Dr.ObesityMed said:

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…

HPA axis assessment on the hormone panel: rarely ordered but informative for understanding the stress-metabolism connection:

4-point salivary cortisol:

• Morning: 15 ng/mL → 13 ng/mL (improved)
• Noon: 8 ng/mL → 6 ng/mL
• Evening: 5 ng/mL → 2 ng/mL
• Night: 3 ng/mL → 1 ng/mL

The cortisol curve is normalizing — less flat, better diurnal variation. Reduced visceral fat = reduced cortisol overproduction. The metabolic benefits cascade into stress hormone regulation.

Dr.PulmRoch said:

Agreed, and reference ranges are laboratory-specific.

Saving this. It is the first explanation that did not require me to already understand it.

Dr.ObesityMed said:

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…

Hormone panel changes on the hormone panel — relevant for anyone curious about endocrine effects:

• Testosterone: increased 42% (weight loss reduces aromatase in adipose tissue)
• Estradiol: normalized from elevated baseline
• SHBG: increased appropriately
• Free testosterone: increased 18%
• Cortisol AM: within normal limits, no significant change

My reproductive endocrinologist says the testosterone improvement alone could explain the energy and mood benefits I've experienced.

One concrete data point for the thread. If you are comparing against somebody else’s result, check that you are comparing the same measurement taken the same way. Most of the apparent contradictions in these threads dissolve at that step.

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