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In addition to its direct metabolism, arginine can be regenerated via the urea cycle through argininosuccinate synthase 1 (ASS1) and argininosuccinate lyase (ASL)

Consultations are available at LIWLI locations in East Meadow, Amityville, Smithtown, and Port Jefferson Station, as well as through telehealth.

Holding at your current tolerable dose is medically appropriate

It also impairs the function of LC by suppressing the expression of steroidogenic enzymes such as steroidogenic acute regulatory protein (StAR), cholesterol side-chain cleavage enzyme (P450scc), and 3-hydroxysteroid dehydrogenase (3-HSD), ultimately reducing testosterone synthesis (111)

Patients with impaired liver or kidney function need extra care, especially when using tirzepatide, which contains benzyl alcohol and may increase the risk of metabolic acidosis