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These high costs, lower adherence in practice, and frequent weight regain after discontinuation, each highlight the importance of complementary nutritional and lifestyle counseling to help maximize overall efficacy and cost-effectiveness [84]

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Hence, words such as "may", "can," and "could" are used in the descriptions

The leading causes include hormonal imbalance (especially low testosterone), sperm DNA damage from oxidative stress, and lifestyle factors like poor diet, alcohol, and lack of sleep