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declining exercise performance Baseline Labs (DUTCH + Standard Panels): Estradiol: Fluctuating wildly (perimenopause) Progesterone: Very low (anovulatory cycles) Cortisol: Elevated evening levels Fasting insulin: 14 IU/mL (insulin resistant) HbA1c: 5.8% (prediabetic range) IGF-1: 156 ng/mL Weight: 178 lbs (goal: 145 lbs) Treatment Protocol: Weeks 1-8: Bioidentical hormone therapy (estradiol patch + oral progesterone) to stabilize hormones, address cortisol with adaptogenic support and sleep optimization Weeks 9-12: Initiate semaglutide 0.25 mg weekly, titrating to 1.0 mg by week 12 Weeks 13-26: Add tesamorelin 2 mg daily to preserve muscle and target visceral fat during weight loss Ongoing: Metformin 500 mg twice daily for insulin sensitivity 26-Week Results: Weight: 148 lbs (-30 lbs total, -16.9%) Body fat: 32% 24% (DEXA) Lean mass: Maintained (actually +1.2 kg gain despite caloric deficit) Fasting insulin: 6 IU/mL (normalized) HbA1c: 5.1% (out of prediabetic range) IGF-1: 223 ng/mL Patient Report: I was terrified Id lose muscle along with the fatId seen friends lose weight on GLP-1s and end up skinny fat. The combination protocol meant I lost fat, kept my muscle, and actually got stronger
2014;164(5 Suppl):S1, 14
Numbness or tingling sensations Pain in the hands and feet Weakness or fatigue Risk Factors for Developing B12 Deficiency Neuropathy Some people are more likely to get nerve damage from B12 shortage
Vitamin B12 Injection Dosage for Adults: Standard Protocols Understanding the standard protocols for vitamin B12 injection dosage is key for adults with deficiency
Are There Side Effects of Vitamin B12 Injections
