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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

MSH melanocortin stimulation hormone ACTH adrenocorticotropin a preferred melanocortin receptor agonist is Ac-Nle-cyc/o(-Asp-His-D-Phe-Arg-Trp-Lys)-OH, called PT-141 , as disclosed in U.S

Response and dosing do not seem to be weight related