McCann, MSN, APRN, AGNP. Updated October 13, 2026.
Tirzepatide produces more weight loss on average, about 20% against 15% in trials, and costs $490 a month to semaglutide's $375. Both are weekly injections with similar side effects. Here is how Alina decides between them.
Both are once-weekly injections that reduce appetite by acting on gut hormones, and both are prescribed and monitored inside our medical weight loss program. Semaglutide acts on one hormone receptor (GLP-1). Tirzepatide acts on two (GLP-1 and GIP), and in head-to-head trials that extra action translated into more weight lost. The price difference is $115 a month.
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| Semaglutide | Tirzepatide | |
|---|---|---|
| Our price | $375 per month up to 3 mg; $490 above | $490 per month |
| Brand names | Ozempic, Wegovy | Mounjaro, Zepbound |
| Mechanism | GLP-1 agonist | GLP-1 and GIP agonist |
| Average loss in trials | 14.9% at 68 weeks (STEP 1) | 20.9% at 72 weeks (SURMOUNT-1) |
| Head to head | 13.7% | 20.2% (SURMOUNT-5, 72 weeks) |
| Dosing | weekly, stepped up over months | weekly, stepped up over months |
| Common side effects | nausea, constipation, reflux | same; often milder in practice |
| Included | weekly visits, dose management, coaching | same |
Sources: Wilding et al., NEJM 2021; Jastreboff et al., NEJM 2022; Aronne et al., NEJM 2025.
The numbers above are averages from large trials at full dose, and real-world results are usually a little lower for both. The gap between them is consistent, though: tirzepatide patients lose roughly a third more. For someone with 20 pounds to lose, semaglutide is almost always enough. For someone with 60 or more, or with pre-diabetes, tirzepatide's extra effect and its stronger action on insulin sensitivity make a real difference.
The list is the same and the mechanism is the same: slower stomach emptying causes nausea, fullness and constipation, mostly in the first weeks of each dose step. In trials, discontinuation for side effects was similar. In our office, patients who felt rough on semaglutide have often done better on tirzepatide, which is why we let them try a month at the lower price. Both carry the same exclusions: thyroid C-cell tumour history, MEN2, pregnancy, prior pancreatitis.
Over six months, semaglutide at the base dose is $2,250 and tirzepatide is $2,940. Semaglutide patients who need more than 3 mg move to the $490 rate, at which point the drugs cost the same and tirzepatide is the better value. Neither is covered by insurance through us; CareCredit financing is available.
Semaglutide if you have a moderate amount to lose, want the lower monthly cost, or are new to GLP-1 medication and want to see how you tolerate it.
Tirzepatide if you have a larger goal, insulin resistance or pre-diabetes, a plateau on semaglutide, or side effects on semaglutide that have not settled.
Either way the program is the same: weekly visits with Alina, dose adjustments based on how you feel and what the scale says, and a maintenance plan before you stop. Start on the semaglutide or tirzepatide page, or book a consultation and let the labs decide.
Prices are our list prices as of October 13, 2026 and are shown in full on the price list. Trial figures are averages from the cited studies; individual results vary. This guide is written by the provider who performs the treatments, so it reflects what we offer as well as what we do not.
Most patients start on semaglutide because it costs less and the results are strong. Alina recommends tirzepatide first for patients with a lot of weight to lose, insulin resistance, or a history of poor tolerance of semaglutide.
Semaglutide is the active drug in Ozempic and Wegovy; tirzepatide is the drug in Mounjaro and Zepbound. We dispense compounded versions through a licensed pharmacy.
Yes. Eligible semaglutide patients can try tirzepatide for one month at the semaglutide price.
A once-weekly GLP-1 injection that lowers appetite and slows how fast your stomach empties, prescribed and monitored by Alina. $375 a month including weekly check-ins.
The medication in Mounjaro and Zepbound. A once-weekly injection acting on two gut hormones, with the strongest average weight loss of any current prescription. $490 a month supervised by Alina.
Lasting weight loss takes more than a prescription. At 4Ever Young STL MedSpa in Creve Coeur, MO, our medical weight loss program pairs proven medications with real support, so the results hold up over time.
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