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Although several factors, such as insulin resistance, abnormal protein metabolism, and uremic toxins, have been involved in the loss of skeletal muscle mass in HD patients [12, 13], several reports suggest that muscle atrophy is attributed to carnitine deficiency in HD patients [14, 15]

Sexual dysfunction, affecting both men and women, is often overlooked but significantly impacts quality of life

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While there has been recent research on the effects of chemical exposure, endocrine disruptors, and environmental pollutants, it has been well established that some medications and recreational drugs can impair sperm production and fertility