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Larger prospective trials, stratified by hormone formulation, route of delivery, timing of initiation, and baseline metabolic health, will be required to establish causality, characterize which women benefit most, and track outcomes across the full range of health domains this article has examined

Animal studies also tout promising results with acetyl-L-carnitine supplementation

Nausea is the most commonly reported symptom with both treatments, particularly during the dose-escalation phase

Patients should monitor for: Unexpected blood glucose elevations without clear cause (dietary changes, illness, new medications) Recurrence of diabetes symptoms such as increased thirst, urination, or fatigue Persistent high blood glucose readings (300 mg/dL) or symptoms of diabetic ketoacidosis (nausea, vomiting, abdominal pain, fruity breath) Severe abdominal pain (possible pancreatitis) These clinical changes have multiple potential causes beyond medication potency loss