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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
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This includes: Adults over the age of 60 People with digestive conditions such as coeliac disease or Crohns Those following vegan or mostly plant-based diets Anyone with a history of gastric surgery or long-term use of certain medications (such as proton pump inhibitors) Individuals with limited intake of animal products These factors can all reduce either your intake of B12 or your bodys ability to absorb it effectively
Dose individualized at intake based on injury type and severity TB-500 loading phase: Higher frequency in the first weeks
