Reta plateau at week 10 - dose up?

A brutal first week like that is exactly why people need to stick with it - once you get past the initial phase the body adapts and it becomes sustainable. 20 lbs from 1mg with minimal muscle loss is a good early number. What dose are you on now and what's the trajectory been?
 
The rule-of-thumb is a rough guide - 'stay if losing' makes sense, but 'stay anyway if side effects' even without loss deserves a closer look. If side effects are at the level they're affecting quality of life and the scale isn't moving, holding through that combination longer doesn't serve either goal.
 
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