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After removing 420 duplicates and excluding 23 articles prior to screening, 1,509 records remained for title and abstract review

A key finding: sermorelin effectively raises GH levels, but testosterone response varies widely depending on baseline age, weight, sleep quality, and pre-existing hormone deficiency patterns

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World J Gastroenterol 18:767777 Enns GM (2008) Neurologic damage and neurocognitive dysfunction in urea cycle disorders

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