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Watch for: Energy crashes: Needing afternoon naps, struggling to finish workouts, losing the drive to pursue hobbies Body composition changes: Losing muscle despite exercise, accumulating belly fat despite decent diet Sexual changes: Reduced spontaneous desire, erectile difficulties, decreased satisfaction Mood shifts: Increased irritability, mild depression, loss of competitive drive Cognitive changes: Trouble with word recall, decreased mental sharpness, reduced problem-solving ability A classic example: a 47-year-old who used to love playing weekend basketball now dreads it because recovery takes days instead of hours

Mild fluid retention some patients experience mild water retention, particularly in the first 2 to 4 weeks

Adapted from Wadden et al

The LAR must be registered and have someone who knows the rules well

2002;282:E1139E1146

The correct protocol: refrigerate bacteriostatic water to 28C before use, inject slowly down the vial wall rather than directly onto the powder, and swirl gently rather than shaking