The main difference is that starting at 48 means youre treating perimenopausal symptoms earlier (which may fluctuate more) versus waiting until youre postmenopausal (when hormone levels are more stable and dosing is often easier to manage)
The prolonged fasting states and reduced food volume result in a lack of regular CCK stimulation
For people experiencing weight gain while still on tirzepatide, these numbers actually provide reassurance

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Declare it even if its packed in your carry-on bag