From the DC Dermatology Skin Truths Podcast, Ep. 1, Pt. 1: GLP-1s & Your Skin, with endocrinologist Dr. Lindsey VanDyke and dermatologist Dr. Dinh.
GLP-1 medications like Ozempic, Wegovy, and Mounjaro are everywhere right now. They’re on TikTok, in your group chat, and in the before-and-after photos of people you haven’t seen in a year. What’s harder to find is a straight conversation about what these drugs actually do to your body beyond the number on the scale, starting with the muscle you can lose.
That’s what the first episode of the DC Dermatology Skin Truths Podcast set out to fix. Dermatologist Dr. Dinh sat down with Dr. Lindsey VanDyke, a physician double board-certified in internal medicine and endocrinology and the owner of the Advanced Institute for Diabetes and Endocrinology in Texas, to walk through the part of the GLP-1 story most patients never hear: the muscle you lose, the plateaus that blindside you, the changes in your skin and hair, and what happens when you stop.
Here’s some of what they covered. The full episode is worth your time, and you’ll find it at the end.
What GLP-1 medications actually are
GLP-1, short for glucagon-like peptide-1, has been used in diabetes care for just over two decades. In the last five or six years it moved into weight loss and other metabolic conditions like fatty liver and sleep apnea. And weight loss isn’t an off-label workaround, Dr. VanDyke is quick to point out. The FDA has approved agents specifically for it. The drugs work. The question is what you do with them.
Do GLP-1s cause muscle loss?
Yes, and this is the line that reframes the whole conversation. When you lose weight fast, a real chunk of what comes off isn’t fat.
“It doesn’t matter how you’re losing weight, whether you’re on an intensive lifestyle regimen, using medications like these, or having bariatric surgery. Up to 35% of the weight that’s lost can be lean mass. And that’s a problem, because your muscle is your largest metabolic organ.” — Dr. VanDyke
Her goal with every patient is the opposite of what the scale rewards. “I don’t want you losing weight, I want you losing fat,” she says. “The muscle we want to keep, because that’s how we age well and remain functional.”
How much protein you need on a GLP-1
Protecting muscle isn’t a vibe. It’s a number. Dr. VanDyke uses body composition analysis to measure how much lean mass a patient actually carries, then sets the target from there.
“We need to find out what you’re made of. Once we know what you’re made of, we can make meaningful decisions about the calorie load, the protein target, and so on.” — Dr. VanDyke
Her rule, outside of kidney disease, is roughly one gram of protein per pound of lean mass per day. For her own body that’s about 95 grams, and she’s honest that it’s a lot of food to hit without a plan.
She frames the whole effort as a toolbox. Medication is one tool. Dietary counseling is another. Exercise is another. And exercise isn’t optional.
“You can’t do this without exercise. That’s fundamentally part of the metabolic plan. If you’re not exercising, your brain decides you don’t need that muscle around, so it starts offloading your lean mass.” — Dr. VanDyke
The kind of exercise matters too. She’s not talking about a casual set of light reps. “You’re lifting to exhaustion, because that’s what it takes to make the body build new muscle fibers.” As a practical floor, most muscle-preservation plans call for resistance training at least two to three times a week, and for protecting muscle, that strength work matters more than cardio.
Hitting a protein target that high takes planning, especially when the medication is suppressing your appetite. On the episode, the doctors walk through the practical side: lean whole-food protein like chicken, turkey, eggs, and fish, plus a protein shake to lock in breakfast. Dr. VanDyke gets 30 to 40 grams that way before lunch. One dermatology caveat from Dr. Dinh: whey protein can trigger acne in some people, so if you break out, switching to a pea-protein option is an easy fix.
Why the weight stalls: your body’s “panic mode”
One of the most useful parts of the episode explains a frustration almost every patient eventually hits. The plateau. You haven’t changed a thing, and the weight stops moving. Dr. VanDyke’s answer is that your body got smarter.
“You were issued a body designed to be maximally efficient under starvation conditions. The part of your brain that regulates energy balance is in the most primitive portion, the hypothalamus, the reptilian part of the brain. It’s very sensitive, but it’s not smart. It doesn’t know you might be doing this on purpose.” — Dr. VanDyke
Lose weight too fast, drop a threshold amount of about 20 pounds, or run nutritionally deficient, and that primitive brain flips into panic mode. It lowers your heart rate, drops your core temperature, drains your motivation, and starts shedding the most metabolically expensive tissue you have, which is your muscle. Less muscle means a slower metabolism, which is exactly why the weight stalls.
It’s also why she pushes back hard on rapid loss and an appetite that shuts off completely. “These are powerful meds, make no mistake. It’s easy to just shut off the appetite, and that’s not okay. You’re supposed to have hunger and satiety throughout the day.” The old gold standard still holds: one to two pounds a week.
“Ozempic face” and hair loss: what GLP-1s do to your skin
This is where the dermatologist’s chair comes in, and where the episode earns its title. Fast weight loss doesn’t just change your body. It shows up in the mirror, and it has a nickname: “Ozempic face.”
Dr. Dinh describes patients who’ve lost a lot of weight, feel great, then catch their reflection and feel like they’ve aged ten years. The skin looks dull and dehydrated, the firmness is gone, and the face looks gaunt and hollow because fat loss is diffuse and shows up there first. Her advice for the skin runs from retinoids that rebuild collagen over time to in-office options like microneedling and radiofrequency, with filler, fat transfer, or biostimulators for lost volume. Severe sagging is the one case where she sends patients to a plastic surgeon. None of it is instant, which is one more reason to lose at a sustainable pace.
Then there’s the hair. Ozempic hair loss is real, and rapid weight loss is the reason: it’s a physical stress, and the body responds by shedding. It has a clinical name, telogen effluvium, the same shed you see postpartum, after a severe illness, or after COVID. It can last six months to a year, and the good news is that it’s temporary. Once your weight and nutrition stabilize, the hair grows back.
Why GLP-1 muscle loss hits women harder
Muscle loss isn’t only a GLP-1 problem. It’s an aging problem, and it lands harder on women moving through their forties and fifties. The clinical name is sarcopenia.
“It’s the age-related wasting of muscle fibers. The fibers get thinner, and then there are fewer of them. And remember, that’s our metabolism. Starting in our thirties, it begins to waste away our caloric expenditure.” — Dr. VanDyke
As lean mass quietly drops, fat mass starts to creep up. You get away with it for a while. Then comes the tipping point: nothing in your routine changed, but suddenly you look different and you’re frustrated. Her advice is to stop trusting the scale and start trusting the tape.
“The money’s in the measurements. I don’t really care what the scale says. Muscle’s heavy. You can have a scale that barely changes, but if you’re building lean mass, your measurements are going to move.” — Dr. VanDyke
Will you gain the weight back if you stop a GLP-1?
If there’s one idea the episode wants to retire, it’s that you can take a GLP-1 for a few months, look great for an event, and stop. Dr. VanDyke treats obesity as a chronic condition, and she compares it to others.
“If you’ve got high blood pressure and you treat it, then take the med away, it goes back to baseline. High cholesterol, same thing. Weight is the same. We’re altering metabolic processes here.” — Dr. VanDyke
The data is sobering. About two-thirds to three-quarters of patients who stop the medication regain most of the weight they lost within roughly the first six months, and because the brain has gotten more efficient, some end up heavier than they started. “We always talk about medical management of obesity as a lifelong decision,” she says. The dose can change. The commitment usually doesn’t.
A prescription is not a plan
Running through the whole conversation is one conviction: the medication is the easy part, and the care around it is what actually works.
“It’s a great disservice to patients for there to be an internet pop-up online form to fill out, get your med delivered to your house, and then, okay, go forth in the world and lose weight.” — Dr. VanDyke
Her practice does the opposite. “We only do comprehensive weight management. I never just say, sure, take this med and I’ll see you in six months.” That means a full lab workup at the start to find what’s driving fat gain, body composition tracking, a protein and training plan built around real numbers, and consistent follow-up to catch problems before they turn into symptoms.
In practice, the monitoring has two jobs. The first is body composition, repeated on intervals, through a DEXA scan or similar body composition test, so you can see whether you’re losing fat or losing muscle, instead of guessing from the bathroom scale. The second is bloodwork. When appetite drops and you eat less, it’s easy to fall short on protein and on micronutrients, and a few deficiencies tend to show up: iron and the nutritional anemia that follows, vitamin B12, and vitamin D. None of that is visible from the outside. As Dr. VanDyke puts it, you won’t know until someone checks, which is the whole argument for follow-up over a refill.
Frequently asked questions
Do GLP-1s like Ozempic cause muscle loss?
They can. Up to 35% of the weight lost during any rapid weight loss, including on a GLP-1, can be lean muscle mass. Adequate protein and resistance training are what protect it.
How do you prevent muscle loss on a GLP-1?
Three things, consistently: eat enough protein, do resistance training at least two to three times a week, and track body composition on a regular cadence so muscle loss gets caught early instead of a year too late. Dr. VanDyke targets about one gram of protein per pound of lean mass per day. Losing at one to two pounds a week, rather than crash speed, protects muscle too.
What is “Ozempic face”?
It’s the gaunt, hollow, aged look some people get after fast weight loss on a GLP-1. Fat loss is diffuse and tends to show in the face first. Dermatologists address it with collagen-building treatments like retinoids, microneedling, radiofrequency, and volume replacement.
How much protein should I eat on a GLP-1?
Dr. VanDyke’s rule of thumb, outside of kidney disease, is about one gram of protein per pound of lean body mass per day, set using a body composition analysis.
Will I regain the weight if I stop a GLP-1?
Usually, yes. Studies show about two-thirds to three-quarters of patients regain most of the weight within roughly six months of stopping, sometimes more than they started with, which is why obesity is managed as a chronic condition.
Watch the full episode
This article only scratches the surface. The full conversation between Dr. Dinh and Dr. VanDyke goes deeper on protein sources, the acne risk with certain protein powders, lab monitoring, and the questions patients bring in every week.
Watch DC Dermatology Skin Truths Podcast, Ep. 1, Pt. 1: GLP-1s & Your Skin on YouTube (@DCDermFV)
Listen to the episode on Spotify
If you’re considering a GLP-1, or you’re already on one and want to be sure you’re doing it the right way, start here.
Part 2, where Dr. VanDyke answers patient questions on side effects and how to minimize them, is coming soon.
About Dr. Lindsey VanDyke
Dr. VanDyke is double board-certified in internal medicine and endocrinology and owns the Advanced Institute for Diabetes and Endocrinology. She sees patients in Mansfield, Texas, and via telehealth across seven states, including California. Learn more about the practice’s comprehensive weight management and diabetes care programs, or schedule a visit.
This content is for educational and informational purposes only. It is not a substitute for medical advice, diagnosis, or treatment from your own healthcare provider.