How do I taper off a GLP-1 instead of stopping cold?

First, the honest disclosure: tapering is consensus practice, not trial-validated — the withdrawal studies stopped people abruptly, and no RCT has compared taper curves. What follows is how prescribers commonly structure it and why the logic holds. A representative descent (your prescriber’s version will vary): 1. From maintenance dose, drop one ladder rung (e.g., Zepbound 10 → 7.5 mg; Wegovy 2.4 → 1.7 mg). 2. Hold 4–8 weeks. Watch weight weekly and appetite honestly — the return of food noise is the leading indicator, arriving before the scale moves. 3. Stable? Drop another rung. Climbing appetite or +3–5 lbs? This rung is your answer — you’ve found your maintenance floor; stay or step back up. 4. Below the lowest pen dose, options are stretching intervals (weekly → every 10–14 days) or compounded fractional doses — the microdose lane exists substantially for this descent. 5. Pre-commit the resume trigger before you start: a written rule (“regain ≥5% of body weight or two straight months of climb → restart”) beats in-the-moment negotiation with returning appetite, which is a negotiation appetite usually wins. Stack the deck before descending: the protein floor and resistance habit should be 6+ months old, not started the week you taper; weight should be stable at goal for a few months; and life should be boring — don’t taper into a stressful season. People who taper successfully tend to be the ones who treated the loss phase as habit school. Why bother, versus cold stop? Pharmacologically the drugs self-taper over 4–5 weeks of half-lives anyway — but the behavioral difference is real: a structured descent with checkpoints catches regain at 4 lbs instead of 40, converts “quitting” into “finding my minimum effective dose,” and keeps the restart decision clinical rather than shameful. The most common good outcome of a taper isn’t zero drug — it’s discovering that a low dose holds everything, at a fraction of the cost.