# Weight Gain Methods

Status: draft complete (first + second wave)

## Scope

Covers ways of intentionally gaining weight, for use on the Dark Arts wiki (especially in the weight-cycling / upcycle direction) and as a complement to the existing downcycle, selective-fat-loss, supplement, and GLP-1 research. Populations kept distinct: healthy bulkers, underweight / sarcopenic, cachexia, anorexia nervosa treatment, and MtF upcycle.

First wave (c001-c015) covers the big levers: diet / training / appetite pharmacology core / peptides / anabolics / topicals / cachexia context / MtF upcycle / hype-and-danger bin.

Second wave (c016-c024) drills into the rest of medicine where weight-change is a real but usually unwanted side effect: antidepressant classes, antipsychotic class effect, mood stabilizers / anti-epileptics, hormonal contraceptives, MtF HRT regimens, other weight-relevant drugs (insulin, sulfonylureas, beta-blockers, steroids, antihistamines, cannabinoids), medications that cause weight *loss* (stimulants, metformin, SGLT2i, orlistat, GLP-1s, bupropion, topiramate/zonisamide), additional supplements (HMB, beta-alanine, vit D, omega-3, citrulline, probiotics, ashwagandha, test-booster herbs), and non-drug behavioral levers (sleep, NEAT, liquid calories, meal frequency, pre-sleep casein, concurrent cardio, stress, alcohol).

## Key takeaways

1. **Food + resistance training is the only robust lever for healthy adults.** A ~10-20% surplus above TDEE aiming for ~0.25-0.5% bodyweight per week + structured resistance training (10-20 sets/muscle/week, 2x frequency, progressive overload) is the only intervention with durable RCT evidence for net weight gain in people who are not depressed / not cachectic / not hypogonadal. Everything else is secondary or inappropriate.
2. **Calorie density beats pharmacology for most healthy adults.** Nuts, nut butters, oils, full-fat dairy, cheese, dried fruit, granola, whole-milk shakes, and mass-gainer formulas make surplus feasible without mechanical overeating. Counterintuitively, whole-nut epidemiology shows little weight gain at population level — energy compensation and reduced metabolizable energy blunt naïve kcal calculations — so nuts work for bulking when treated as *deliberate meal additions*, not as assumed-neutral snacks.
3. **Protein ~1.6 g/kg/day is a defensible ceiling** (Morton 2018), distributed ~0.4 g/kg across 3-5 meals; leucine threshold ~2.5-3 g (young) / 3-4 g (older); the strict leucine-trigger model is weaker than gym-community claims. Arginine and "test-booster" herbs have weak evidence.
4. **Creatine monohydrate** (~1 kg lean + 1-2 kg water, cheap, safe), **beta-alanine** (volume-mediated indirect benefit), **vitamin D** (only if deficient), **omega-3 EPA/DHA** (anti-catabolic / MPS potentiation in older adults), and **citrulline malate** (acute training volume) are modest evidence-based helpers. **HMB** has clear effect only in untrained / older / cachectic / deficit populations, marginal-at-best in trained bulkers. **Ashwagandha** has small strength/LBM signal with honest effect-size caveats. **ZMA / turkesterone / fenugreek / tongkat ali** are mostly hype tier.
5. **Sleep is a major under-priced lever.** Short sleep on a surplus shifts gain toward fat and reduces MPS — Nedeltcheva 2010 showed dramatic lean-fat ratio shifts on a 5.5h vs 8.5h schedule; Dattilo 2011 and Grandner 2020 back the hypertrophy direction. **Liquid calories** exploit poor satiety regulation (Mattes 2005, DiMeglio 2000) and are an explicit advantage for bulking. **Pre-sleep casein** is real but modest (Res 2012). **Meal frequency** and **"anabolic window"** are deflated dogmas — mechanical kcal-hitting value only. **Concurrent high-volume cardio** blunts hypertrophy on a surplus (interference effect, Wilson 2012). **Chronic stress** biases visceral fat.
6. **Clinical appetite stimulants have meaningful effect sizes — only in cachexia / AN / FTT, not in healthy bulkers.** The 2023 ASCO rapid update has made **low-dose olanzapine (2.5 mg)** the preferred first-line for cancer cachexia (Sandhya 2023: 60% vs 9% gaining >5% body weight) ahead of megestrol, corticosteroids, and cannabinoids. Cyproheptadine has FTT/CF evidence (Homnick 2004, Najib 2014); mirtazapine has clear weight-gain signal in depression (~2 kg over 6-12 weeks) but a *negative* cachexia RCT (Hunter 2021). Megestrol carries real mortality signal in nursing-home elderly (Bodenner 2007). None of these are responsible bulking aids in healthy adults.
7. **Antipsychotic class-effect weight gain is one of the best-documented iatrogenic weight effects in medicine** — clozapine (~4-6 kg/10 wk Allison 1999) > olanzapine > quetiapine ≈ risperidone > aripiprazole > lurasidone ≈ ziprasidone (Leucht 2013, Pillinger 2020). Pediatric effect sizes (Correll 2009 SATIETY) are larger than adult. Mechanism: H1 + 5-HT2C + M3 antagonism. Still not a defensible bulking strategy — you get sedation, EPS, prolactin, metabolic syndrome, and FDA class diabetes warning alongside the weight.
8. **Antidepressant class weight effects are heterogeneous.** Paroxetine is the most weight-gaining SSRI (Fava 2000: +3.6% vs -0.2% fluoxetine); amitriptyline is the top TCA (~1.8 kg placebo-contrast; Berken 1984); MAOIs (phenelzine) and trazodone gain mildly; bupropion is a *weight-loss* drug (flagged in c022 — stacks into naltrexone-bupropion for -6.1% vs -1.3%). The Petimar 2024 target trial emulation (n=183,118) and the Salazar de Pablo 2025 Lancet network meta-analysis are the best modern anchors. Off-label use for pure bulking is almost never defensible — weight gain is a side effect that comes with full antidepressant pharmacology.
9. **Mood stabilizers and anti-epileptics split sharply.** Lithium (2-6 kg / 1-2 yr), valproate (3-10 kg, dose-dependent), gabapentin (2-5 kg), pregabalin (~14% of patients gain ≥7% at 450 mg) all gain; **topiramate and zonisamide are weight-loss drugs** — explicitly flag as "don't stack these if bulking". Lamotrigine, carbamazepine, oxcarbazepine, levetiracetam are mostly neutral.
10. **Hormonal contraceptives are mostly weight-neutral in evidence despite strong public perception.** Cochrane 2014 (Gallo, 49 trials) found no meaningful COCP causal weight effect; old high-dose estrogen formulations are a different beast. **DMPA (Depo-Provera) is the clear exception:** ~2-3 kg at 1 year, ~5-6 kg at 2-3 years, non-linear with first-year gain largest; MPA's glucocorticoid-receptor affinity distinguishes it from other progestin-only LARCs. Etonogestrel implant is mildly gaining (~1-2 kg); LNG-IUS and copper IUD are neutral. DMPA is not an appropriate bulking tool because of BMD black-box + delayed-fertility-return — but is a flagged confounder for anyone already on it, and is sometimes used in MtF care as an anti-androgen (see c020).
11. **MtF HRT regimens shift body composition reliably and shift total weight modestly.** Klaver 2017 meta-analysis: +1.8 kg body weight / +3.0 kg fat / -2.4 kg lean at 12 months on feminizing HRT. Elbers 1999 MRI: +38% hip/thigh SC fat at 12 months. Anti-androgen choice moves kg on the scale: **cyproterone acetate** is a known weight-gainer (plus meningioma / depression / CV risks → EMA PRAC 2020 restrictions drove dose down dramatically); **spironolactone** is essentially weight-neutral (diuretic → mild initial fluid loss); **bicalutamide** is weight-neutral beyond T-suppression; **GnRH analogs** are weight-neutral. **DMPA used as an anti-androgen** brings the DMPA weight profile. **Progesterone's** specific breast/hip benefit is mechanistically interesting but under-evidenced.
12. **Peptides / GH / ghrelin agents are mostly exploratory vs. the forum narrative.** **MK-677** gains real weight in elderly (Nass 2008: +2.7 kg, but +1.1 kg FFM is largely water, no strength; Adunsky: 6.5% vs 1.7% CHF in frail elderly, C1 independently verified). **Anamorelin** gains ~0.65-0.99 kg LBM over 12 weeks in NSCLC cachexia but *no handgrip benefit* — Japan-approved, EMA rejected, FDA never approved. **Tesamorelin** is approved to *reduce* visceral fat in HIV lipodystrophy, not to bulk. **CJC-1295 / ipamorelin / sermorelin**: essentially no body-comp RCT evidence — forum-only claims. **Somatropin** in healthy elderly (Liu 2007): ~2 kg LBM shift mostly water, no functional gain.
13. **Anabolic steroids and SARMs are the largest lean-mass lever in pharmacology but are inappropriate for MtF goals and carry real health cost.** Bhasin 1996: ~6.1 kg FFM in 10 weeks on 600 mg/wk testosterone + training (C1). 2025 AAS meta-analysis: LVEF -2.25 pp. ~20% of users never recover HPG axis. SARMs (ostarine +1.4 kg LBM, LGD-4033, RAD-140, YK-11): no FDA approval, WADA-prohibited, hepatotoxicity case reports, and the GTx enobosarm POWER cachexia trial failed. For MtF-transitioning users, androgenic agents actively oppose the feminization goal — they must not be stacked with estradiol.
14. **GH and IGF-1 are smaller effects than gym culture claims.** Supraphysiologic GH in athletes produces body-comp change that is mostly extracellular water. Mecasermin is pediatric-only with 42% hypoglycemia. Myostatin inhibitors have failed repeatedly (ACE-031 halted for bleeding, domagrozumab missed endpoint).
15. **Topical local-adipogenesis agents lack independent human imaging evidence.** Acetyl hexapeptide-38 (Adifyline), volufiline (sarsasapogenin, Sederma), and topical pioglitazone all trace to manufacturer brochures or in-vitro assays at concentrations unreachable in skin (transdermal penetration arguments give ~0.2% reaching dermis). The one DIY topical-pioglitazone report that describes effect also reports systemic signs (+14 lb, appetite increase) — undermining the "local-only" framing.
16. **Systemic PPAR-γ agonists (pioglitazone, rosiglitazone) do cause ~2-4 kg weight gain over 6-12 months** with a visceral→subcutaneous redistribution signal, but fluid retention + heart-failure signal + bone loss argue against cosmetic use.
17. **MtF upcycle framing is mechanistically plausible; peer-reviewed cycling evidence is effectively absent.** Estradiol biases adipogenesis toward gluteofemoral / breast depots — the direction is robust (Palmer & Clegg 2015, Karastergiou 2012, Elbers 1999). The mesityl heuristic (calorie-dense fat + modest carbs; avoid alcohol) is partly speculative: de novo lipogenesis on mixed diets is low and dietary fat isn't required to become body fat. Alcohol avoidance is better-supported (visceral bias; raises androgens in women).
18. **The "don't take these if bulking" list is real and non-obvious.** Psychostimulants (methylphenidate, amphetamines, lisdexamfetamine, modafinil — Poulton 2013 meta-analysis), metformin, SGLT2 inhibitors (~2-3 kg loss), bupropion, topiramate, zonisamide, GLP-1/GIP agonists, orlistat, phentermine, and chronic nicotine use all push weight down and should be reviewed with a prescriber if an upcycle is planned.
19. **Hype / danger bin is distinct from "modest helper" categories.** Insulin abuse (hypoglycemic coma deaths), clenbuterol "bulking" (cardiotoxicity), Apetamin / adulterated OTC cyproheptadine syrups (FDA + CBP actions), uncontrolled research-chemical SARMs (a 2017 JAMA analysis of 44 products found only ~41% matched label; ~39% contained no SARM; ~25% contained a different unapproved drug), DNP "recovery bulk" myth, home NG-tube use, myostatin-blocker supplements (epicatechin, Fortetropin / MYO-T12), and mass-gainer brand claims.
20. **Autologous fat transfer is the surgical complement to upcycling.** You cannot graft fat you do not have, so an upcycle is often a prerequisite. Gluteal fat grafting (BBL) historically had the highest mortality rate of any cosmetic procedure (~1:3000 via pulmonary fat embolism from intramuscular injection); the 2018/2022 Multi-Society Gluteal Fat Grafting Task Force consensus mandated subcutaneous-only injection and ultrasound guidance, and the post-guideline mortality rate has dropped substantially. Typical retention is 50-70%; breast fat grafting needs 2-3 sessions for cup-size change; HA/PLLA/silicone gluteal fillers carry an FDA warning (embolism, granuloma, infection cluster) and are a separate category.

## Practical ranking

### Evidence-based primary levers (do these)

1. **Calorie surplus ~10-20% above TDEE** — target 0.25-0.5% bodyweight/week gain.
2. **Resistance training** — 10-20 sets/muscle/week, 2x frequency, progressive overload.
3. **Protein ~1.6 g/kg/day**, 3-5 meals, leucine ≥ 2.5-3 g/meal.
4. **Calorie-dense foods** as deliberate meal additions — nuts, nut butters, oils, full-fat dairy, dried fruit, granola, whole-milk shakes.
5. **Sleep** — 7-9 h; short sleep on surplus costs lean mass.
6. **Creatine monohydrate** 3-5 g/day — cheapest, best-evidenced supplement for hypertrophy signal.
7. **Minimise non-essential cardio** during active bulking; control NEAT.

### Situational helpers / indication-specific

8. **Beta-alanine, vitamin D (if deficient), omega-3 EPA/DHA, citrulline malate** — modest, evidence-based.
9. **Liquid calories** when kcal targets are mechanically hard to hit.
10. **Pre-sleep casein** — real, modest, optional.
11. **Probiotics (Lactobacillus rhamnosus context)** — small-but-real protein-absorption synergy signal.
12. **Ashwagandha** — modest strength/LBM effect; honest effect-size caveats.
13. **Clinical appetite stimulants** — only for cachexia, AN, FTT under medical supervision. Low-dose olanzapine is ASCO 2023 first-line for cancer cachexia; cyproheptadine has pediatric/CF evidence; mirtazapine fails its cachexia RCT; megestrol carries mortality signal.

### Exploratory / forum-driven (evidence weaker than claims)

14. **MK-677 / ibutamoren** — real weight signal, partly water/fat, glucose deterioration, C1 CHF signal in frail elderly.
15. **Anamorelin** — Japan-approved (cachexia); LBM modest; functional benefit not demonstrated.
16. **CJC-1295 / ipamorelin / sermorelin / tesamorelin** — no RCT evidence for bulking; tesamorelin specifically *reduces* visceral fat.
17. **Topical adipogenesis cosmetics** (Adifyline, volufiline, topical pioglitazone) — no independent human imaging RCT.
18. **Turkesterone, ashwagandha higher-dose claims, test-booster herbs** — small or inconsistent signal.

### Counterproductive for MtF upcycle

19. **Testosterone / nandrolone / oxandrolone / SARMs** — drive masculinization, oppose HRT goals.
20. **Systemic oral PPAR-γ (pioglitazone, rosiglitazone)** — real gain but heart failure / bone / edema risk.

### Hype / danger

21. **Insulin abuse, clenbuterol "bulking", Apetamin, uncontrolled SARM / peptide stacks, DNP recovery bulk, myostatin-blocker supplements, mass-gainer brand claims.** See c015.

## Effect-size snapshot

| Intervention | Effect on body weight | Effect on lean mass | Key caveat |
|---|---|---|---|
| 10-20% surplus + resistance training | ~0.25-0.5%/week | Meaningful share lean | Without training: mostly fat |
| Creatine monohydrate | ~2-3 kg in weeks | ~1 kg lean + 1-2 kg water | Water is mechanistically useful |
| Beta-alanine | Via training volume | Small indirect | Requires consistent dosing, ~4 weeks to saturate |
| Vitamin D (deficient) | Neutral | Meaningful if deficient | No effect if replete |
| Omega-3 EPA/DHA | Neutral | Modest MPS potentiation | Clearer in older adults |
| HMB | Neutral | ~0.3 kg in untrained/older; negligible in trained | Overhyped for trained bulkers |
| Ashwagandha 500-600 mg/d × 8-12 wk | Small | Modest strength/LBM signal | Effect sizes vary; smaller in meta-analysis |
| Testosterone 600 mg/wk + training (Bhasin 1996) | Large | +6.1 kg FFM / 10 wk | Masculinizes; opposes HRT |
| Ostarine 3 mg/d × 12 wk (Dalton 2011) | Small | +1.4 kg LBM | WADA-banned; hepatotoxicity reports |
| MK-677 elderly (Nass 2008) | +2.7 kg | +1.1 kg FFM (mostly water) | No strength gain; CHF signal in frail elderly |
| Anamorelin 100 mg/d × 12 wk (ROMANA) | Modest | +0.65-0.99 kg | No handgrip benefit; Japan-only |
| Tesamorelin (HIV lipodystrophy) | No BMI change | +1.42 kg LBM | REDUCES visceral fat |
| Somatropin in healthy elderly (Liu 2007) | Small | ~2 kg | Mostly water; no functional gain |
| Megestrol 800 mg/d (Cochrane) | ~4-5 kg / 12 wk in AIDS | Mostly fat | VTE, adrenal, mortality signal |
| Olanzapine 2.5 mg (Sandhya 2023) | 60% vs 9% gained >5% BW | — | Cachexia-specific |
| Olanzapine in AN (Attia 2019) | Faster BMI rise | — | BMI rate-per-month 0.259 vs 0.095 |
| Mirtazapine cachexia (Hunter 2021) | Negative RCT | — | MDD signal does not transfer |
| Mirtazapine MDD | ~2 kg / 6-12 wk | — | Full antidepressant profile |
| Cyproheptadine pediatric FTT | +0.5-1 kg / weeks | — | Sedation; not adult-healthy-bulker data |
| Clozapine (Allison 1999) | ~4-6 kg / 10 wk | Mostly fat + fluid | Hematologic monitoring required |
| Olanzapine class position | ~3-4 kg / 10 wk | Mostly fat | Class metabolic warning |
| Valproate | +3-10 kg, dose-dependent | Mostly fat | Teratogen; hepatic risk |
| Gabapentin | +2-5 kg | — | Sedation, edema |
| Pregabalin 450 mg | ~14% of pts ≥7% BW | — | Class-schedule-V in US |
| DMPA | +2-3 kg / 1 yr; +5-6 kg / 2-3 yr | Mostly fat | BMD black box; delayed fertility return |
| COCP / LNG-IUS | Neutral | Neutral | Cochrane 2014 |
| Cyproterone acetate (MtF doses) | Real gain; dose-dependent | — | Meningioma + depression + CV risks |
| Feminizing HRT (Klaver 2017) | +1.8 kg / 12 mo | -2.4 kg lean | +3.0 kg fat, gynoid-biased |
| Oral pioglitazone | +2-4 kg / 6-12 mo | Small | Fluid, CHF, bone loss |
| Topical adipogenesis cosmetics | No RCT data | — | Manufacturer claims only |
| Psychostimulants | Weight LOSS | — | Avoid if bulking |
| Metformin | -2-3 kg / 1-2 yr | — | Avoid if bulking |
| SGLT2 inhibitors | -2-3 kg | — | Avoid if bulking |
| Topiramate, zonisamide | Weight LOSS | — | Avoid if bulking |
| Bupropion | -2.8 to -3.7 kg vs placebo | — | Avoid if bulking (cross-check depression indication) |
| Short sleep on surplus (Nedeltcheva 2010) | Similar kg | Shifts toward fat | 5.5 h vs 8.5 h |
| Liquid vs solid calories | Easier to overeat | — | Poor satiety regulation is the advantage here |

## Framing for the wiki

- Lead with: `Gaining weight is mostly a food and resistance-training problem. Sleep, protein, and a modest calorie surplus do most of the work. Pharmacology is for specific clinical populations.`
- For MtF upcycle: `Estradiol biases adipogenesis toward feminine depots. Aim for a modest surplus, protein at ~1.6 g/kg, calorie-dense food, enough sleep, low alcohol, and skip androgenic agents entirely. Anti-androgen choice moves kg on the scale — CPA gains, spironolactone neutral-ish, bicalutamide / GnRH analog neutral, DMPA adds the DMPA weight profile on top.`
- For someone already on psychiatric medication: `Review the medication list with a prescriber before an upcycle. Psychostimulants, bupropion, topiramate, zonisamide, and GLP-1s all push weight down. Mirtazapine, paroxetine, amitriptyline, olanzapine/clozapine, valproate, and gabapentin push weight up — these are side effects, not bulking tools, and come with full-drug pharmacology.`
- Caution bin: `Insulin abuse, unregulated SARMs / research-chemical peptides, OTC cyproheptadine syrups, DNP recovery bulk myths, clenbuterol stacks — separate from the "modest helper" bucket.`

## Cross-references

- `research/selective-fat-redistribution/_summary.md` — the complementary downcycle half of the MtF weight cycle.
- `research/diet-patterns-for-downcycle/_summary.md` — for the loss half of the cycle.
- `research/downcycle-maintenance/_summary.md` — for reconciling with maintenance after a loss phase.
- `research/glp1-antiobesity-meds/_summary.md` — GLP-1/GIP agonists go the other direction.
- `research/supplements-for-downcycle/_summary.md` — parallel evidence-vs-hype exercise on the loss side.
- `verification/cross-check-results.md` — independent audit of this research project.

## Claim file index

| # | Topic | File |
|---|---|---|
| c001 | Diet structure — surplus and rate | c001-diet-structure-surplus-and-rate.md |
| c002 | Calorie-dense foods + insulin/DNL | c002-calorie-dense-foods-and-insulin.md |
| c003 | Resistance training for lean mass | c003-resistance-training-for-lean-mass.md |
| c004 | Cyproheptadine + mirtazapine | c004-appetite-stimulants-cyproheptadine-mirtazapine.md |
| c005 | Megestrol + dronabinol + olanzapine | c005-appetite-stimulants-megestrol-dronabinol-olanzapine.md |
| c006 | MK-677 + anamorelin | c006-ghrelin-gh-peptides-mk677-anamorelin.md |
| c007 | CJC-1295 + ipamorelin + tesamorelin + sermorelin | c007-ghrh-peptides-cjc1295-ipamorelin-tesamorelin.md |
| c008 | Anabolic steroids + SARMs | c008-anabolic-steroids-and-sarms.md |
| c009 | GH + IGF-1 + myostatin inhibitors | c009-igf1-and-growth-factors.md |
| c010 | Topical local adipogenesis agents | c010-topical-local-adipogenesis.md |
| c011 | Clinical cachexia / AN / FTT context | c011-clinical-cachexia-context.md |
| c012 | Protein + leucine + arginine | c012-protein-leucine-arginine.md |
| c013 | Creatine + mass gainer supplements | c013-creatine-and-mass-gainer-supplements.md |
| c014 | MtF upcycle framing | c014-upcycle-framing-for-mtf.md |
| c015 | Hype / danger bin | c015-low-value-hype-and-dangerous.md |
| c016 | Antidepressants (SSRI / SNRI / TCA / MAOI / atypical) | c016-antidepressants-and-weight.md |
| c017 | Antipsychotic class effect | c017-antipsychotics-class-effect.md |
| c018 | Mood stabilizers and anti-epileptics | c018-mood-stabilizers-and-aeds.md |
| c019 | Hormonal contraceptives | c019-hormonal-contraceptives-and-weight.md |
| c020 | MtF HRT and body composition | c020-mtf-hrt-and-body-composition.md |
| c021 | Other weight-relevant meds (insulin / SU / BB / steroids / antihistamines / cannabinoids) | c021-other-weight-relevant-meds.md |
| c022 | Medications that cause weight loss (warning list) | c022-medications-that-cause-weight-loss.md |
| c023 | Additional supplements (HMB / beta-ala / vit D / EPA / probiotics / ashwagandha) | c023-additional-supplements-for-anabolism.md |
| c024 | Behavioral + lifestyle levers | c024-behavioral-and-lifestyle-levers.md |
| c025 | Autologous fat transfer / grafting (BBL / breast / hip / 360°) | c025-fat-transfer-and-grafting.md |

## Scope checklist

- [x] Define healthy rate of gain and surplus size with meta-analytic support
- [x] Map calorie-dense foods, insulin / DNL framing
- [x] Resistance training evidence for lean gain
- [x] Clinical appetite stimulants — effect sizes and populations
- [x] Antidepressant class weight effects
- [x] Antipsychotic class effect
- [x] Mood stabilizers and anti-epileptics
- [x] Hormonal contraceptives
- [x] MtF HRT regimen effects on weight and body composition
- [x] Other weight-relevant meds (insulin, SU, BB, steroids, antihistamines, cannabinoids)
- [x] Medications that cause weight loss — warning list
- [x] GH / ghrelin peptide evidence (honest "still exploratory" framing)
- [x] Anabolic steroid / SARM evidence with risks
- [x] Topical adipogenesis agents from the MtF upcycle literature
- [x] Protein / leucine / arginine / EAAs
- [x] Creatine and mass gainers
- [x] Additional supplements — HMB / beta-ala / vit D / EPA / citrulline / probiotics / test-boosters
- [x] Behavioral / lifestyle levers — sleep, NEAT, liquid cal, meal frequency, anabolic window, pre-sleep casein, stress, cardio, alcohol
- [x] Upcycle framing specific to MtF weight cycling
- [x] Hype / dangerous practices bin
- [x] Independent cross-verification of first-wave claim files (c001-c015)
- [ ] (Follow-up) Cross-verification sweep of second-wave claim files (c016-c024)
- [ ] (Follow-up) Targeted Scholar/EMBASE sweep on sarsasapogenin adipocyte biology
- [ ] (Follow-up) Regulatory-status pass on topical PPAR-γ products
- [x] Surgical complement: autologous fat transfer / BBL / breast / hip / 360° (c025, added 2026-04-16)

## Verifier corrections applied (2026-04-14)

Per `verification/cross-check-results.md`:
- **c004**: Hunter 2021 mirtazapine trial duration corrected to "8 weeks with day-28 primary endpoint" (was "× 28 days").
- **c005**: Attia 2019 olanzapine-in-AN claim rewritten to cite the BMI-rate-per-month primary endpoint (0.259 vs 0.095) rather than non-primary kg figures.
- **c006**: Adunsky MK-677 CHF claim upgraded to C1 with primary PMID 21067829 and cross-verified flipped to yes.
- **c010**: Volufiline breast-volume figure loosened to a range (roughly 5-8%, commonly ~6.5%) because the exact number varies across Sederma brochure editions.

## Open audit items

- Second-wave claim files (c016-c024) have not yet had an independent cross-verification pass.
- The SARM contamination literature (c015) should be cited with label-discordance (~59%) separate from wrong-compound-in-bottle (~39% none, ~25% different) — the three-number framing is captured here; any downstream wiki copy should preserve the distinction.
- The Svensson 1998 vs. Murphy 2001 MK-677 trial distinction (c006) is correctly handled — preserve it in any derived content.
- The "nuts don't cause proportional weight gain" literature (c002) genuinely cuts against gym-bro folklore; the correct framing is that nuts work for bulking when used as deliberate meal additions, not as assumed-inert snacks.
- Most cachexia / AN / MDD effect sizes for the psychiatric drugs do NOT transfer to healthy bulkers. Any wiki section citing those drugs must preserve this population distinction or it will mislead.