acetyl l carnitine sperm motility l-carnitine and l-acetylcarnitine supplementation for idiopathic male infertility Mouse testicular sperm motility after

doi: 10.1038/s41420-023-01369-2 10 YuanCMaZXieJLiWSuLZhangGet al

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

Cell 5 : 897904 Watanabe M, Osada J, Aratani Y, Kluckman K, Reddick R, Malinow MR and Maeda N (1995) Mice deficient in cystathionine beta-synthase: animal models for mild and severe homocyst(e)inemia

: increased