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Yohimbine is a potent selective α2R antagonist with weaker α1R antagonist activity that blocks the presynaptic feedback inhibition of noradrenaline release, prolonging the excitatory effects of noradrenaline at postsynaptic α1R and β-receptors [237,238]. More interestingly, several cases of manic-like effects, such as confusion, agitation, irritation, nervousness, anxiety, and bizarre behavior, without history of psychiatric disorder, were reported following ginseng use [77,78,81,85,87,88,90,228]. Psychiatric and neurological side effects are rare, and causality is difficult to ascertain [77,79,80,82,83,84,85,86,87,89,90,91,92,93,94]. We’ll explore some of the reasons behind the increased discussion and how Selena herself has addressed these comments over time. It’s a complex topic that touches on body positivity, media influence, and personal well-being. She’s undergone serious medical treatments, including a kidney transplant, which naturally impact the body. In recent years, Selena has become a strong advocate for body positivity and self-acceptance. It’s a powerful reminder that health isn’t always visible and that our bodies change for many reasons, some of which are beyond our control. She’s also emphasized that her primary focus is on her health and well-being, not on conforming to unrealistic beauty standards. She’s also talked about how her relationship with her body has evolved, learning to love and accept herself through different phases. Her willingness to be vulnerable and honest about these struggles has resonated with millions, fostering a more empathetic conversation around body image. Through her social media, interviews, and even her beauty brand, Rare Beauty, she consistently emphasizes the importance of kindness, mental well-being, and embracing imperfections. Social media algorithms often amplify controversial or attention-grabbing content, meaning negative or speculative posts about someone’s body can spread like wildfire. Over the years, she has focused not only on losing weight but also on improving her overall well-being. With the help of her trainer, Amy Rosoff Davis, she adopted a balanced approach to fitness and nutrition. Her goal was not just to shed pounds but to develop a positive and lasting relationship with her body. Research also indicates she included intermittent fasting, which involves eating within a set time frame each day. Her diet is balanced, allowing her to enjoy food in moderation while making smart, nutritious choices. She has become an inspiration for many who struggle with similar challenges by focusing on self-care and body positivity. Though she’s been battling various health ailments in the last few years, the star claimed she was back to work and doing much better. 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Although this process is not directly linked to ketosis, the boost in fat metabolism complements the goals of a ketogenic diet, supporting the breakdown of excess fat.24 Studies on androgen replacement in elderly men on LDL-C and HDL-C are controversial.235,236 The correlation between testosterone levels and HDL-C and insulin sensitivity is only observed within the physiologic male concentration range of testosterone.237 A physiologic dose of androgens did not cause significant change in lipids.238 A recent randomized controlled trial showed decrease in high-density lipoprotein cholesterol.239 A 24-week, multi-center, randomized, parallel-group study by Dobs et al240 of transdermal and intramuscular administration of androgens in 58 men did not detect any significant change in HDL levels or in the ratio of total cholesterol to HDL in either group, apart from the mode of therapy. On the other hand, several placebo-controlled testosterone replacement studies did not show a testosterone-placebo difference distinguishable with respect to mood.150,164,167,168 No relationship between testosterone level and depressive symptoms was found in the Massachusetts Male Aging Study (MMAS).14 This discrepancy in the results of the effects of testosterone replacement therapy on mood may be explained by the genetic polymorphism in the androgen receptor which defines a vulnerable group in whom depression is expressed when testosterone levels fall below a particular threshold.169,170 There is significant inverse correlation between bioavailable testosterone and a depression score in elderly men, independent of age and weight but not with total testosterone levels.146 There was a reduced libido and reduced feelings of well being and minimal effect on mood in patients with induced testosterone deficiency; the depressive symptoms during the hypogonadal state were reversed by testosterone replacement.147 One study showed that the relationship between testosterone level and depression was nonlinear and may be idiosyncratic.148 The risk of depression was increased for hypogonadal and hypergonadal men, but this effect was only detectable in underweight and obese men, not in ‘normal’ weight men in whom a linear decrease in the risk of depression with increasing testosterone level was noted.149 In addition to improvement in sexual function, testosterone therapy may also improve lower urinary tract symptomatology (LUTS)/bladder functions by increasing bladder capacity and compliance and decreasing detrusor pressure at maximal flow in men with SLOH.103 However, the role of testosterone supplementation in men with erectile dysfunction who are not androgen deficient or in the low to normal range needs further investigation to determine whether testosterone therapy will improve erectile function in older men and to weigh the risk–benefit ratio for testosterone therapy in this setting.86 In the presence of a clinical picture of testosterone deficiency and borderline serum testosterone levels, a short therapeutic trial may be tried.95 An inadequate response to testosterone treatment requires reassessment of the causes of the erectile dysfunction.45 There is evidence that the combined use of testosterone and phosphodiesterase type 5 inhibitors in hypogonadal or borderline eugonadal men have a synergetic effect.96–101 The combination treatment should be considered in hypogonadal patients with erectile dysfunction (ED) failing to respond to either treatment alone. 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