Fallout 4 lowmeds
Requirements: official DLCs

Originally started lowering amount of medicines and decreased their effects, but kept modding further so name of the mod doesn't really tell much. Left it as working name.
Idea of the mod is simple: You get out of the vault and no one has bothered to actually loot wasteland (in 200+ years), lots of stuff just lying there? Not anymore. You find already looted boxes, containers etc. Only scraps left in wasteland. Radiation is one of the biggest concerns you have to face.

Big changes to gameplay
- radiation is deadly and one of the biggest obstacles, for example water is highly radiated (you notice when swimming or drinking)
- very hard to find stimpaks and radaways
- stimpaks won't give health, they only heal limbs
- consumables won't restore much health anymore
- cooking is efficient way to have boosts/health-ups but now you need lots of ingredients
- vendors have shipments to sell, but they are very rare so you might need to loot every single item you find wandering in the wasteland
- very hard to get full health back without sleeping/seeing doctor but doctors services costs increased so you may not afford to see them so often

Removed respawn option from many of robots, turrets, animals, NPCs, loot boxes (including medical, safes etc.) so once you clear/loot place:
- containers stay empty (many loot boxes are empty also as default)
- some enemies may respawn but much less than originally (for example turrets mostly stay as destroyed but some factions/gangs get new members once awhile)

Also changes
- building and maintaining settlements is very hard (settlers dying in attacks, getting building components is time consuming because increased building costs)
- bobby pins, ammunition, fusion cores are very rare (for example power armors in the game lack fusion cores by default)
- many item respawns removed from "well known loot spawns" so harder running back and forth same place looting same items all over again to get rare needed components
- removed item loots from (basic) animals, you get meat and leather for example, but no items like caps, guns, armor etc.

It takes huge effort to build large settlement with electricity, factories and so on. Attacks against settlements can wipe settlers easily now that settlers can die, so planning defences and giving good gear for settlers is crucial.
Because respawning is taken off from many of deadliest animals (including mirelurk queens and such) you might find some places becoming easier to visit later. Then again you can wipe entire species off the wasteland. Many places stay totally empty after all enemies cleared, gives you option to start living there if you want to.

Also changes such as:
- new recipes for foods and medicines (pre-war junk food is common ingredient to craft other foods, also flowers etc. which didn't have much of a use earlier)
- vendors now sell good gear starting from player level 1, but they have low stocks
- added magazines spawn option to mailboxes (mailboxes won't respawn so it's based on chances if you find any magazines or not)
- it's not so common anymore to have nice, clear weather

Made this mod originally just for myself, after conclusive testing decided to share this if someone wants to have really hard experience. And see the results of your work, like places turning to empty (safe) after all hostiles are killed. Some animals going to extinct - "should I kill that last remaining death claw or not?". And the efford it takes to build huge settlements - nothing comes easy but the feeling when you accomplish it all!

Why I did these changes? Didn't like how Fallout 4 turned out to be. Too easy, holding hand all the time. With this mod difficulty is certainly above survival mode, so you might want to play this with normal difficulty. Been testing tens of hours, thanks also to my friends for testing. Only thing we noticed is that if you use weather changing mods, radiation may become so deadly you die in seconds.

This mod is at its best used with Scavengers mod.

Ps. because of dramatic changes I recommend starting completely new game with this mod