The diagnostic problem is that we cannot determine T3 status in muscle, only in the circulation, which of course is not always a reliable mirror of what is going on in the target tissues. Yet, while I am convinced that the patients with impaired Se transport will profit from such Se and T3 treatment, other patients with intact Se status and transport may not, and may even experience cardiovascular side effects from hyperthyroidism. This is why I strongly recommend to test these experimental treatment strategies only in collaboration with the treating physician, and ideally after an analysis of Selenium and Selenoprotein P (SELENOP) concentrations, and an assessment of potential autoimmunity to SELENOP. Unfortunately, these analyses are not (yet) available in the USA, but I am very happy that we have succeeded in convincing a diagnostic provider to offer these analyses in Germany, and hopefully soon also elsewhere

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That controlling point is also recognized in the most recent reviews (Gwyer et al., 2019
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This approach is best suited to: Adults 4065 with longevity-focused health goals who are already engaged in foundational health optimisation (sleep, nutrition, resistance training, metabolic health) Individuals with confirmed age-related decline in GH/IGF-1, with symptoms including reduced lean mass, increased visceral fat, impaired recovery, or sleep-quality deterioration Patients with chronically elevated inflammatory markers without acute disease Adults with disrupted circadian rhythm or age-related sleep degradation (Epitalon specifically addresses this) Those who have optimised foundational lifestyle variables and want an additional, evidence-informed intervention layer It is not appropriate as a standalone intervention for adults who have not addressed metabolic health, sleep, or body composition fundamentals