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Patients on long-term corticosteroids may experience unpredictable appetite patterns, making it harder to gauge whether tirzepatide is working or whether steroid-driven hunger is overriding the medication's satiety effects

High homocysteine could also mean you have an MTHFR gene mutation, which makes you less efficient at converting inactive folate to the active form of folate that breaks down homocysteine

doi: 10.3389/fendo.2022.918899 68 XuZ

For people who cannot tolerate GI side effects or who have medical conditions that make GLP-1 agonists risky, this safety differential is not a minor footnote