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While monogenic forms existtypically rare, early-onset, and associated with high penetrancelate-onset familial cases often display incomplete penetrance, with carriers remaining asymptomatic until midlife or after hormonal transitions such as menopause and andropause (Breeze et al., 2024

Problem: no appetite suppression after 4+ weeks If you have completed the loading phase with zero noticeable appetite change, several factors could be at play