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.

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).