Best Add-Ons to a GLP-1 Plan

The best add-ons to a GLP-1 plan like semaglutide or tirzepatide are enough protein and strength training two to three times a week. These drugs take muscle along with fat, and keeping that muscle is what leaves you lean and lifted instead of smaller and softer. Once those two are in place, choose your next add-on by what you see changing:

• If your skin looks looser or drier, ask about a retinoid such as tretinoin.
• If you're shedding, focus on nutrition and start a hair plan early.
• If nausea is stopping you from eating enough, switch to smaller meals and eat the protein first.

What should I add to my GLP-1 plan first?

Add protein and strength training first. A 2024 Obesity Reviews paper on muscle loss during GLP-1 treatment says everyone taking these drugs for weight loss should follow a program built on enough protein and resistance training to keep muscle mass and function.

In the large trials, people lost 10% or more of their muscle mass over 68 to 72 weeks. That's about what 20 years of aging would take. An analysis of lean mass on GLP-1 therapies found that about a quarter of the weight lost was lean mass. Semaglutide 2.4 mg and tirzepatide 15 mg weekly did the least to protect it. The drug takes the fat off, and your protein and lifting decide how much muscle you keep.

For a woman in her 30s, 40s or 50s, this decides whether you end up smaller or toned. Muscle gives your arms, legs and butt their shape, and age is already taking some of it.

One scan result is no reason to panic. A 2026 review on keeping muscle during GLP-1 treatment points out that lean mass loss on a DXA scan (the body composition scan used in these studies) isn't the same as clinically significant muscle loss. The goal is to keep your strength and your shape.

How much protein and strength training do I need on a GLP-1?

• Eat more than 1.2 grams of protein per kilogram of body weight a day. That's the target a global consensus group set for people on GLP-1 therapies, according to this review. For a 70 kg (154 lb) woman, that's a bit over 84 grams a day.
• Spread it out, at about 25 to 30 grams per meal. In a week-long feeding study, people ate about 25 to 30 g of protein at each of breakfast, lunch and dinner. Their muscle protein synthesis (how your body builds and repairs muscle) rose by 25% compared with a pattern that piled most of the protein into one meal.
• Use a shake when your appetite won't cooperate. Shakes and other nutrition supplements can help if you can't meet your protein needs from food. No current guidelines recommend protein beyond what you need, so a shake fills the gap. It isn't a bonus.
• Lift two to three times a week. The 2026 review recommends a minimum of two to three resistance sessions a week that work your major muscle groups. If you're training on your own while you get used to your dose, two sessions is more realistic and more likely to stick.
• Keep walking, but don't count it as lifting. During calorie cutting, resistance training and mixed training kept more lean mass than cardio alone. For holding on to muscle, the review says lifting can't be swapped for other exercise.
• Lifting can do more than slow the loss. In a small case series, three people on semaglutide or tirzepatide lifted 3 to 5 days a week. Two of them gained lean tissue (2.5% and 5.8%) while losing 26.8% and 13.2% of their body weight. The third lost lean tissue, 8.7% of her total weight loss.
• Make it part of your routine. One woman who lost 77.4 lbs over 16 months on Zepbound wrote in r/Zepbound that she had "Very few side effects and am very conscious of getting enough protein and drinking water."

Which GLP-1 add-on fits what I'm seeing change?

Start with the change that bothers you most. Ask your clinical team about the add-on in that row. The survey figures below come from adults in a telemedicine weight program who lost 10% to 20% of their body weight.

What can I do about my face, skin and hair on a GLP-1?

Sagging skin, a thinner face and shedding are common on these drugs, and they get more common the more weight you lose. In the same telemedicine survey, sagging skin, hair loss, lost facial volume and reduced strength all rose significantly as the share of weight lost went up.

About a quarter of respondents (24.1%) said their skin got worse, including dryness, wrinkles or fine lines. The authors think eating less protein and fewer micronutrients, because your appetite is lower, may play a part. So your protein habit helps your skin too.

For skin, the authors list several options:

• retinoids
• antioxidants
• micronutrient support
• hyaluronic acid microdepot injections (tiny filler-like deposits under the skin)
• energy-based procedures

Tretinoin is a prescription retinoid that you put on at home. Our clinical team can prescribe it if it fits your goal.

Shedding on a GLP-1 may be telogen effluvium, a temporary shed that can follow a big change to your body. Eating less can leave you short on nutrients, and that may speed up the hair loss. The authors say the shedding may be temporary with enough nutrition, so tell your clinical team as soon as you notice it instead of waiting it out alone. Hot or Nothing's hair plans include minoxidil and GHK-Cu copper peptide, and your clinical team can tell you whether either fits.

It's easier to plan for this from the start than to react once you see it. The survey authors say that spotting likely skin changes early lets clinicians start skincare, hair growth and muscle-building routines before the changes show up.

What if nausea makes it hard to eat enough protein on a GLP-1?

Nausea, constipation and diarrhea are the most common side effects, and they're a leading reason people stop. These steps help:

• Raise your dose gradually.
• Eat about 14 grams of fiber for every 1,000 calories.
• Drink more than 2 to 3 liters of fluid a day.

When your appetite is small, eat the protein on your plate first, so the part that protects your muscle gets eaten before you feel full. The 2026 review lists protein-first meals among the practical ways to keep your protein, energy and fluids up while your stomach is acting up.

If side effects keep getting worse instead of settling, tell your clinical team rather than pushing through. They can change how quickly your dose goes up and, when needed, prescribe short-term anti-nausea medicine so you can keep eating enough to protect your muscle.

You want to finish your GLP-1 plan leaner and more toned, not only smaller. Take the quiz so your clinical team can build a plan around your weight goal and the changes you most want to protect against, like your skin, hair or strength.