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While the two-hit model has been influential, there are likely multiple parallel and interacting factors leading to the disease, including genetic predisposition, gut microbiome alterations, and various metabolic, inflammatory, and fibrotic pathways

Estrogen Amplifies the Drug: Estrogen upregulates GLP-1 receptors and boosts your bodys own GLP-1 production, so menopause directly weakens the drugs effect

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The higher TMAO precursor trimethyl lysine (TML)-derived N, N, N-trimethyl-5-aminovaleric acid (TMAVA) synthesis by the gut microbiota was linked to a progressive reduction in fatty acid oxidation (104)

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This highlights that GLP-1RA treatment must be continuous, along with a healthy lifestyle