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doi: 10.3390/antiox9121228

This reaction may stem from coppers ability to boost metalloproteinase (MMP) expression

71 (Supplement_1)

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Possible explanations for how HRT could adversely affect MASLD development include adverse effects from the progesterone component of HRT (which is infrequently considered in existing studies), nonphysiologically high hepatic estrogen exposure from oral estrogens, and the inability to replicate the natural oscillatory patterns of hepatic estrogen exposure in the premenopausal state (10)