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Studies have shown that environmental chemicals can disrupt the carefully orchestrated androgen-dependent processes essential for normal sperm development, from spermatogonial stem cell maintenance through final sperm maturation (68)

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Coadministration of other ototoxic drugs, such as gentamicin or furosemide, may increase the risk of ototoxicity

The 1-3 hour onset window eliminates true spontaneity compared to oral ED medications, requiring planning and communication with partners

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For competitive athletes, hexarelin (also called examorelin) is explicitly named as a prohibited growth-hormone-releasing peptide under WADA's Prohibited List in category S2 (Peptide Hormones, Growth Factors, Related Substances and Mimetics), banned at all times as a non-specified substance carrying a default four-year sanction