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Citric acid is mainly converted from pyruvate and -ketoglutarate, the metabolite of glutamine (119, 120)

ACS Nano 11(4):34963505 Ren H, Liu J, Li Y, Wang H, Ge S, Yuan A, Hu Y, Wu J (2017) Oxygen self-enriched nanoparticles functionalized with erythrocyte membranes for long circulation and enhanced phototherapy

Nature 565 , 96100 (2019)

10.1016/j.bioactmat.2022.12.026 66

Given the illegal nature of AAS use in many settings and the ethical impossibility of conducting long-term interventional studies with supraphysiological androgen doses in humans, a substantial proportion of cases likely remain unreported, and the true prevalence of this phenomenon may be underestimated in the existing literature