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The heart is thus endowed with impressive ATP production capacities depending on tightly regulated metabolic processes, the alterations of which have extensively been described in HF settings since the 1980s [3]

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Why One Therapy Alone May Not Be Enough Many patients start TRT and experience significant improvements in energy, libido, and strength, but still report: Persistent poor sleep quality Slower-than-expected recovery Incomplete body composition changes Plateau in fat loss despite improved muscle mass These residual symptoms often reflect concurrent GH deficiency that TRT protocols alone cannot address