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The changes may warrant investigation, but they are unlikely to be a sign of medication-induced hormonal disruption

Contact your GP if cold sensations are accompanied by severe fatigue, unexplained weight loss beyond expected effects, heart rate changes, skin changes, shortness of breath, or swelling of the neck, as these may indicate thyroid dysfunction, anaemia, or other conditions requiring investigation

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Instead of mimicking gut hormones, phentermine stimulates the release of norepinephrine in the brain a neurotransmitter that suppresses appetite and increases alertness and energy

& Navaneethan, S