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For instance, studies have shown that chemotherapeutic agents like melphalan can directly disrupt ileal BA reabsorption (156), while other treatments reduce the abundance of key BA-metabolizing bacteria, such as those within the Clostridiales order

However, a semen analysis should be performed prior to initiating gonadotrophin treatment, as nearly 50% of men with hypopituitarism treated with testosterone had adequate spermatogenesis for fertility in one series 88 (see Supplementary Box 5 for further discussion)

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