Posting this because the summary going around does not say what the paper says, and the difference matters for how people here are using it.
Most of the hormonal change here is a consequence of adiposity falling rather than a drug effect. Less adipose tissue means less aromatase activity, so in men testosterone commonly rises and estradiol falls, and SHBG rises as insulin resistance improves — which means total testosterone can rise while free testosterone moves less than expected. In PCOS, improved insulin sensitivity frequently restores ovulation, which is a fertility change people are not always expecting.
Where I think it is weakest: the population was selected and supported in ways a real cohort is not, so I would read the effect size as a ceiling rather than an expectation.
What would genuinely help is knowing why total and free can move differently here, and which of the two is worth tracking. Happy to be told the question itself is wrong.
EndoResFellow said:Most of the hormonal change here is a consequence of adiposity falling rather than a drug effect.
Agreed, and reference ranges are laboratory-specific. Comparing your number to somebody else's range, or to a screenshot from another country, is how people convince themselves something is wrong.
EndoResFellow said:Most of the hormonal change here is a consequence of adiposity falling rather than a drug effect.
Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. I would drop the "get everything" instinct further than this thread does. Every extra test is another chance at a false positive, and incidental findings have their own cost in scans, biopsies and worry.
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View ResultsShort answer first, then the reasoning. Quarterly for the first year is convention rather than evidence, and it is defensible for a simple reason: it is roughly the interval over which HbA1c becomes informative again, since it reflects about three months of glycaemia. After the first year, and once doses are stable, annual is reasonable unless something specific is being followed.
Dr.NutriCornell said:Agreed, and reference ranges are laboratory-specific.
This is my experience too, for whatever a second data point is worth. I had assumed I was the exception until I read this.