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(2012) detected no R-1,3-butanediol in the plasma of participants taking a ketone monoester supplement, except at the highest dosage of 714 mg/kg body weight, at which dose plasma R-1,3-butanediol was detectable at a level of ≤ 1.0 mmol/L and was undetectable 4 h later. Ketone supplements might also improve fueling during exercise, reduce lactate production, and improve performance due to glucose sparing (Okuda et al., 1991), and have positive effects on anxiety (Kashiwaya et al., 2013), and mental performance and memory (Kashiwaya et al., 2013). There is a paucity of studies on time to NK and mitigation of symptoms of keto-induction an as data related to the effects of various supplements on time to induction of ketosis and on symptoms of keto-induction are limited, and there is a lack of homogeneity between study objectives, outcomes, and measures, a narrative review style was chosen. This paper reviews the available scientific literature relevant to improvements in time to ketosis and symptoms of keto-induction, resulting from these nutritional supplements. There have been several methods suggested to reduce symptoms of keto-induction and to reduce the time taken to achieve NK, including the ketogenic amino acid leucine, short chain fatty acids, medium chain fatty acids, and exogenous ketones. Hoorn and colleagues observed no difference between fasted and non-fasted ketogenic protocols for time to ketosis, without specifically describing their definitions for ketosis or the time to ketosis itself (Kang et al., 2007; Chul Kang et al., 2005). This treatment for epilepsy was pioneered at Johns Hopkins University Hospital (Livingstone, 1972; Livingston, Pauli & Pruce, 1977), and is referred to as a ‘classic’ or ‘standard’ ketogenic diet. To elicit this carbohydrate restriction, while also providing sufficient alternate fuel to ensure sustainability of the diet, i.e., in comparison to fasting to achieve ketosis, VLCKDs have been used to encourage ketosis. Ketosis refers to the production of ketone bodies, derived from fats (and some amino acids) for use as an alternative fuel in times of fasting or drastic carbohydrate restriction. Ketogenic diets elicit a state of ketosis known as ‘nutritional ketosis’ (NK), a state of hyperketonaemia distinct from pathological ketosis such as diabetic ketoacidosis (DKA) (Krebs, 1966). In post-oophorectomy FTM patients receiving exogenous testosterone (with dosing adjusted to achieve normal male serum testosterone concentrations), estradiol levels are comparable to those in natal men. One can thus think of testosterone as an estrogen precursor, and furthermore as an endogenous source of estrogen production even in patients without ovaries. 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