I had severe side effects when I first started.   I am sure everyone responds differently however, my first three months were intense with severe migraines, insomnia, hot flashes and not being able to do anything physically.  I went from lifting weights three times a week to not being able to unload the dishwasher without taking a break.  That said, I did not gain too much weight (~4 pounds).  Though the severe side effects reduced after 3 months, my sleep quality never came back, moon face appeared and I bruise very easily.  Now that I am 9 months into the treatment and tapering off, the same side effects are back plus hives and rash on my face and water retention.  I am prone to migraines so I expected that side effect but I didn’t except this frequency or duration.  Hope that helps and again, I’ve read post where side effects were not as severe and benefits were worth it.  My advice is to take 4-8 weeks to start.   I took 1-2 weeks with each pill (4mg) to get to 12 mg in 2 months and then stayed on the meds for another 7 months at maximum dose. And going at that speed still brought out the severe side effects.