Week 6 tesofensine: appetite suppression gone, RHR still +8 bpm?

TSH 1.8 to 2.4 isn’t huge, but if free T3 slid too that could explain appetite rebound. Did you test FT3?

Opposite pattern here: appetite stayed suppressed, but RHR normalized right around week 4. Sleep latency was the tell, though — that moved first.

Any ferritin/iron panel? Low ferritin wrecks my sleep latency.

Ferritin is a good call. Mine was 38 ng/mL when I had the same pattern—appetite came back before HR settled. Not saying that’s your cause, but iron and thyroid both shift with sleep debt. The walking increase could also mask appetite if you’re burning more, though +8 bpm RHR sounds more adrenergic. What’s your HRV doing? That would separate stress load from simple tolerance. I’d also look at whether the glucose drop plateaued; if fasting glucose is still falling while appetite returns, that argues against pure tolerance. And sleep debt can muddy all of it.

HRV dropped 12 ms for me the whole time. RHR came back down only after I cut late caffeine.

Caffeine timing matters more than people admit. My sleep latency tracks my last cup, not the tesofensine.

That’s where I’d look first. If latency is up 25 min, you’re losing ~3 hours of sleep per week. Appetite hormones will notice that before any receptor story. The RHR still being high could be sympathetic carryover. I’d want a week of no walking increase and fixed sleep/wake times before blaming the compound. Not advice, just what I’d track. Also, did TSH and FT3 get drawn at the same time of day?

Common surprise about four weeks into tracking: the hunger pattern doesn't fade, it moves. Log a 1-5 hunger score at 8am, noon, 4pm, and 8pm and the 4pm number can go from a 2 to a solid 4 by week 5 while mornings stay flat. Easy to swear the appetite signal is dying — then you shift the walk earlier and realize the evening "hunger" was really just dinner at 5pm instead of 7pm. The body was anticipating food, not rebounding. Resting HR is the other one people notice: it can stay +6 even after sleep latency normalizes around week 7, so that lag might be normal for you too. If your glucose and TSH numbers

The 4pm wall hit me too and it turned out to be my lunch, not my appetite coming back — I'd been doing coffee plus a ~300 cal salad and by 3:30 I would've eaten a shoe. Added a real 3pm snack (plain Greek yogurt + ~20 almonds), logged it daily for two weeks, and my "hunger's back" days went from 9 of 14 down to 2. The weird part was the heart rate side: mine sat at +6 and I was taking ~25 min to fall asleep until I moved my walk from 7pm to 8am — same ~8k steps, just earlier in the day. RHR drifted back to +2 and I was out in about 10. So if your added walking is evening walking, that alone could explain both the latency and some of the elevated resting number, which might make the appetite thing look more like a med story than it is. Do your high-hunger afternoons and bad-sleep nights land on the same days? Mine lined up almost perfectly, which is what made me stop blaming the appetite part.

Airport 4pm hunger is a whole different beast—my carry-on snacks never survive security lol.

I log overnight minimum HR, not morning spot checks, because sleep latency skews the first cycle. My +7 bpm looked real until I split sleep vs awake; the whole bump sat in the first 90 min after lights-out and tracked with late screens plus a warmer room. What does your overnight trend look like if you ignore the latency window? Also, what was the “more wa” you added—walking? My step count jump raised daytime RHR before it eventually dropped.

Curious whether you pulled free T3/T4 with that TSH, not just TSH alone. Mine went

Budget dorm rat here. Is the added “wa…” walking? When I bumped my steps to save bus fare, my RHR stayed up ~7 bpm and sleep latency got ridiculous, especially on night walks. I also kept trying to stretch one dining-hall chicken breast into three meals, so I’d crash-hungry later and blame the med. Tracking walk timing—not just total steps—was the only thing that matched the HR/sleep pattern. Are you walking ater dinner, or earlier in the day?

Hotel lobby cookies at 4pm are my final boss. Solidarity from the road.

What’s your ferritin/transferrin saturation? TSH drift with glucose falling can be iron-status or inflammation, not necessarily thyroid. My RHR stayed +7 and sleep latency +20 until ferritin went 28→70; no med change. Also, any alcohol or late high-fat meals? Those reliably push my resting pulse up and delay sleep even when daytime appetite is back. I’d track those variables before tweaking anything.

That 4pm hunger ambush is so real — mne came back like it never left. Hang in there!

Are you logging overnight HR or just morning RHR? A +8 with +25 min sleep latency reads more autonomic than appetite. I’d separate overnight HR/HRV from daytime values before blaming appetite rebound. My n=1: late evening cardio kept RHR elevated for ~24h and wrecked sleep onset, while 4pm hunger tracked almost perfectly with low first-meal protein. What’s your first meal timing and overnight HR?

Honestly, appetite ghosted me but my pulse didn’t get the memo. Solidarity.