Before the Needle

Read This First

Millions of people are already injecting these drugs. Your colleague, your cousin, the woman at the school gate who suddenly looks like a different person. Some got a prescription after a long talk with a doctor. Some filled in a five-minute form online. Some bought a pen from a friend who had a spare. This book assumes you might be next, and it tells you everything the advert, the before-and-after photo and the group chat leave out.

What this book is

This is a harm-reduction book. That means three things.

We don't judge the decision. The pressure to lose weight is real, the health reasons are often real, and these drugs really do work for a lot of people. You'll read that plainly in the first chapter.

We don't soften the consequences. If something can put you in hospital, we say so, we say how often when anyone has counted, and we tell you what it feels like before it gets bad.

We assume you're an adult who may go ahead. So instead of only saying "don't", we tell you which route carries the least risk, what to ask before you start, and the exact signs that mean you stop reading and go to an emergency department.

The book covers semaglutide (sold as Ozempic, Wegovy and Rybelsus), tirzepatide (sold as Mounjaro and Zepbound) and the older daily drug liraglutide (Saxenda), in pens, vials and pills, from pharmacies, compounding pharmacies, online clinics and places that are none of those.

What this book is not

• It is not medical advice. It can't examine you, read your blood results or know your history. Use it to prepare for a conversation with a clinician who can.
• It is not a prescription or a dosing guide. You will not find doses to follow, ways to split a pen, ways to convert "units", or how to mix a powder. When we quote a dose, it is quoted from the official label only to explain a risk.
• It is not a shopping guide. No sellers, no websites, no discount codes. We tell you how to recognise a fake, not where to find a real one.
• MediQuestAI does not prescribe, sell or dispense any medicine. The link at the back of this book helps you get your history in order before you see a clinician. That's all it does.

Ozempic®, Wegovy®, Rybelsus® and Saxenda® are trademarks of Novo Nordisk A/S. Mounjaro® and Zepbound® are trademarks of Eli Lilly and Company. This book is not affiliated with, sponsored or endorsed by either company. Brand names are used only so you can recognise what you are holding.

About the stories

Where a chapter opens with a real event (a regulator's warning, a court case, a published case report), we say so and cite the source. Everything else is labelled as a composite.

Some stories are composites; names and details are changed. No composite in this book contains a real patient's words, a real clinic's name or a statistic. The numbers live in the main text, with a source for each one.

Danger now?

If you or someone you're with is on one of these drugs and has severe belly pain spreading to the back, pain under the right ribs with fever or yellow eyes, can't keep fluids down, is shaky and confused, has a swelling face or throat, has suddenly lost vision in one eye, or is struggling to breathe after a procedure: stop reading. Call your local emergency number (911 in the US, 999 or 112 in the UK, 999 or 112 in Kenya) or go to the nearest emergency department.

The full list is on the Go Now Card at the back of this book. Photograph it now.

How to read this book

You don't have to read it in order. Here's the map.

• Chapters 1 and 2 explain why everyone seems to be on these drugs and what they actually do in your body. Start here if you're new to all of it.
• Chapters 3 and 4 are the core of the book. The side effects almost everyone gets, and the serious ones that send people to hospital. If you read nothing else, read these two.
• Chapters 5 to 10 cover special situations. Read the ones that apply to you, in any order: muscle and "Ozempic face" (5), eating enough (6), surgery and anaesthesia (7), pregnancy and contraception (8), fake and compounded pens (9), and who should not take these drugs at all (10).
• Chapter 11 is about stopping. Read it before you start, not after.
• Chapter 12 is the decision. It turns everything into a set of questions for your prescriber and a one-page Before-You-Start Card.

At the back you'll find the Go Now Card, the Before-You-Start Card, a glossary and the full list of sources.

Where are you right now?

Tick the one that fits. It tells you where to start.

• I'm deciding. Read chapters 1 to 4, then 10, then 12.
• I'm already on it. Go straight to chapters 3 and 4, then 7 if you have any procedure coming up, and 11.
• I'm getting it from somewhere other than a regular pharmacy (compounded, online, a friend, a salon, abroad). Read chapter 9 today, then chapters 3 and 4.
• I'm supporting someone who's on it. Read chapters 3 and 4 and photograph the Go Now Card. You may be the one who notices first.

About this book

This book is educational. It is not medical advice, and it is not a substitute for a clinician who knows your history. If you have warning signs now, use the Go Now card or call your local emergency number. For everything else, take the questions in this book to a doctor, nurse or pharmacist.

*Facts in this book were checked against sources available in October

1. Drug approvals, safety warnings and the rules on compounded drugs change often. Check the date on any warning before you rely on it.*

Why Everyone's On It

It's eleven at night, eight weeks before her sister's wedding, and Tasha is lying in bed scrolling. Her cousin has posted a photo: the same green dress from last Christmas, hanging off her now. The caption says "No gym, no starving, just the jab." Forty people have commented. Half of them are asking where she got it.

Tasha is 34. She has tried the apps, the shakes, the 5 a.m. runs that lasted nine days. She has a bridesmaid fitting in a fortnight and a dress that was ordered a size smaller "for motivation". She opens WhatsApp and types to her cousin: Is it really that easy?

The reply comes in under a minute. Honestly yes. My friend's got a spare pen, she's going up a dose. Want it?

Tasha looks at the message for a long time. It's the same stuff doctors prescribe, she thinks. Everyone's on it. What's the worst that can happen?

Tasha is a composite. Names and details are changed.

Here is what Tasha doesn't know, and what this chapter and this book are about. The pen her cousin's friend is offering is real medicine, made to be used in a very particular way: started low, stepped up slowly, with someone watching for the side effects that can turn serious. The headline results she has seen came from people who had all of that. A spare pen passed across a table has none of it.