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Rigorous, adequately powered randomised controlled trials, with standardised background therapy, longitudinal biomarker sampling, and patient-reported outcomes, are now needed to determine efficacy, optimal candidates, and durability of response

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The article adds that metabolic stress from rapid loss can suppress gonadotropin-releasing hormone and disrupt pituitary-ovarian signaling, while shifts in ghrelin and satiety hormones may alter gonadotropin secretion