In 2004, a German toddler shocked neurologists at Berlin’s Charité hospital. At four and a half years old, the boy could hold seven-pound dumbbells with his arms extended. His quads bulged like tree trunks. He was roughly twice as strong as other kids his age.

This wasn’t some toddler CrossFit cult, nor was he dosed with steroids. He’d been born with a genetic mutation that shut off his body’s production of myostatin, a protein that inhibits muscle growth (it literally means “muscle remain”).

His mother, a former sprinter, carried one copy of the mutation, and several of his relatives were known for their unusual strength, including a construction worker who could unload heavy curbstones by hand. Like Belgian Blue cattle and “Mighty Mice” before them (cattle and mice breeds genetically engineered to be freakishly muscular), this toddler’s family was naturally hypertrophic.

Twenty years later, that discovery is colliding with a new medical phenomenon.

Ozempic Is Giving People Tofu Bodies

Millions are injecting GLP-1 drugs like Ozempic to shed pounds, but they’re discovering an ugly truth: the drugs turn longtime users into deflated balloons.

Semaglutide (the active ingredient in Ozempic) strips away muscle alongside fat. In a 2021 trial, ~40 percent of weight lost on the drug was lean muscle, not fat. Patients on Tirzepatide (an Ozempic competitor) fared slightly better in a 2022 trial, with lean muscle dropping by around 25 percent.

Ozempic users tend to be sedentary (they’re naturally fat, remember) which compounds the muscle-loss problem. They’re not hitting the gym or eating protein-rich diets to preserve muscle — so they lose much more of it.

The result? They end up “skinny-fat”: thin but weak, with a slower metabolism and higher risk of regaining weight (as fat). Lean muscle stabilizes blood sugar, boosts immunity, keeps bones strong, and maintains metabolic rate. Women are most at risk of health complications from becoming skinny-fat because muscle loss compounds age-related bone density issues.

When these women stop taking Ozempic, they regain mostly fat (not the muscle they’ve lost). It’s a vicious cycle.

The ‘Swole Pill’

Since the discovery of myostatin inhibitors in the ‘90s, scientists have been digging around for a use case. At first, they thought these drugs could treat muscular dystrophy, but that didn’t work. Now they’ve found their killer app: preventing the “muscle tax” that makes Ozempic users look so weak.

Two recent trials demonstrate the concept:

• In June, Regeneron proved that semaglutide alone strips 34.5 percent of weight loss from muscle. But add their myostatin inhibitor, trevogrumab? Patients lost 30 pounds total and only 1.5 pounds were muscle (versus 7.9 pounds on semaglutide without the myostatin inhibitor).

• Scholar Rock, a decade-old biotech company founded by Harvard Medical School researchers, reached a similar conclusion a week later. Its drug apitegromab (a myostatin-blocking antibody) preserved 54.9 percent of lean mass when combined with tirzepatide. Instead of losing weight as 70 percent fat and 30 percent muscle, patients on the tirzepatide-apitegromab combo lost 85 percent fat and 15 percent muscle.

In other words, patients taking these cutting-edge drugs didn’t just lose more weight. They finally lost the right weight.

These trials are extra-reliable because they exploit a delicious irony: the same lazy, muscle-wasting population that makes Ozempic so problematic represents an ideal testing ground for myostatin inhibitors. These people, who won’t lift a weight or track a macro, are experiencing the worst-case scenario for body composition — and their abnormally high muscle loss makes the benefits of these drugs crystal clear in trials.

Now that pharma has clocked the potential, it’s a gold rush.

Scholar Rock could receive FDA approval within months and become the first to market. Its stock exploded 300 percent when data from the trial summarized above dropped. Biohaven and Roche (competing pharma companies) are also in advanced clinical trials. Eli Lilly paid $1.925 billion for a drug that blocks muscle-limiting receptors, and last year AstraZeneca dropped $80 million on something similar.

When pharma starts writing billion-dollar checks, you know they smell profit. Longtime pharma-journalism insiders tell me this is the sort of pharmaceutical boom that strikes actual (as opposed to fool’s) gold.

We are likely very close to the next wave of weight-loss drugs. They will not only make you skinny, but jacked. And the potential applications of myostatin inhibitors extend far beyond fat people. FDA-approved myostatin inhibitors that could revolutionize muscle preservation and growth for everyone: athletes, aging adults, or everyday men and women who simply want more mass. Your body, your choice.

Ozempic proved dramatic weight loss was possible. Now the race is about quality, which entails not just losing pounds but using pharmaceuticals to sculpt your body mass as you see fit.

The winners — Scholar Rock, Regeneron, or up-and-comers — won’t just capture market share. They’ll define the next decade of metabolic medicine. Nobody should have to pay hundreds of dollars a month plus a 35 percent muscle tax just to look like an empty sack of potatoes when they could look like they actually lift.

—Oliver Bateman