Men over 40 have a distinct cardiometabolic profile: testosterone decline, sarcopenia risk, visceral adiposity, rising CV risk. Specific considerations apply.
Why this demographic differs
Cardiovascular risk rises substantially through the 40s and 50s. Sarcopenia begins clinically meaningful progression. Testosterone declines on average ~1%/year after 30. Alcohol consumption patterns are typically higher than in women.
The SELECT advantage
For men 40+ with BMI ≥27 and established CVD (prior MI, ischemic stroke, hemorrhagic stroke, or symptomatic PAD), the Wegovy CV indication (March 2024) and Medicare Part D coverage expansion (April 2026) may apply. See CVD page.
Muscle preservation is non-negotiable
Without resistance training + adequate protein (1.6–2.0 g/kg target weight), GLP-1 weight loss accelerates the sarcopenia that's already underway. Resistance training 2–3×/week is not optional. See muscle preservation.
Testosterone considerations
Significant weight loss can improve endogenous testosterone in men with weight-related hypogonadism. Baseline testosterone screening is reasonable; recheck at 6 months if symptomatic.
Alcohol
Many men on GLP-1 report markedly reduced alcohol desire and tolerance — a documented class effect. Plan for social events. Hydrate; don't drive at usual tolerance levels.
CV risk monitoring
If you have CV risk factors or established CVD, coordinate with your cardiologist or primary care. GLP-1 BP and lipid effects can be meaningful; medications may need adjustment.