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Key Insights: Identifies systemic modulators (cortisol, sex hormones, sleep, NAD) that may influence OTM Evidence-grading adapted from Oxford CEBM 2011 Levels of Evidence Stratifies interventions from evidence-based (aspirin caution, menstrual cycle timing) to hypothesis-generating (NMN supplementation, Zone 2 training) Why This Matters: Identical mechanical protocols produce vastly different clinical responses

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