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1st Optimal vs Enhance MD

Name: 1st Optimal
Brand: 1st Optimal
Availability: OnlineOnly

An in-depth comparison of two leading GLP-1 Providers

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6.7

1st Optimal

Best for Patients wanting GLP-1 therapy within a lab-driven functional-medicine program

★★★☆☆3.4

Semaglutide GLP-1Tirzepatide GLP-1Oral tablet optionAt-home lab testing

Visit 1st Optimal →

8.6

Enhance MD

Best for lab-monitored compounded GLP-1 with mandatory video visit

★★★★☆4.3

Starting at $49/mo

CompoundedSemaglutideTirzepatideVideo Visit

Visit Enhance MD →

Side-by-Side Comparison

Feature	1st Optimal	Enhance MD
Overall Score	6.7/10	✓8.6/10
Starting Price	—	$49/mo
Editorial Rating	3.4 ★ /5	✓4.3 ★ /5
Features	✓8 features	6 features
States Available	0	✓39
Compounded	—	✓ Yes
Brand Name	—	—
FSA/HSA Accepted	—	—
FDA Warnings	None	None

Pros & Cons

1st Optimal

Pros

✓Offers both semaglutide and tirzepatide with injectable and oral formats
✓Functional-medicine approach with at-home labs and blood-work interpretation
✓Unlimited coaching and ongoing support included
✓No long-term contracts
✓Board-certified doctors and nurse practitioners referenced

Cons

✗No public monthly pricing disclosed
✗No published state availability list
✗Compounded vs branded sourcing not clarified on site
✗Pricing only revealed after quiz or consultation

Enhance MD

Pros

✓Baseline and ongoing metabolic labs (CMP, lipids, TSH, HbA1c) at Quest every 6 months — rare for compounded GLP-1
✓Mandatory video visit with a US-licensed MD or NP before your first prescription — not a pure questionnaire model
✓Three tiers, including a combined semaglutide + tirzepatide Elite plan ($322/mo) for patients plateaued on one GLP-1
✓Uses LegitScript-certified 503A pharmacies (Tru Meds Rx, Strive Pharmacy, Pharmacy Hub)
✓Low first-month intro pricing: $49 Core, $99 Advanced, $189 Elite
✓Unlimited clinician messaging and dose-adjustment support included

Cons

✗Compounded only — no FDA-approved Ozempic, Wegovy, Zepbound, or Mounjaro
✗Not available in 10 states: AL, AR, GA, HI, LA, MS, MO, SC, TN, WV
✗Mandatory lab work adds 5–10 days to onboarding vs async-only competitors
✗No insurance accepted — cash pay, HSA/FSA eligible
✗Intro pricing resets to full tier rate after 30 days — the $49/$99/$189 figures aren't ongoing cost

Our Verdict

Winner: Enhance MDScore: 8.6/10

Enhance MD edges out 1st Optimal with a higher overall score of 8.6/10 and is particularly strong for lab-monitored compounded GLP-1 with mandatory video visit. 1st Optimal remains a solid alternative, especially if you're looking for Patients wanting GLP-1 therapy within a lab-driven functional-medicine program.

Get Started with 1st Optimal →Get Started with Enhance MD →

Glossary references

Key terms in this article, linked to their canonical definitions.

Semaglutide · Drugs and brands
Tirzepatide · Drugs and brands
Compounded GLP-1 · Pharmacy and drug forms
503A pharmacy · Pharmacy and drug forms
PCAB accreditation · Pharmacy and drug forms
Prior authorization (PA) · Insurance and regulatory
Off-label use · Insurance and regulatory
FDA Drug Shortage List · Insurance and regulatory

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Wegovy®, Ozempic®, and Rybelsus® are trademarks of Novo Nordisk A/S. Mounjaro® and Zepbound® are trademarks of Eli Lilly and Company. All other product names and trademarks referenced on this page belong to their respective owners. WeightLossRankings.org is not affiliated with any pharmaceutical manufacturer. See trademark disclaimer.