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Comprehensive evaluation should include complete thyroid panel (not just TSH), fasting insulin and HOMA-IR for insulin resistance assessment, cortisol testing for adrenal dysfunction, sex hormone panel (testosterone, estrogen, progesterone), sleep study if sleep apnea is suspected, medication review for weight-promoting drugs, and psychological evaluation for eating disorders or food addiction

Without insurance, expect $800-1,400 monthly for medication alone

People are also encouraged to avoid highly processed products like diet shakes, bars, and meal replacements and to limit or avoid heavily refined and processed foods and snacks in general

Do not change brands or dosage forms of levocarnitine without first checking with your doctor or pharmacist