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This alternative reaction, using Cys instead of serine as the substrate that binds to enzyme site 1 (i.e., reaction 2), effectively removes Hcy and leads to Cys synthesis by transsulfuration

Key laboratory markers include: IGF-1: Primary marker for sermorelin effectiveness and GH status Total and free testosterone: Evaluates TRT dosing adequacy Estradiol (E2): Monitors testosterone-to-estrogen conversion SHBG (sex hormone-binding globulin): Assesses bioavailable testosterone CBC/hematocrit: Monitors for TRT-related polycythemia PSA: Prostate screening for men on TRT Comprehensive metabolic panel: Liver function, kidney function, glucose metabolism Lipid panel: Cholesterol and triglyceride monitoring Hemoglobin A1c: Long-term glucose control assessment Labs are typically drawn at baseline, 6-8 weeks after initiation, and then every 3-6 months

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There are several isoenzymes of ALDH with different kinetic and binding parameters that influence acetaldehyde oxidation rates

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