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Beyond hormonal changes, severe undereating may affect libido through several additional pathways: Neurotransmitter changes: Inadequate intake of amino acids (protein building blocks) may contribute to altered production of dopamine and serotonin, neurotransmitters involved in pleasure, motivation, and mood regulation Micronutrient deficiencies: Deficiencies in nutrients such as zinc and vitamin D have been associated with impaired sexual function, though evidence for direct causation is limited [22] Elevated cortisol: Severe energy deficit acts as a physiological stressor, which may raise cortisol levels

Simple UTIs usually affect healthy people with normal urinary tracts

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Fourth, we performed a sensitivity analyses excluding individuals with follow-up times less than 6 months