THE EVIDENCE
The NIH maintains a database called LiverTox that rates how often each compound shows up in cases of liver injury. Semaglutide is rated Likelihood Score D, and the database is direct on the verdict: liver injury from semaglutide may occur but is very rare.
Significant weight loss tends to *improve* fatty liver disease, not worsen it.
THE PATTERN
When people report pain in the area of the liver while on these peptides, the underlying issue is usually the gallbladder, not the liver itself. Right-upper-quadrant pain during rapid weight loss is much more often biliary (the bile duct and gallbladder) than hepatic (the liver itself).
What this means
The peptide isn't a primary cause of liver damage in large clinical experience. Right-upper-quadrant pain deserves evaluation rather than self-diagnosis, and the evaluation usually points at the gallbladder.
The liver isn't where the damage shows up. The gallbladder often is.