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It usually occurs in fair-skinned elderly adults with a history of significant sun exposure

Without adequate thyroid hormone replacement, even strict calorie restriction often fails to produce meaningful weight loss because the body's baseline calorie burn is suppressed

In some cases, it may introduce additional variables that have not been evaluated for safety, quality, or consistency

Self-reported community cycling is a more conservative pattern than the trial supported, driven by community-level concerns about receptor downregulation and long-term tolerability that the 48-week trial window did not directly address