Both tirzepatide and semaglutide are GLP-1 receptor agonists used for weight management. Both work. Both are available through Derive. But they're not identical, and the right choice depends on your goals, tolerance, and budget.
The Core Difference
Semaglutide activates one receptor: GLP-1. It reduces appetite, slows gastric emptying, and improves insulin sensitivity through a single pathway.
Tirzepatide activates two receptors: GLP-1 and GIP. This dual mechanism produces stronger appetite suppression and enhanced fat metabolism. It's the first drug in its class.
Think of it this way: semaglutide is a focused tool. Tirzepatide is a broader one.
Clinical Results
The numbers from clinical trials:
- Semaglutide (STEP trials): — 15-17% average body weight reduction over 68 weeks
- Tirzepatide (SURMOUNT trials): — 20-22% average body weight reduction over 72 weeks
Tirzepatide consistently outperforms semaglutide in head-to-head comparisons. The SURPASS trials (in diabetes patients) showed tirzepatide produced greater A1C reductions and more weight loss than semaglutide at comparable doses.
Side Effects
Both share similar GI side effects — nausea, occasional vomiting, diarrhea — primarily during dose titration. These are dose-dependent and typically resolve within 4-6 weeks.
The side effect profiles are comparable. Neither has a meaningful safety advantage over the other based on current trial data.
Cost
At Derive: - Contour (Semaglutide): $199/month - Evolve (Tirzepatide): $249/month
The $50/month difference reflects the dual-mechanism advantage and stronger clinical results of tirzepatide.
Which Should You Choose?
Choose Semaglutide (Contour) if: - You're starting GLP-1 therapy for the first time - You want the more established option with extensive long-term data - Budget is a primary consideration - You're looking for moderate, sustained weight loss
Choose Tirzepatide (Evolve) if: - You want maximum weight loss efficacy - You've tried semaglutide and want something stronger - You have metabolic syndrome or insulin resistance - You want the most advanced option available
Both are care team reviewed, HSA/FSA eligible, and ship free. Take our quiz to get a personalized recommendation.