# Human tasks

Date opened: 2026-04-13
Last updated: 2026-04-14 (selective-fat-redistribution second pass)

## Advanced skin pass (2026-05-06)

- If the public-facing version later wants a strong quantified statement that feminizing estradiol increases bruising risk, skin thinning, or shortens retention after microneedling/RF microneedling, run a dedicated full-text or library-assisted trans-dermatology search. This pass did **not** find a publication-grade trans-specific dataset for that claim.
- If the public-facing version later wants a hard `deep-plane facelift > SMAS facelift` superiority statement on longevity or revision rate, run a dedicated surgical-technique review with full-text retrieval. This pass found strong deep-plane case series and anatomical arguments, but not robust comparative evidence proving superiority.
- If the public-facing version wants exact current national `2025-2026` price tables for branded device treatments such as `Ultherapy`, `Thermage FLX`, `Morpheus8`, or `Sofwave`, do a dedicated immediate-pre-publication market scan. Society-audited national cost data were available for broad surgery/resurfacing categories, but branded device pricing remained mostly clinic-market data.

## Skin-melanin pass (2026-05-06)

- If the public-facing version later wants a hard verified regulatory table covering `South Korea`, `Thailand`, and `India` for each of `hydroquinone cosmetics`, `glutathione injections`, and `Melanotan-II`, run a dedicated regulator-language pass. This run verified US/EU/UK anchors strongly, but did **not** cleanly verify every requested jurisdiction from primary official English-language pages.
- If the public-facing version wants a precise current `2026` cost figure for `Scenesse / afamelanotide` rather than the current “specialty-drug expensive / likely tens of thousands per implant cash-list” framing, do a dedicated immediate-pre-publication pricing pass. I verified the medical indication and dosing, but not a publication-grade universal price.
- If the public-facing version later wants a stronger statement on intentional `laser-induced hyperpigmentation` as a cosmetic strategy, treat that as a search-gap topic rather than a missing sentence. This pass did **not** find a real evidence base beyond complication literature and adjacent vitiligo work.

## Egg-storage pass (2026-05-06)

- If the public-facing version later wants a firm quantitative statement on how much `AMH` or `AFC` recover after stopping testosterone, run a dedicated full-text or library-assisted search. This pass did **not** verify a strong prospective pause-recovery curve with enough data to publish a precise reversibility timeline.
- If the public-facing version wants a stronger statement that `continued-testosterone stimulation` is equivalent to `paused-testosterone stimulation`, do not make that claim without a dedicated update pass. Current evidence is still limited to tiny case series and small observational cohorts.
- If the public-facing version wants exact current `2025-2026` clinic pricing tables for named US/UK/Spain/Israel programs, do a dedicated immediate-pre-publication market scan. This pass verified realistic ranges and some official fee examples, but not a stable apples-to-apples named-clinic price table across all target programs.
- If the public-facing version wants a hard ranking of "best trans-friendly egg-freezing clinics," treat that as a separate project. This pass verified public trans-facing pages and some published trans outcomes, but did **not** verify staff-training quality or clinic-level dysphoria accommodations strongly enough for an honest quality ranking.

## Facial fat pass (2026-05-06)

- If the public-facing version wants a strong `1/3/5 year` facial-fat timeline under feminizing HRT, run a dedicated full-text and perhaps library-assisted search for longer-term direct face-specific cohorts. This pass verified `12-month` and `>=2 year` evidence but did **not** find a robust direct `3-year` or `5-year` facial-fat dataset.
- If the public-facing version wants exact region-by-region facial fat-graft retention tables (`malar`, `temple`, `lip`, `perioral`) with high confidence, do a dedicated retention-methodology pass. This run found a solid pooled overall retention estimate but weak support for universal precise per-region percentages.
- Decide how much of the `HA persistence beyond marketed duration` discussion should appear in the public-facing version. The backend evidence supports caution, but the topic is socially volatile and can be overstated easily if stripped of context.
- Consider a clinician/editorial review before publication for the sections on buccal fat removal, biostimulatory fillers, and vascular-risk framing in facial fat grafting. The evidence map is conservative, but these are still high-stakes cosmetic-procedure topics.
- If the public-facing version wants a firmer sequencing rule for `soft-tissue work before/after FFS`, run a dedicated FFS-plus-fat-grafting timing pass. This research pass supported the structural-first principle but did **not** find a strong comparative dataset on the ideal postoperative interval or on retention in operated tissue beds.

## From earlier passes

- If a local Claude-style CLI becomes available, run `scripts/start_research_jobs.sh` to launch both research workers in tmux.
- Review final summaries for any claims that should not be included in the public-facing wiki due to safety or evidentiary weakness.
- Review the GLP-1 medication summary before public publication for medical-risk wording around pregnancy, contraindications, and discontinuation. The evidence synthesis is source-backed, but final public-facing wording on medication safety should get a human clinical sanity check.
- Review the supplements summary before public publication for safety wording around psyllium, glucomannan, and green tea extract so the public-facing caution language stays appropriately conservative.
- Review the selective-fat-redistribution summary before public publication. Several sections involve cosmetic procedures, off-label use, or thin evidence, so the public-facing wording should stay explicitly conservative and avoid implying DIY clinical safety.

## Hair-removal pain-reduction pass (2026-04-18)

- Decide whether the public-facing wiki should include the named fatal cases (`Blanca Bolanos`, `Shiri Berg`) in the main narrative or reserve them for a clinician-safety sidebar. Backend research should keep them; publication framing is a human editorial/legal call.
- If stronger publication-grade evidence is wanted on oral premedication, retrieve and review full texts specifically for pre-session `ibuprofen`, `naproxen`, and `acetaminophen` in laser hair removal. This pass did not locate a strong direct RCT base.
- If stronger publication-grade evidence is wanted on genital electrolysis pain control, locate surgeon/clinic protocols or conference material specifically describing `pudendal`, `spermatic cord`, or field blocks for gender-affirming pre-op clearance. Surgical block literature exists; electrolysis-specific publication remains sparse.
- Consider a clinician sanity check before publication for the `Intralipid rescue` wording and the methaemoglobinaemia emergency section. The safety framing is intentionally conservative and source-backed, but it is high-stakes enough to justify review.
- FDA MAUDE mining for pain-related hair-removal adverse events was not completed in a structured way in this pass. If device-adverse-event granularity becomes important for publication, run a dedicated MAUDE extraction pass.
- If a publication-grade primary source for the older Arizona fatal case is needed, retrieve court filings or coroner records for `Blanca Bolanos`. The accessible public evidence in this pass was strong enough to correct the name and core circumstances, but much of the detail still comes from contemporaneous secondary reporting rather than a single public primary case document.

## Selective-fat-redistribution second pass (2026-04-14)

- Decide whether the published writeup should include a dedicated "What we removed or downgraded from the April 13 draft" callout. The evidence changes for aminophylline, caffeine, and adipotide are large enough that readers familiar with the draft may notice the shift; explicit framing may be more honest than a quiet revision.
- Investigate whether the adipotide phase 1 trial (NCT01262664) ever produced a public disclosure of termination reason beyond "per PI's request." The preclinical renal signal plus stalled enrollment strongly suggest human nephrotoxicity, but no primary statement confirms this. If a peer-reviewed letter or conference abstract exists, it would upgrade c006-adipotide.md from C3 to C2 on termination mechanism.
- Decide whether to cross-reference GLP-1/incretin literature into the selective-fat-redistribution writeup, since incretin mimetics produce the most reliable "selective" visceral-fat reduction currently documented in pharmacology. This crosses medication-track and body-contouring-track scope.
- Decide whether CBL-514 (Caliway) warrants a dedicated section or just a brief mention. Current position: dedicated mention but not a dedicated claim file beyond c017.
- Decide how to frame the PAH ~0.005% vs ~0.22% discrepancy for a lay audience. Current recommendation is to state both numbers, name the methodological drift (follow-up length, per-cycle vs per-patient, manufacturer vs independent data), and note Linda Evangelista's 2021-2022 lawsuit as the catalyst for disclosure improvement.
- Decide whether the writeup should explicitly name specific consumer-marketed creams (ProCellix, Celluderm) as unreliable, or stay at category level. The safer legal framing is category level plus the FTC enforcement record.
- If stronger publication-quality evidence is wanted on topical aminophylline or topical caffeine, retrieve and read full texts of: Collis 1999 (PMID 10654755), Bielfeldt 2016 right-left placebo RCT, and any post-2023 replication beyond Ahmadraji et al.
- If the writeup wants to extend to related device modalities (HIFU, laser, HIFEM, RF), decide whether each gets a standalone section or is folded into a single "noninvasive body-contouring devices" section. Current recommendation is a single section with a tiered table rather than separate sections per device.

## Selective-fat-redistribution third pass (2026-04-14)

- Decide how the public writeup should handle the Bostin Loyd case. It is the loudest named adipotide-adjacent kidney-failure case but has a significant polypharmacy confound (AAS, insulin, SARMs, diuretics) and Loyd self-attributed causality. Options: (a) name Loyd specifically with confound noted; (b) describe the case without naming; (c) omit entirely. Current files go with (a). Consider privacy/legal implications of naming a deceased person's medical self-experimentation in a public-facing blog.
- The deficit-dependence vs blinding-quality confound in the aminophylline literature is an honest methodological point. Decide whether to foreground this in the writeup or leave it in the backend. Foregrounding is more intellectually honest; backgrounding produces a simpler consumer-ready recommendation.
- Consider whether to cross-reference retatrutide's VAT-preferential body-composition substudy from this writeup. The user's existing framing of the post is contouring-focused, but retatrutide is arguably the best current "selective fat redistribution" signal in medicine. Possible compromise: a single paragraph cross-linking to the GLP-1 track with the specific VAT/ASAT numbers.
- Decide the framing for yohimbine. It has a genuinely interesting alpha-2 mechanism that pairs conceptually with the aminophylline depot-selectivity story, but the controlled human evidence does not support reliable selective effect. Current recommendation: brief skeptical mention rather than a standalone section.
- Decide whether the public writeup should name the active adipotide vendor ecosystem (Peptide Sciences, Core Peptides, etc.) or stay at category level. Naming is more useful to a researcher reader; category-level is safer legally and reduces inadvertent advertising.

## Hair styling pass (2026-04-18)

- Decide whether the public-facing version should include direct wig-adhesive brand names in the harm section. The backend research names `Got2b` because the misuse pattern is common enough to be practically relevant, but a higher-level "hair gel used as scalp adhesive" framing may be safer if the public page should avoid sounding like a usage guide.
- If stronger evidence is wanted on bond-builders beyond mechanistic plausibility, retrieve any full independent laboratory papers directly testing bis-aminopropyl diglycol dimaleate or comparable bond-builder systems in human hair fibers. Current writeup treats this area conservatively as C3 because brand claims are much stronger than the independent evidence I could verify in this pass.
- If stronger publication-quality evidence is wanted on trans-specific wig and hairline styling, do a dedicated community research pass centered on `r/TransWigs`, `r/Powers`, and Susan's Place with a narrower brief. Search quality on those exact communities was uneven in this pass, so some trans-specific presentation guidance remains honestly tagged `C4-community`.

## Hair styling critique 2026-04-18

- If the public page later wants a stronger statement on `Got2b` or similar hair gels causing scalp folliculitis, do a dedicated literature pass for brand-specific adverse-event reports or dermatology case reports. This revision found good support for adhesive dermatitis and only thinner indirect support for folliculitis/occlusion.
- If the public page later wants harder trans-specific claims on HRT-related curl-pattern or texture shifts, do a dedicated pass for longitudinal trans hair-texture data. This revision found published support for sebum/body-hair/scalp-hair changes, but curl-pattern shift remained mostly `C4-community`.
- If publication wants a stronger evidence grade on chelating shampoos beyond mineral-deposition plausibility, retrieve fuller cosmetic-science literature on EDTA/phytic-acid intervention studies. This revision verified hard-water deposition clearly, but the consumer-product response literature remained thinner than the mechanism.

## Hair removal community layer (2026-04-18)

- Verify whether the older trans-community practitioner references `Vera Male` (Los Angeles), `Rita Henn & Norma` (New York), `Lupe's` (Dallas), and `Ginger Chien` (Bothell) still map to active hair-removal practices in 2026. This pass did not find current official sites or booking pages for them, so the new community files mark them as `unverified (pre-2026 reference)`.
- Build a cleaner 2026-04 state matrix for Medicaid and major commercial-plan coverage of facial hair removal versus genital-prep-only coverage. This pass verified Washington, Massachusetts, Oregon, New York, and California, but not the full broader matrix requested in the brief.
- Verify current 2026 status of federal employee / FEHB / PSHB coverage for hair removal after the 2025 benefit changes. Community/legal secondary sources suggest a rollback, but I did not complete a carrier-by-carrier primary-source pass.
- Verify whether any current 2026 US urology/dermatology clinics explicitly advertise spermatic-cord blocks for scrotal electrolysis clearance. The community discusses cord blocks a lot, but this pass did not produce a clean current provider list.
- If the public-facing writeup wants to name medical-tourism hubs for electrology or laser (Thailand, Tehran/Iran, Argentina, Minnesota), do a dedicated verification pass focused on current clinics and 2026 booking pages rather than relying on older community lore.
- For the community-layer correction pass, locate stronger original external sources for the older practitioner names `Morgan Electrolysis`, `Vera Male`, `Rita Henn`, `Lupe's`, and `Ginger Chien` if the project wants to keep them as historical community references rather than just carrying them forward from the original brief.
- If the project wants a cleaner California or New York Medicaid row for facial hair removal, retrieve a current state Medicaid manual, bulletin, or managed-care policy that explicitly addresses hair removal rather than relying on broader gender-affirming-care nondiscrimination language.
- If the project wants Iran or Argentina kept in the settled medical-tourism discussion, retrieve current clinic websites or 2024-2026 reports with concrete pricing and modality details. This pass did not verify them strongly enough.

## Skin texture pass (2026-04-18)

- Review the `research/skin-texture/` writeup before public publication for medical-risk wording around pregnancy, isotretinoin timing, Fitz IV-VI PIH risk, and procedure complications. The evidence map is intentionally conservative, but public-facing language on procedures should still get a human clinical sanity check.
- Decide whether the final public version should include explicit product-name mentions for common KP products (`AmLactin`, `CeraVe SA`) or stay category-level. Current backend notes reference ingredient classes more heavily than brands.
- If a stronger sebaceous-hyperplasia section is desired, retrieve full texts or specialty texts for low-dose isotretinoin, PDT, and laser case series. Current evidence was enough for conservative ranking but remains weak and heterogeneous.
- If the final public page wants more precise national 2025-26 costs beyond representative US ranges, sample a larger clinic-menu set or obtain a current aesthetic-pricing database. The present ranges are grounded in ASPS statistics where available plus current US clinic menus, but they are not a formal national price survey.
- Decide whether scalp/beard/chest textural disorders should get a separate follow-up page or stay as cross-links to `research/hair-removal/` and `research/hair-loss/`. They are out of main scope here except for strawberry-legs / PFB overlap.
- If the public-facing texture page later wants exact brand-by-brand RF-microneedling treatment settings for `Morpheus8`, `Genius`, and `Vivace`, do a dedicated full-text protocol extraction pass. This revision verified device depth ranges from FDA/manufacturer materials and primary studies, but the published literature still reports energy, pulse, and pass settings too inconsistently to justify one canonical protocol table.

## HRT timing × body maturation pass (2026-04-18)

- Retrieve stronger publication-grade primary data for `ribcage / thoracic-width remodeling after age 18`, if a later pass wants a numeric per-year effect. This pass found the clavicle and late skeletal maturation literature clearly, but the specific "ribcage widens on T after 18" claim remains only partly quantified.
- Retrieve stronger primary data for `thyroid / cricoid / arytenoid / hyoid dimensions by age and sex` if a later revision wants a dedicated dimensional table rather than a synthesis from modern morphometric reviews and anatomy references.
- Retrieve stronger publication-grade quantitative data for `penile/testicular atrophy time course` on feminizing GAHT. This pass verified fertility impairment and expected clinical timelines, but the direct longitudinal volume-loss literature was thinner than the body-composition and breast-development literature.
- Retrieve a cleaner primary source for the classic `Stoicheff 1981` age-by-F0 female curve if the later visualization pass needs exact plotted points rather than a literature-composite description.
- If a future public-facing version wants harder numbers on `late androgenic body-hair recruitment` (chest/back/ear/nose/tragus per decade), do a dedicated dermatology/gerontology pass. This pass verified the direction of effect and used a systematic review for GAHT, but found fewer standardized density curves than hoped.
- Consider a clinician/editorial review before publication for the most consequential timing-language sections. The current draft is intentionally non-catastrophic but direct about irreversible windows; wording around youth timing, fertility, and surgery may merit a human pass before public release.

## HRT timing × body maturation critique 2026-04-18

- Retrieve and inspect the original `Shuster 1975` full text directly if a later pass wants the collagen-decline sentence quoted with stricter wording than "approximately 1% per year after early adulthood." The current revision is conservative but still partly review-mediated.
- If the public-facing version wants exact `Greulich-Pyle / Scheuer & Black` fusion ages bone-by-bone and sex-by-sex, do a dedicated primary-table transcription pass from the books/atlases. This revision deliberately removed unsupported exact ages rather than risk fake precision.
- If the public-facing version wants a quantitative `testicular-volume` trajectory on feminizing GAHT, retrieve dedicated longitudinal primary studies; this pass did not find a source strong enough to defend the previously quoted "`~50% in 12-24 months`" claim.
- If the public-facing version wants a quantitative `penile-atrophy` trajectory, retrieve full primary cohorts or surgeon measurement series. Current evidence was enough to support cautious qualitative wording only.
- If the public-facing version wants hard plotted points for classic `Hollien / Stoicheff / Pegoraro-Krook` normative F0 curves, retrieve the full papers rather than relying on abstract/snippet-level confirmation and composite review synthesis.
- If a later revision wants named `medical tourism / FFS surgeons / centers`, do a separate current-status verification pass for those entities. They were intentionally removed from the face file in this pass because the biology page did not need them and they would require ongoing current-status maintenance.

## Electrolysis deep dive (2026-04-19)

- If the project later wants publication-grade primary-history support for the `Michel 1875` and `Bordier 1924` origin stories, retrieve the original texts or cleaner archival scans rather than relying partly on strong secondary historical sources and archive indexes.
- If the project wants a stronger settled statement on `Apilus Cleo` as a current versus legacy platform, do a focused manufacturer/distributor verification pass. This draft found credible lineage evidence and aftermarket compatibility references, but not a clean current Dectro product page equivalent to xCell's documentation.
- If the project wants a stricter primary-source probe appendix for every requested `Laurier` and related insulated variant, do a dedicated distributor/manufacturer pass with current catalogs. The current probe chapter is honest about using mixed manufacturer/distributor sources where direct official pages were thin.
- Decide whether the public-facing wiki should explicitly call out the stale-trade-source problem on state licensing numbers. The backend research now corrects `Texas 150` and `Oregon 300` to the current-source picture, but a reader familiar with older electrology lore may notice the contradiction.

## HGH analogues pass (2026-04-30)

- Review the `research/hgh-analogues/` summary and claim files before public publication for medical-risk wording around cancer, IGF-1 / mortality U-curve, diabetes signals (especially MK-677 + tesamorelin label HR 3.3), pregnancy contraindications, and adrenal-crisis risk on GH + glucocorticoid co-therapy. The evidence synthesis is source-backed but the public-facing wording on these topics deserves a clinician sanity check given the high-stakes domain.
- Verify the current 503A bulks-list category status of `sermorelin`, `ipamorelin acetate`, `CJC-1295` (with and without DAC), `GHRP-2`, `GHRP-6`, `hexarelin`, `MK-677` / `ibutamoren`, and any further GHRH-analogue or GHS as of the most recent FDA PCAC update. The HHS announcement on 2026-02-27 was a policy intent statement; downstream PCAC outcomes and any subsequent rulemaking should be checked before any compounding decision flowed from the page.
- Verify current 2026 commercial supply status of `macimorelin` (Macrilen) in the US. The c012 file flagged that supply has been intermittently disrupted while the manufacturer searched for a marketing partner; if the page is going to recommend macimorelin as the first-line oral diagnostic for AGHD, this should be checked against the current distributor.
- Decide whether the public version should name specific peptide vendors (e.g. `PeptiLab` per the c023 claim file) as documented quality failures or stay at category level. Backend research keeps the named example because it is well-sourced; publication-facing framing is an editorial / legal call.
- If the page wants a tighter pediatric height-gain table (cm gained per cohort by diagnosis - GHD, ISS, SHOX, Turner, Noonan), do a dedicated pediatric endocrinology pass. The current writeup uses an approximate "4-6 cm typical, up to 7-8 cm at high doses" range from Finkelstein 2002 and Rahmati 2017 meta-analyses but does not cover the disease-specific tables.
- If the page wants a quantitative bodybuilding-pattern dose comparison between "GH abuse" and "on-label GHD replacement," retrieve a current academic review with primary IU/mg figures and supraphysiologic-IGF-1 ranges. The current writeup uses a ~5-10x ratio that is reasonable but is sourced from a 2024 review (PMC11578072) rather than from a primary dose-comparison study.
- Decide whether the public version should explicitly cite the 2006 ConjuChem CJC-1295 trial death (per c009) in main-narrative text or restrict it to a footnote. The death was assessed by the attending physician as most likely unrelated to study drug, but the program halt is part of the regulatory reason CJC-1295 has no contemporary efficacy data, so omitting it would change the framing.
- Verify whether a contemporary primary-PK reference for CJC-1295 with DAC (the GH 2-10x for 6+ days, IGF-1 0.5-3x for 9-11 days figures) is available beyond Teichman et al. JCEM 2006 and the secondary references used in c009. The current statement leans on a single original PK paper plus Wikipedia confirmation.
- If the page wants a stronger statement on `IGF-1 LR3` and `IGF-1 DES` than "no human RCT, hypoglycemia risk, research-chem only," retrieve any case-series reports of human adverse events specifically from research-chem IGF-1 use. The current backend uses general IGF-1-receptor pharmacology and the Increlex hypoglycemia label rather than direct LR3 case reports.
- Cross-reference with `research/glp1-antiobesity-meds/` and `research/hrt-timing-body-changes/` and `research/selective-fat-redistribution/` for the comparator framing. The summary already cross-links these but a final consistency pass before public publication is warranted (e.g., to ensure nothing in this writeup contradicts the existing GLP-1 ranking or HRT body-comp claims).
- Consider a clinician sanity check before publication for the "oral estrogen blunts IGF-1, transdermal does not, sublingual is intermediate, injectable behaves more like transdermal" framing in c022 and the trans-specific section. The first-pass biology is well-established but the route-by-route practical clinical advice may benefit from review.

## Breast development / chest surgery pass (2026-05-06)

- Retrieve and review the full peer-reviewed efficacy paper, if now published, corresponding to the Amsterdam UMC progesterone announcement dated `September 5, 2025` ("Addition of Progesterone Leads to Increased Breast Growth for Transgender Women"). This pass verified the institutional report and the older protocol / systematic-review backdrop, but not a final full paper with methods and subgroup tables strong enough to upgrade the positive signal above `C2`.
- If the public-facing version wants a firmer statement on `buttonhole`, `inferior pedicle`, or other nipple-preserving top-surgery techniques, do a dedicated nipple-sensation pass. The available literature on complication and revision rates is much better than the literature on preserved tactile or erotic sensation.
- If the page later wants a quantitative surgeon-volume recommendation for chest masculinization surgery, run a focused surgical-quality pass. This pass found strong reason to believe experience matters but did not verify a clean volume threshold from high-quality multi-center data.
- Consider a clinician/editorial review before publication for the sections distinguishing true breast-growth plateau from shape-limited dissatisfaction and for the augmentation-surveillance language. The evidence map is conservative, but the topic is high-stakes enough that final public-facing wording should avoid implying that medical escalation can usually outperform surgery after `2-3 years`.

## Waist-to-hip ratio pass (2026-05-06)

- Verify current named-surgeon market status before any public-facing recommendation table names specific waist-rib, hip-implant, or body-contouring surgeons. This pass found that several names in the brief had weak or no verifiable published outcome data for the specific procedures, and some search results were ambiguous or marketing-only.
- If the public-facing version wants precise `2025-2026` cost tables for `rib surgery`, `hip implants`, `Korea/Turkey/Mexico body contouring`, or `combined lipo + hip/glute fat grafting`, do a dedicated current-price verification pass immediately before publication. Stable audited cost data were available for ASPS `liposuction` and `buttock enhancement`, but rib-surgery and medical-tourism pricing remained mostly marketing-page noise.
- If the public-facing version wants a stronger statement on `Cathie 1948` or modern `waist training`, retrieve the original historical text and any radiographic or anthropological primary sources directly rather than relying on later summaries and skeletal-anthropology interpretation. This pass verified the historical direction of the claim but did not find a clean modern clinical evidence base.
- If the public-facing version wants a firmer estimate of total `combined-protocol WHR delta` for transfeminine patients, do a dedicated body-contouring outcomes pass focused on papers that actually report pre/post `waist`, `hip`, and `WHR` rather than just satisfaction, volume, or generic contour improvement. This pass found the trans-specific literature too thin to defend a precise additive formula.
- Consider a clinician/editorial review before publication for the `BBL safety` and `rib surgery` framing. The sourcing is conservative, but the combination of cosmetic surgery, medical tourism, and severe complications is high-stakes enough that publication wording should stay explicitly cautionary.

## HRT genetics / pharmacogenomics pass (2026-05-06)

- Decide how prominently to surface the deflationary conclusion that there is no validated transfeminine HRT PGx panel yet. It is the most evidence-based conclusion of the pass, but it cuts against some popular community narratives.
- If publication-grade certainty is wanted on `AR` CAG repeat utility, retrieve the full texts of the most relevant hypogonadism, prostate-cancer, and transgender meta-analysis papers and consider a dedicated repeat-biology deep dive. This pass found the mechanism clear but the clinical actionability weak.
- If publication-grade certainty is wanted on `PGR` and progesterone-response heterogeneity, run a separate full-text pass focused on breast-development and mood outcomes. Direct transfeminine genotype-outcome data were not found in this run.
- If publication-grade certainty is wanted on anti-androgen PGx, run a dedicated search for `spironolactone` metabolite-formation studies and uncommon `CYP3A` or `CES1` variants. The current conclusion is that community claims run ahead of published clinical evidence.

## FFS pass (2026-05-06)

- If the public-facing writeup later wants a true surgeon-ranking page rather than the current archetype map, do a dedicated provider-outcomes pass. This run did **not** find publication-grade comparative revision-rate denominators or surgeon-volume thresholds strong enough for honest ranking.
- Decide how aggressive the public-facing FFS page should be in naming specific surgeons and regions (`Deschamps-Braly`, `Spiegel`, `Bart van de Ven`, `Pomahač`, `Peer Eyup Kayatas`, `Korea`, `Turkey`). The current file stays at an archetype level because the published evidence base is too sparse to support strong value claims.
- If stronger publication-grade evidence is wanted on `Korea-style V-line` versus `Western-style mandibular body contouring`, run a dedicated OMFS/KAOMS pass. This research run did not locate a clean comparative study tying one style to better femininity ratings or lower revision burden.
- If the public-facing page wants precise current pricing by region or surgeon, do a dedicated 2026 market-scan pass using official clinic pricing or consult material. The published medical literature is poor on real-world FFS pricing, so the current `cost-decision-tree.md` intentionally avoids false precision.
- If the public-facing page later wants stronger guidance on when to require pre-op `CT` for forehead work, retrieve and compare additional full texts on `virtual surgical planning`, `cutting guides`, and revision forehead cases. Current evidence supports mixed practice rather than a single rule.

## Voice training pass (2026-05-06)

- If the public-facing version later wants precise `2026` price tables for `private online voice coaches`, `SLP cash-pay visits`, or `app subscriptions`, do a dedicated market scan immediately before publication. This pass intentionally avoided false precision because creator/clinic pricing is unstable and often partly hidden behind consult funnels.
- If the public-facing version wants a firmer statement on `vocal fry` as a feminine cue versus a risky low-register habit, run a dedicated sociophonetics pass. This research pass found enough to say “not a core target” but not enough to defend a stronger prescriptive rule.
- If the page later wants a publication-grade recommendation for `screening laryngoscopy` or `videostroboscopy` before intensive self-training, retrieve full specialty-clinic protocols or consensus material from laryngology societies. Current guidance clearly supports evaluation when pathology is suspected or surgery is contemplated, but the threshold for routine pre-training endoscopy remains more practice-pattern than universal rule.

## Shoulders pass (2026-05-06)

- Verify the surgeon map in `research/shoulders/clavicle-shortening-surgery.md` before any public-facing recommendation names specific providers. This pass verified current official clavicle-reduction pages for `Yonsei Baro Chuk Hospital` and `WIH International Hospital`, but did **not** cleanly verify the brief’s named entities `BeautyHub / Geon Kang`, `Charlie Chen Taiwan`, `Daniel Bohl Chicago`, `Konstantinos Gasparis Greece`, or `Bohdan Pomahač` as current clavicle-shortening providers. Some may be stale references; some may be identity mismatches.
- If the public-facing version wants a publication-grade complication table for elective cosmetic clavicle shortening, retrieve any conference abstracts, case series, or surgeon outcome reports that directly cover bilateral healthy-shoulder cosmetic shortening. This pass found only indirect orthopedic evidence plus current marketing pages; I did not locate a strong peer-reviewed aesthetic denominator.
- If the public-facing version wants a harder number for `actual shoulder-width change in cm` after adult feminizing GAHT alone, do a dedicated search for longitudinal anthropometric studies directly measuring shoulder span or bideltoid breadth. This pass found solid evidence for lean-mass loss and skeletal non-change, but not a clean direct `cm` change study.
- Consider a clinician/editorial review before publication for the clavicle-shortening section. The current framing is intentionally conservative, but the topic combines niche cosmetic surgery, orthopedic biomechanics, and incomplete complication denominators.

## Oral-vs-sublingual E2 research (2026-05-21)

- Retrieve the full text/table image for Price et al. 1997 from a library source before public release if exact Price Cmax/Tmax/AUC/terminal-half-life values need to be quoted as direct table extractions. This pass verified the DOI, abstract, design, and Kuhl's Price-derived peak values, but the publisher table was not accessible during the run.
- If the public-facing version wants precise "2 mg oral E2 E1S trough" values, retrieve the original steady-state study underlying the Zumenon SmPC or a modern LC-MS/MS cohort. The SmPC gives 1 mg values, Slater 2001 gives a much higher 1 mg long-term RIA value, and Kuhl/Aedo support 2 mg ratios, but exact 2 mg trough E1S by modern assay was not located.
- Run a dedicated full-text tissue-pass if the writeup wants a quantitative "X% of breast/endometrial/brain E2 comes from E1S" table. Current evidence supports the pathway, but not one universal fraction.
- Do not publish a claim that E1S predicts transfeminine breast development unless a direct E1S + breast-volume cohort is found. This pass located direct estrone outcome data only, and it was null.
- Consider clinician/editorial review before public release for route-choice implications, especially clot-risk/liver-first-pass wording and any discussion of aromatase inhibitors.