How is Healthy You Endocrinology and Weight Loss different from a traditional endocrinology practice?

Healthy You operates on a Direct Care model without the constraints of insurance billing. This allows Dr. Borensztein to take on a smaller patient panel, offering same-week appointments, longer visits (60–90 minutes for new patients), transparent pricing, and direct access to the doctor between visits. There are no surprise bills — all costs are listed upfront and HSA/FSA payments are accepted.

Does Healthy You accept Medicare or Medicaid?

Healthy You accepts select Medicare and Medicare Advantage plans on a limited basis. Medicaid is not accepted. Medicare and Medicaid patients cannot enroll in the membership program. Please call the office at 856-559-7616 for current availability.

How quickly can a new patient get an appointment?

New patients can typically be seen within the same week, often the same day or the next day. Patients are encouraged to gather their health records before their appointment to make the most of their visit.

Can I be reimbursed by my insurance for visits at Healthy You?

If your insurance plan includes out-of-network coverage, you may be able to submit a superbill (which the practice will provide) for reimbursement. Reimbursement is not guaranteed. HSA and FSA funds can also be used to pay for visits. Contact your insurance company to confirm your out-of-network benefits.

Can I still use my insurance for labs, imaging, and prescriptions?

Yes, in most cases you can use your insurance for labs, imaging, and prescriptions ordered by Dr. Borensztein. In rare instances, insurance may deny payment for testing ordered by an out-of-network provider. If you are concerned, it is best to check with your insurance company directly.

What is included in the Healthy You membership?

The Weight Loss and Endocrine Memberships include unlimited in-person and telemedicine visits, direct text access to Dr. Borensztein, prior authorization support, letters and forms, and communication with other medical offices. Weight Loss members also receive monthly body composition analysis and access to a members-only site with recipes, workouts, and blog posts. Memberships start at $125/month for Endocrine and $200/month for Weight Loss.

What ages does Healthy You treat?

Healthy You typically sees patients age 16 and older. For patients under 18, it is recommended to call the office first at 856-559-7616 to confirm that the appropriate care can be provided.

What conditions does Dr. Borensztein treat?

Dr. Borensztein treats the full spectrum of endocrine conditions including hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, Graves' disease, thyroid nodules, Type 1 and Type 2 diabetes, prediabetes, insulin resistance, PCOS, menopause and perimenopause, hormone replacement therapy (HRT), adrenal disorders (Cushing's syndrome, adrenal insufficiency), pituitary disorders, osteoporosis, hyperparathyroidism, and medical weight loss with GLP-1 medications such as Wegovy, Zepbound, and Ozempic.

Does Healthy You offer telemedicine appointments?

Yes. Telemedicine visits are available for established patients located in New Jersey or Pennsylvania. New patient first visits are required to be in person at the Collingswood, NJ office.

Where is Healthy You Endocrinology located?

Healthy You Endocrinology and Weight Loss is located at 900 Haddon Avenue, Suite 409, Collingswood, NJ 08108 — just outside of Philadelphia. There is onsite parking and the PATCO station is nearby. Call 856-559-7616 or email info@healthyyouendo.com.

Your Roadmap When Semaglutide Isn't Working

Jun 1

Written By Alejandra Borensztein

A step-by-step clinical approach — including when to consider tirzepatide

By Dr. Alejandra Borensztein, MD, DABOM, MSCP | healthyyouendo.com

Last week, we covered the biology behind variable semaglutide response — why genetics, hormones, sleep, stress, and dosing all shape your results, and why a limited response is never simply a matter of trying harder.

This week: what to actually do about it. Here's the systematic, evidence-based approach we use at Healthy You when semaglutide isn't delivering the results a patient deserves.

Step 1: Rule Out Treatable Underlying Causes

Before assuming the medication has failed, we make sure nothing is working against it. Several common and frequently overlooked conditions can blunt weight loss response:

Thyroid Evaluation

• TSH, free T4, free T3, and TPO antibodies

• Even a TSH at the high end of "normal" can slow metabolism meaningfully

• Hashimoto's patients may benefit from T3 optimization even with adequate T4 levels

Insulin Resistance Assessment

• Fasting insulin and glucose to calculate HOMA-IR, C peptide check

• Significant insulin resistance may require direct treatment alongside GLP-1 therapy

• Consider adding metformin in patients with PCOS, prediabetes, or metabolic syndrome

Sex Hormone Evaluation

• In women: estradiol, FSH, progesterone, testosterone, SHBG

• Perimenopause and menopause create a metabolic environment that often requires HRT alongside weight loss treatment

• In men: total and free testosterone — low T significantly impairs fat loss and muscle preservation

Cortisol if Clinically Indicated

• Late night salivary cortisol, dexamethasone suppression test or 24-hour urinary free cortisol if Cushing's is suspected

• Even functional hypercortisolism from chronic stress can act as a pharmacological barrier

Sleep Assessment

• Screen for obstructive sleep apnea — undertreated OSA elevates cortisol and ghrelin chronically

• Address insomnia: poor sleep quality impairs the appetite regulation that GLP-1 medications rely on

Step 2: Optimize the Dose

This sounds obvious, but it's frequently skipped. Many patients on semaglutide are not on the highest tolerated dose — and the dose-response relationship is real.

• Target dose for weight loss is 2.4 mg weekly (Wegovy) — not 0.5 mg or 1 mg

• If GI side effects have prevented titration, manage them aggressively rather than accepting a subtherapeutic dose

• Slower titration schedules are clinically valid — the goal is reaching the therapeutic dose, even if it takes longer

• Consistent injection timing and proper technique matter; variable absorption is a real phenomenon

If you've been on semaglutide for 3–6 months at a dose below 2.4 mg, dose optimization may produce meaningful additional results before any medication change is needed.

Step 3: Address the Behavioral Levers

GLP-1 medications work through appetite suppression — but they work best when paired with intentional nutritional and lifestyle structure. These aren't lifestyle lectures; they're pharmacological amplifiers.

Protein Intake

Targeting a minimum of 100–130g of protein daily preserves lean muscle mass during caloric deficit. Without adequate protein, weight loss on GLP-1 medications can disproportionately come from muscle — which lowers resting metabolic rate and makes long-term maintenance harder.

Resistance Training

Two to three sessions per week of resistance training protects muscle mass, improves insulin sensitivity, and supports metabolic rate during active weight loss. It's not optional for optimal long-term outcomes.

Sleep Prioritization

Targeting 7–8 hours of quality sleep per night is not a lifestyle suggestion — it's a metabolic intervention. Treat insomnia as a clinical problem, not a personal failing.

Stress and Cortisol

Chronic psychosocial stress is a real pharmacological barrier. Behavioral approaches, therapy, or stress reduction strategies are legitimately part of a comprehensive weight management plan — not soft add-ons.

Step 4: Evaluate Medication Optimization — Including Tirzepatide

When to Consider a Switch

If you've completed Steps 1–3 and remain below your treatment goals after 12–16 weeks at an optimized semaglutide dose, a medication change is a clinically appropriate next step — not a last resort.

A switch to tirzepatide may be indicated when:

• Weight loss is less than 5% of body weight after 12–16 weeks at the highest tolerated semaglutide dose

• You've plateaued well below your goal despite dose optimization

• You have significant insulin resistance, type 2 diabetes, or PCOS — conditions where the GIP mechanism offers additional metabolic benefit

• You're in perimenopause or menopause, where the metabolic environment may require a more potent pharmacological approach

• Your clinical goals require greater total weight loss

Why Tirzepatide Is More Than "Stronger Semaglutide"

Tirzepatide (Mounjaro for diabetes, Zepbound for obesity) is a dual GIP/GLP-1 receptor agonist. Where semaglutide activates only the GLP-1 receptor, tirzepatide simultaneously activates the GIP (glucose-dependent insulinotropic polypeptide) receptor — a distinct pathway with additive effects on appetite, insulin sensitivity, and fat metabolism.

Tirzepatide doesn't just add more of the same signal — it works through a second mechanism that appears to have synergistic effects. That's why the outcomes look different, not just incrementally better.

What the SURMOUNT Trials Show

In the SURMOUNT-1 trial, tirzepatide at 15 mg produced an average weight loss of 22.5% of body weight — meaningfully greater than the ~15% seen with semaglutide in STEP 1. The response distribution also shifted significantly:

• More than 1 in 3 participants lost over 25% of their body weight

• A substantial subset approached or exceeded 30%

Head-to-head data from the SURPASS trials and real-world analyses consistently show tirzepatide producing greater weight loss than semaglutide — including in patients who had a limited response to semaglutide.

What to Expect in the Transition

Switching from semaglutide to tirzepatide does not require a washout period and is generally well-tolerated. Most patients start at the lowest tirzepatide dose (2.5 mg) and titrate based on tolerability and response.

Some patients experience a temporary increase in GI side effects during the first few weeks — this typically resolves with dose stability. Others notice improved appetite suppression relatively quickly, which can be both encouraging and, occasionally, surprising.

Other Medication Considerations

For select patients, additional pharmacological approaches may be appropriate alongside or instead of a GLP-1 switch:

• Metformin: First-line for insulin resistance, PCOS, and prediabetes — amplifies metabolic response

• Phentermine, Topiramate or bupropion/naltrexone: Adjunctive options in appropriate patients with specific phenotypes

• Hormone therapy : For perimenopausal and menopausal women, HRT may be an essential complement to weight loss medications — not an afterthought:

The Bottom Line

A limited response to semaglutide is not the end of the conversation — it's the beginning of a more precise one. The tools exist to systematically evaluate why you're not responding, correct what's correctable, optimize what's optimizable, and escalate when escalation is appropriate.

Obesity is a complex, multifactorial disease. Your treatment plan should match that complexity. At Healthy You, we don't stop when the first medication doesn't deliver. We figure out why— and we build the plan from there.

If you're ready for a more individualized approach to your weight health, we're here. Book a consultation at healthyyouendo.com/scheduling or call us at 856-559-7616.

📞 [Call us] | 💬 [Send a message] | 🗓️ [Book an appointment]

Healthy You Endocrinology & Weight Loss | Dr. Alejandra Borensztein, MD, DABOM, MSCP
900 Haddon Ave, Suite 409, Collingswood, NJ 08108 | 856-559-7616 | healthyyouendo.com

This content is for educational purposes only and does not constitute medical advice. Please consult your physician for individualized medical guidance.

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Alejandra Borensztein