Exclusive Interview with Michael Goldberg, founder of Effecty

The bootstrapped journey behind GLP-1 provider Effecty, and the turbulent and exciting nature of the fastest growing market in pharmaceuticals.

Andrew WatsonSeptember 15, 2026

The Danish

In 2023, Denmark's statistics agency showed that without the pharmaceutical industry, the country's GDP would have fallen by 0.1%, because one company had grown large enough to distort the economic picture of an entire country.

That company was Novo Nordisk, maker of Ozempic. By September 2023 it had overtaken LVMH as the most valuable listed company in Europe, and at its peak it was worth around $570B, more than Denmark's entire annual GDP.

Then on the 20th of December 2024, Novo published phase three results for CagriSema, the drug meant to be its next act. It delivered 22.7% weight loss.

Which is genuinely excellent. Ozempic, and its weight loss twin Wegovy (same drug, semaglutide, different label), manages around 15%.

The problem was Eli Lilly. Their drug tirzepatide, sold as Mounjaro for diabetes and Zepbound for weight loss, was already on the market doing roughly 22%. So Novo's next generation drug had landed level with Lilly's current one. Worse, Lilly's retatrutide had already posted around 24% in phase two trials, in twenty fewer weeks, and hadn't plateaued.

Novo had also spent a year letting everyone believe CagriSema would hit 25%.

The stock fell roughly a fifth in a single session, about €90bn evaporated before lunch, and by May 2025 the chief executive was gone. Not for building a bad drug. For building an excellent one in second place.

Why's this all relevant? Well like any sector, competition with growth is inevitable. But the same in longevity (but even still not a fraction of the size), and hair-loss (pretty big boom and still compounding), GLP-1 and weight-loss has become the most democratized product in the consumer markets that I've seen, and as a result, the DTC space and the advertising auctions become a victim of this excitement.

So I sat down with Michael Goldberg, founder of Effecty to dive into everything GLP-1.

It's not new, but it's the new new thing.

GLP-1s are not new. They have been treating diabetics for decades. As Michael put it to me bluntly, "this is not some new thing." What changed was dosing, indication and approval. Wegovy was cleared for weight management in 2021 and ever since the genie's out the bottle.

Which brings me to Michael.

The birth of Effecty

Quick disclosure before I go further. Igloo ran paid marketing for Effecty, so I've watched a decent chunk of this from inside the ad account rather than the mechanics of the backend, which I could only imagine is more than a headache to build.

Michael Goldberg had no business starting a telemedicine company (and he'll admit this), and I mean that as a compliment. Before Effecty Michael ran a private label operation supplying cleaning chemicals and food storage products to Aldi, Costco, Kroger and Meijer. If you have ever picked up an own brand surface spray in a US supermarket, there's a fair chance it passed through his world at some point. He still runs that business today, just far more hands off he explains.

"Zero telehealth experience. Zero healthcare experience" he says.

What he did have was thirty odd years of yo-yo dieting. In January 2023 he took the medication himself.

"It was such a profound experience and success, and ease of success, that I'd never felt before," he told me. "After the first week or two I basically said, I absolutely have to get involved here. I don't know what, I don't know how, but this is going to change the world."

Worth remembering how that sounded at the time. The standard response was still scepticism. What do you mean you don't need a shot to lose weight, nobody knows the long term effects. Michael's answer to that then and now is the same: GLP-1s had been treating diabetics for decades. The novelty was the application, not the molecule.

He launched within a few months of his first dose.

I want to sit on that, because it is the entire strategy. The regulatory window had opened ten months earlier and would close about three years later. Michael took medication in January, worked out what to build, and was live by spring. Plenty of founders would still have been refining a deck, pitching to investors or doing market research. So, this is a great example of a bootstrapped operation with high accountability and basically zero bureaucracy to get things off the ground as soon as possible.

The decision not to build the infrastructure was the GTM strategy

But how's that kind of speed possible? Michael's decision was to build as little as possible on the infrastructure for the MVP, and focus entirely on customer experience, branding and efficiency of service.

Effecty licensed its backend and Michael's view was blunt: "If we were to ever exit one day, I don't think anyone's buying us for the tech. I think they're buying us for our patients, our patient experience, and the community we build."

He walked me through what building it would actually have meant. A patient portal. An EHR for the clinical providers. A HIPAA compliant prescribing platform that transmits to pharmacies in your network. Onboarding those pharmacies in the first place. Messaging infrastructure between providers and patients, and separately between the company and its providers. Then all the workflows connecting those systems, until eventually the list gets too extensive you become an admin junky rather than focusing on the brand.

"It just felt too overwhelming," he said. "I wanted speed to market. I took the medicine in January and I wanted to launch within a couple of months. I had no interest in waiting on that and hiring a dev team."

However, "is owning that stack a moat" I asked? His answer is that it's a fairly expensive one rather than a defensible one, and that for company one in a time boxed category it would have been the wrong thing to spend a year on. He's more interested in building parts of it now, for later iterations, when the clock isn't running.

Which is a reasonably uncomfortable thought for anyone who has spent eighteen months building infrastructure while the opportunity quietly closed around them.

The PPC landscape for a GLP-1 brand

Every founder has an "oh shit" moment as I call it. The point where the thing stops being a plan and starts being a business. Shoutout to Delbert Cline, who was our first ever electric skateboard customer (at EBC my first company with Alex)! I asked Michael what his moment was.

Unconventionally, it was one influencer post, on a site he freely admits wasn't ready. "The patient intake, the landers, the website, it really wasn't that refined. It was pretty clunky, but we just wanted to go. I remember the onslaught of signups that happened from it. It was like watching the stock market. It was like day trading. I just could not believe it."

Worth noting this was a paid partnership, not a lucky organic hit he adds and acknowledging that getting traction even from paid influencers can be a minefield. "Her post was great, but there are lots of great influencer posts out there, and I know the game. Typically you're not going to see that." The surprise wasn't that the creator performed. It was the scale of the response to a clunky funnel.

"That really solidified it. Okay, we're early. We are early. We're here. Let's go."

Creator content works disproportionately well here for a reason that isn't really about creators. GLP-1 has a fast, unambiguous feedback loop. As Michael put it, "the effects happen so quickly that you become your own mini expert of your own body." Which means the creator's body becomes the evidence (same with hair-loss I guess?). Followers don't watch an endorsement, they watch a transformation across four or five weeks from the sidelines. Almost nothing else in wellness can do that and if your customer can't tell whether your product is working, you're not in the product business, you're in the marketing business. In reality, this is very possible and we see it everyday, but it goes without saying, this is an unusually great product line for the creator market.

Predictably it's no longer a secret. "It's a bit saturated now. If you go on Meta you'll be flooded with UGC and whitelisting." CAC and CPM's have gone up multifold since 2023 which sucks of course, though Michael is fairly relaxed about it, knowing the core KPI to focus is New Customer CAC: LTV. I actually wrote a piece about the inevitability of CAC increasing, and so this interview was well-timed.

"Traditional telemedicine payback is twelve months for some of the larger players. So even though our CAC has gone up multifold, it's still generally a healthy payback period." But his brutal honesty, one shared with many in the same boat: "What's harder about it is your cash flow maintenance during that payback period." That distinction matters because how this affects growth is everything. A twelve month payback on a good ratio is a fine business, and also one that can kill you if you're bootstrapped, because you're funding twelve months of acquisition from a balance sheet built when payback was thirty days.

A common roadblock for many e-commerce brands, and to be honest the biggest benefit in my opinion of raising is the ability to fund potential future earnings.

So Michael's answer isn't revolutionary, but widening the top of the funnel with an omni-channel approach rather than purely optimising it, seems to be working well while keeping scale and growth under a short leash. National radio, which performed well, along with TV and Reddit. He also says an in person rep model, explicitly not an MLM, where people sign patients up in local salons seems to be gaining traction as well.

From my POV and having sat on the other side of the account, the thing that stands out about Michael is pace. Nothing hurts me more as an agency founder when brands drown in bureaucracy leading to slow decision making. He doesn't agonise, and its rare action items don't get concluded within 30-mins. Things get tested, read quickly, then scaled or dropped without ceremony. Considering the size of the brand, Michael's kept a fairly lean team with the wonderful Robyn, Sam and Diego steering the ship alongside him.

What comes next, and why pharma is due its own AI verticals

Effecty has expanded into NAD+, glutathione, sermorelin and, most significantly, hormone replacement therapy (HRT). Again, not re-inventing the wheel but the customer experience takes priority one. The interesting problem is that the workflows and customer experiences take a different path for each supplement.

Michael explains: "A patient coming in for a GLP-1 knows exactly what they want. The minute they take it, it's very clear what it's doing." Not losing weight on a dose? Go up a dose, simple stuff. Now HRT: "Estradiol patches, progesterone, estradiol cream. These take a very long time to work, and sometimes it's unclear if it's working, or why it's not."

Same company, often the same patients, but a very different user journey and experience. Working with the team (and with experience across longevity stacks), we have to make sure to also compartmentalise the CAC by product category, to get a firm grip on New Customer CAC:LTV down to the SKU, and build a consumer experience in the funnel that really sets the standard from creative, landing page, purchase and post-purchase. Something Michael and the team admittedly are working on.

Does AI fit into this model in some respect? I asked, hesitant to not sound stupid with no knowledge of any healthcare AI powered tech-stacks supporting this niche. "Health tech, white label telehealth, is still wildly far behind for AI automation. There's really no AI automation within white label telehealth at the moment. It's complicated, and there's a lot of compliance in that."

His example: a patient orders three vials and receives two. What follows is a manual chain across the rep, the partner pharmacy, a completely different identification system, and then billing reconciliation on both shipments. Elapsed time, 24 to 48 hours, during which the patient may not be taking their medication. "It's all manual. Nothing speaks to each other."

I put a theory to him that came out of a recent conversation with Ron at Upspring, which is that we're watching the birth of vertical AI. Lovable doesn't try to be a general reasoning engine, it builds websites, and it's faster at that one job precisely because it isn't wasting cycles on anything else. Harvey does the same for law. Telehealth looks like an obvious candidate: not one enormous regulated portal reasoning across patients, pharmacies, billing and clinical oversight at once, but narrow models handling one slice and plugging in.

Michael's reframe was better than my question. The bottleneck isn't reasoning capability, it's that none of these systems can talk to each other. "If that rep could just have a system automatically check with the pharmacy and confirm, yes, only two vials shipped, and so on down that process, a lot more efficient." AI isn't the hard part. The permissioned plumbing between four parties who all identify the same order differently is the hard part.

Meanwhile they're doing what a lot of teams are quietly doing, which is building software instead of buying it. "We build little mini software bits on Claude Code all the time. Not on the clinical side. But on the top of the funnel and marketing side we're constantly looking at why a company is trying to charge us thousands a month, and then spinning up a smaller version with everything we actually need." Naturally, this is something we're also doing at Igloo.

Sources

1. Euronews, Denmark's GDP soars thanks to growing pharma sector (Feb 2024)
2. CNBC, Weight loss drugmaker Novo Nordisk vies to become Europe's most valuable company, toppling LVMH(Sep 2023)
3. Fortune, Novo Nordisk's market value of $570 billion is more than Denmark's annual GDP (Sep 2024)
4. Novo Nordisk via GlobeNewswire, CagriSema demonstrates superior weight loss in the REDEFINE 1 trial (Dec 2024)
5. New England Journal of Medicine, Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1)(2021)
6. Eli Lilly, SURMOUNT-1 results published in NEJM show tirzepatide achieved up to 22.5% weight loss (Jun 2022)
7. New England Journal of Medicine, Triple Hormone Receptor Agonist Retatrutide for Obesity: A Phase 2 Trial(2023)
8. CNBC, Novo Nordisk shares plunge 20% after disappointing trial results (Dec 2024)
9. Euronews, Novo Nordisk shares plunge on the back of disappointing trial results (Dec 2024)
10. STAT, Lars Fruergaard Jørgensen, CEO of Novo Nordisk, to step down (May 2025)
11. Novo Nordisk via PR Newswire, Novo Nordisk receives FDA approval for Wegovy (Jun 2021)
12. GoodRx, Is There a Semaglutide Shortage?
13. FDA, FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize (2025)
14. Dollar Commerce, CAC will rise. What to do about it? (Jul 2026)
15. Dollar Commerce, Exclusive Interview with Ron Dahan, founder of Upspring AI (Aug 2026)
16. Novo Nordisk, Financial report for 2021, 2022, 2023, 2024, 2025
17. Eli Lilly, Q4 2022, Q4 2024 and Q4 2025 results
18. OECD, DKK/USD annual average exchange rates