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MCTs promote ketonaemia and ketogenesis (useful to reduce the risk of night-time hypoglycaemic coma) in those with carnitine palmitoyltransferase deficiency, a rare genetic condition which inhibits the ability to produce ketone bodies from long-chain fatty acids (Bonnefont et al., 1989; Bougnères et al., 1981). There is a paucity of studies on time to NK and mitigation of symptoms of keto-induction an as data related to the effects of various supplements on time to induction of ketosis and on symptoms of keto-induction are limited, and there is a lack of homogeneity between study objectives, outcomes, and measures, a narrative review style was chosen. When it comes to trying to improve his mental health around the issue of his size, Matt says he’s struggled to find a therapist who is ‘suitable and qualified because it’s a niche topic’. ‘Out of desperation, I stumbled upon some audio files online that claimed to be able to encourage “penis shrinking”. ‘I had planned to self-medicate with testosterone blockers and pills that deal with oestrogen and fluid build-up, but month-by-month it seemed like it was actually increasing my size. ‘It’s not a surgery that’s done very much,’ he adds, ‘It’s super rare actually. Matt struggles to talk about his size and the issues that come with it because people are quick to shrug him off. Conversely, classic clinically used NO donors have produced contrasting and even negative results in double-blind crossover trials when tested for the treatment of human erectile dysfunction . These compounds include EGb 761 (a Ginkgo biloba extract), ginsenoside Rg1 (isolated from Panax ginseng) and Lycium Barbarum Polysaccharide, obtained by the Lycium Barbarum berries extensively used in Chinese medicine, and are used as food supplements. In fact, such selectivity is difficult to obtain, as this requires the use of an administration route yet to be discovered that allows a drug (such as a NO synthase inhibitor or a NO donor) to cross the blood–brain barrier and reach the central nervous system without reaching the systemic blood circulation, or the synthesis of drugs that differentially release NO in the brain, cavernous corpora and vascular tissues. Whether mechanisms similar to those identified in female rats and mice are operative also in the central nervous system in women is unknown, although it is tempting to speculate that this preclinical evidence may prove useful for the therapy of female sexual dysfunctions . 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