More people than ever are combining therapies: testosterone replacement (TRT), a GLP-1 medication for weight loss, and sometimes peptides on top. The goal is usually the same. Lose fat, keep or build muscle, and feel better for longer.
The problem is that the bathroom scale can't tell you which of those things is happening. A new article in Urology Times makes that point directly, and it names the tool that can: a DEXA scan.
What clinicians are being told
In the September 2026 article, Jean Cunningham, PharmD, senior director of Medical Affairs at Empower Pharmacy, explains how providers should counsel patients who want to stack these therapies (read the full article).
Her advice for patients adding a GLP-1 to TRT is to order a DEXA scan before starting. GLP-1 therapy tends to reduce how much you eat, and that can come with losses in strength and bone density. TRT and resistance training can help offset those losses, but only if someone is actually measuring whether they're working.
"But how are you measuring that?"
Jean Cunningham, PharmD, in Urology Times
That question is the whole case for DEXA.
Why weight alone misleads you
On a GLP-1, it's common to lose one to two pounds a week. That looks like success on a regular scale. But weight loss is made up of fat, muscle, water and even bone. If a meaningful share of what you're losing is muscle, you're losing strength, lowering your metabolism and setting yourself up for weight regain.
TRT and strength training are often added specifically to protect muscle. Without a measurement, you're guessing whether they're doing that job.
What a DEXA scan measures
A DEXA scan is a quick, low-dose X-ray scan that breaks your body into its components.
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Lean mass
How much muscle you have, broken down by arms, legs and trunk.
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Body fat
Your total fat and body fat percentage, and where it's stored.
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Visceral fat
The fat around your internal organs, linked to metabolic and heart risk. It doesn't show up on a scale or in BMI.
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Bone density
An important check for anyone on a GLP-1, since eating less can affect bone.
Together, those numbers answer the question every person on a stack is really asking: is this working the way I want it to?
How DEXA fits each therapy
GLP-1 medications
The priority is making sure the weight coming off is mostly fat. A baseline scan followed by repeat scans shows whether you're keeping your lean mass as the number on the scale drops.
TRT
People start TRT expecting more muscle and less fat. DEXA shows whether lean mass is actually increasing and fat is actually decreasing, with numbers instead of a feeling.
Peptides
This is the area where, according to the article, patient enthusiasm most often runs ahead of the evidence. Cunningham describes sorting therapies into three groups: those with established benefit, those with a plausible mechanism but limited human data, and those where the risks outweigh the benefits. Whatever you and your provider decide, objective body composition data is the fairest way to judge whether a peptide is doing anything for you.
When to scan
- Before you start. The baseline scan is the most important one. Without it, you have nothing to compare against.
- At regular check-ins. Many people rescan about every three months so changes have time to show. Your provider can tell you the right schedule for your plan.
- When something changes. Adding a new therapy, changing a dose or hitting a plateau are all good reasons to scan again.
Between scans: track the trend at home
A DEXA scan is the most detailed snapshot you can get, but it's still a snapshot. The DEXA+ Smart Body Composition Scale lets you follow your body composition trend at home between scans, so you can spot a shift early instead of waiting months to find out.
Your scan sets the baseline. Your scale tracks the trend.
Talk to your provider, then get your baseline
TRT, GLP-1s and peptides are medical therapies, and decisions about starting, stopping or combining them belong with your healthcare provider. What you can do on your own is make sure those decisions are based on real data.
Find a DEXA scan near youInvest in your health. Optimize your future.
Source: Jean Cunningham, PharmD, BCPS, "TRT, GLP-1s, and peptides: How to counsel patients stacking longevity therapies," Urology Times, September 2026. This article is for educational purposes and is not medical advice.