She’s 5-Foot-11, 138 Pounds, and Taking a GLP-1 for Endometriosis Pain
The FDA has added sleep apnea, kidney disease, and fatty liver to the label. Endometriosis pain is still off-label — and some patients are paying cash for a compounded microdose anyway.
By Sean Anees Saifi · Capital Wealth · Published Thursday, October 1, 2026 · Source: The Wall Street Journal, Tuesday, September 29, 2026 edition, whose market figures are the Monday, September 28 close (Personal Journal)
Key Points
Ali Balkey, 41, a Dallas real-estate investor, is 5-foot-11 and 138 pounds. She has taken a compounded GLP-1 since February, Sumathi Reddy writes in Your Health — a microdose, she says, for endometriosis pain, not weight loss.
Dr. Andrea Vidali, an endometriosis surgeon in Florida and New York, estimates nearly one in five of his endometriosis patients take a GLP-1 off-label, some prescribed by him, some already on it when they arrive.
FDA-approved uses for certain GLP-1s now include obstructive sleep apnea, chronic kidney disease, and severe fatty liver disease, on top of diabetes and weight loss. Side effects can include gastrointestinal issues, muscle and bone loss, and rare pancreatitis.
Dr. Louis Cohen at Mount Sinai is enrolling mostly normal-weight Crohn’s patients in a small six-month trial of standard-dose tirzepatide — the active ingredient in Eli Lilly’s (LLY) Zepbound and Mounjaro — versus usual care, with a nutritionist watching weight.
Compounded copies and microdoses sit outside the branded label. Insurers often will not pay for off-label pain. The Journal notes the drugs are increasingly researched and prescribed experimentally for inflammatory conditions; that is not the same as an approval.
138 lb
Balkey’s weight — the GLP-1 is not for the scale
~1 in 5
Vidali’s endometriosis patients on a GLP-1 off-label
Off-label
endometriosis pain is not an FDA-approved use
Cash
compounded microdoses often sit outside insurance
Off-label starts in a waiting room: a clinician call first, then the question of who pays.
In one line: GLP-1s are being used off-label for endometriosis pain, including by people who are not trying to lose weight. That is a medical experiment and, often, a cash bill.
Ali Balkey is 5-foot-11, 138 pounds, 41, a Dallas real-estate investor, and not trying to lose weight. Since February she has taken a compounded GLP-1 at a microdose, she told the Journal’s Sumathi Reddy, to manage endometriosis pain — tissue outside the uterus, scarring, adhesions. The Food and Drug Administration has added sleep apnea, chronic kidney disease, and severe fatty liver to certain GLP-1 labels. Endometriosis pain isn’t on that list. She is paying for an experiment her own body is running.
Dr. Andrea Vidali, who operates in Florida and New York, estimates nearly one in five of his endometriosis patients is on a GLP-1 off-label, some from him, some already on it. A rheumatologist in the piece starts some patients on a six-month microdose trial and watches lean-mass loss, because muscle is what protects an inflamed joint. Dr. Louis Cohen at Mount Sinai is enrolling mostly normal-weight Crohn’s patients in a small six-month study of standard-dose tirzepatide — the active ingredient in Eli Lilly’s Zepbound and Mounjaro — versus usual care, with a nutritionist on the calories. That’s a trial. A compounded vial from a spa-adjacent shop isn’t.
Off-label is a medical sentence. It’s also a claims sentence
These drugs are widely considered safe for most people and can still wreck a week with nausea, and in rare cases inflame the pancreas. Muscle and bone loss are on the list. Insurers generally pay for on-label obesity and diabetes, sometimes the new indications, and often nothing for pelvic pain. Compounded copies proliferated when branded pens were scarce; they’re a different product, a different quality control, and usually a credit-card bill. Lilly and the other makers don’t support every off-label story that shows up on a forum.
Our read
Insurance / Consumer Protection (M11): a household considering a GLP-1 for something other than the label needs three lines on one page — the clinician of record (not a comment thread), what the brand versus compounded actually is, and whether insurance, an HSA, or cash will fund it. Off-label is legal with a prescriber. It isn’t a promise the claim will pay, and it isn’t a reason to stop a treatment a specialist already has working.
If someone in the house is already on Zepbound or Mounjaro, the next article in this edition is Lilly’s amylin combination study. That’s a pipeline story. This one is the cash-and-consent story. Fifteen minutes with the prior-auth letter beats a microdose that only the patient and a compounding shop can explain.
What It Means For Your Portfolio
Watch — off-label pain use is a clinician decision and, often, a cash bill
Nearly one in five of one surgeon’s endometriosis patients is on a GLP-1 off-label. That is not an FDA indication, and insurers often will not pay.
General planning principles, not advice for anyone in particular. Whether a GLP-1 belongs in a pain plan is a medical decision with a clinician. The planning piece is the bill: branded on-label versus compounded off-label, prior authorization versus cash, and an HSA only if the account can legally take the expense. Do not fund a forum protocol out of retirement cash.
Write down who prescribed it, what is in the vial, and who is paying. If the answer is a compounding shop and a credit card, treat that as a discretionary medical experiment — with a stop date and a specialist who knows.
