GLP-1 pills vs. injections — which should I choose?

The current needle-free menu, ranked by evidence: 1. Rybelsus (oral semaglutide) — FDA-approved, swallowed daily. Solid diabetes drug; modest weight loss (≈3–5 kg) at approved doses. Requires a strict ritual: fasting, ≤4 oz water, 30 minutes before anything else. A higher-dose obesity version (25 mg, ≈15% loss in OASIS 4) is under regulatory review — the pill story improves soon. Full profile. 2. Compounded sublingual semaglutide or tirzepatide — rapid-dissolve tablets under the tongue, typically weekly, available through a few telehealth programs (NexLife has the broadest sublingual menu). Not FDA-approved, no randomized trials; real-world response exists but is less predictable (does sublingual work?). The honest niche: needle-averse patients who would otherwise take nothing. 3. Orforglipron (pipeline) — a daily non-peptide pill with ≈12% loss in phase 3 and no fasting ritual; potentially the convenience breakthrough when approved. Why injections still dominate: a weekly subcutaneous shot with a 4–5 mm needle is nearly painless, takes ten seconds, and delivers the full trial-proven dose with predictable absorption. Most needle-anxious patients report the fear outlasting reality by exactly one injection (technique guide). Decision shortcut: want maximum, proven results → injection. Have diabetes and hate needles → Rybelsus. No diabetes, absolute needle refusal, accept thinner evidence → sublingual from a well-vetted program. Can wait a year → the pill landscape is about to get better.