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Interestingly, even a dosage that is roughly twice that of TRT (200 mg testosterone enanthate weekly) only partially suppresses LH (-66.7%) and FSH (-62.5%) and, indeed, leads to azoospermia in only about two out of three men (182). The premise of hormonal male contraception hinges on the negative feedback exerted by sex hormones on LH and FSH secretion. Despite testosterone being the primary mediator of LH’s effect on spermatogenesis, exogenous administration of testosterone cannot support spermatogenesis. FSH acts directly on spermatogenesis by activating FSH receptors on Sertoli cells, whereas LH works indirectly through stimulating testosterone production by activating LHCGRs on Leydig cells, which in turn activates ARs on Sertoli cells (179). 243) Wesley U, Bhute V, Hatcher J, Palecek S, Dempsey R. 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PICO (participants, intervention/exposure, comparison, outcomes, and study design) criteria for inclusion and exclusion of studies After excluding duplicate studies, two authors (AH and MP) independently reviewed articles based on titles, abstracts, or full-texts to identify relevant studies. Additionally, the reference lists of related review articles and the retrieved studies were also hand-searched to detect eligible trials that might have been missed. The search keywords were seldom based on vinegar and related phrases to minimize the chance of missing studies which reported lipids or glycemic related markers as secondary outcomes. A comprehensive literature search was performed to identify and appraise investigations that had assessed the effects of ACV supplementation on lipid profiles and glycemic parameters. 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