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August 18, 2026 · Side-by-side comparison authority

Semaglutide vs Tirzepatide: Direct Efficacy Comparison from SURPASS-2

SURPASS-2 was the definitive head-to-head randomized trial comparing tirzepatide to semaglutide in adults with type 2 diabetes. The results have shaped molecule-choice conversations ever since. Here's what the data showed and how to read it.

The Trial Design

SURPASS-2 randomized adults with type 2 diabetes to tirzepatide at multiple doses (5, 10, 15 mg weekly) or semaglutide at 1 mg weekly (the maintenance dose commonly used for glycemic control in T2D at the time of trial design). Primary endpoint was change in HbA1c at 40 weeks; secondary endpoints included body weight change and other cardiometabolic markers.

The Efficacy Results

EndpointSemaglutide 1mgTirzepatide 5/10/15mg
HbA1c reduction-1.9%-2.0 to -2.3%
Weight reduction-5.7 kg-7.6 to -11.2 kg
Percentage at HbA1c <7%~79%~82-86%
Trial duration40 weeks40 weeks

Telos Rx

Compounded tirzepatide

Compounded tirzepatide via direct pharmacy.

  • Compounded tirzepatide
  • Direct-link intake
  • Verify pricing
FDA note: Compounded GLP-1 medications are not FDA-approved. Personalization must be based on a documented clinical need per current FDA guidance.
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Embody

Injectable semaglutide, $400 CPA tier

Injectable semaglutide only — lead compounded option.

  • Injectable semaglutide focus
  • Standard titration
  • Direct pharmacy shipping
FDA note: Compounded GLP-1 medications are not FDA-approved. Personalization must be based on a documented clinical need per current FDA guidance.
Check Latest Pricing

How to Read the Comparison

Two important context notes. First, semaglutide's 1 mg dose is the diabetes maintenance dose; the weight-management indication uses higher doses (2.4 mg in Wegovy). A comparison at higher semaglutide doses would narrow the weight-loss gap. Second, individual response varies enormously — some patients on semaglutide lose more than some patients on tirzepatide.

At the population level, tirzepatide's advantage on both glycemic control and weight is real. At the individual level, molecule choice depends on the person, not the trial averages.

Wellorithm

Sema ~$147/mo, tirz ~$249/mo

Compounded GLP-1 with dose-tier pricing.

  • Sema and tirz options
  • Tier pricing by dose
  • Verify at intake
FDA note: Compounded GLP-1 medications are not FDA-approved. Personalization must be based on a documented clinical need per current FDA guidance.
Check Latest Pricing

MadeMed

Compounded GLP-1 options

Independent compounder — sema, tirz, and oral formats.

  • Compounded sema/tirz
  • Oral tirz $167-229
  • Direct pharmacy fulfillment
FDA note: Compounded GLP-1 medications are not FDA-approved. Personalization must be based on a documented clinical need per current FDA guidance.
Check Latest Pricing

What This Means for Molecule Choice

SURPASS-2 supports tirzepatide as generally more potent than semaglutide at the doses compared. For patients where maximum weight loss or glycemic control is the priority, this is one input into the choice. For patients where cost, tolerability, or specific comorbid conditions (CV or kidney with more mature semaglutide evidence) matter more, semaglutide remains fully defensible.

Oak Weight Loss

GLP-1 program

Telehealth program with compounded GLP-1 access.

  • Compounded GLP-1
  • Standard intake
  • Membership pricing
FDA note: Compounded GLP-1 medications are not FDA-approved. Personalization must be based on a documented clinical need per current FDA guidance.
Check Latest Pricing

The Practical Question

Neither medication is universally "better." Both are highly effective at what they do. The molecule choice depends on your specific clinical picture, insurance coverage, cost sensitivity, and prescriber recommendation. SURPASS-2 informs the conversation; it doesn't decide it for any individual patient.

Sesame Care

Brand-name pathways

Marketplace for brand-name FDA-approved GLP-1 only.

  • Brand-name only
  • Direct consult marketplace
  • Cash-pay clarity
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Found Health

$100 off promo

Brand-name GLP-1 access with coaching layer.

  • Brand-name focus
  • Coaching + accountability
  • Insurance-coordinated
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Where to Start

Embody

Injectable semaglutide, $400 CPA tier

Injectable semaglutide only — lead compounded option.

  • Injectable semaglutide focus
  • Standard titration
  • Direct pharmacy shipping
FDA note: Compounded GLP-1 medications are not FDA-approved. Personalization must be based on a documented clinical need per current FDA guidance.
Check Latest Pricing

Wellorithm

Sema ~$147/mo, tirz ~$249/mo

Compounded GLP-1 with dose-tier pricing.

  • Sema and tirz options
  • Tier pricing by dose
  • Verify at intake
FDA note: Compounded GLP-1 medications are not FDA-approved. Personalization must be based on a documented clinical need per current FDA guidance.
Check Latest Pricing

MadeMed

Compounded GLP-1 options

Independent compounder — sema, tirz, and oral formats.

  • Compounded sema/tirz
  • Oral tirz $167-229
  • Direct pharmacy fulfillment
FDA note: Compounded GLP-1 medications are not FDA-approved. Personalization must be based on a documented clinical need per current FDA guidance.
Check Latest Pricing
Medical & editorial disclaimer. This article is for informational purposes only and is not medical advice. GLP-1 medications require prescriber evaluation. Compounded GLP-1 medications are not FDA-approved. Talk to a licensed clinician before starting, stopping, or changing any prescription. Provider pricing, availability, and program terms change frequently — verify current details on each provider's site before making a decision. Some links are affiliate links, which means we may earn a commission if you sign up; this does not change our recommendations or the price you pay.