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doi: 10.1210/jc.2011-0089 C

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Factors That Affect Testosterone Production Several factors directly influence testosterone levels: Blood flow to the testes: Adequate vascular perfusion is necessary for Leydig cell function Inflammation: Chronic systemic inflammation suppresses HPG axis signaling (Tremellen, 2016) Oxidative stress: Excessive reactive oxygen species damage Leydig cells and impair steroidogenesis Sleep quality: Testosterone production peaks during deep sleep (Leproult & Van Cauter, 2011) Body composition: Excess adipose tissue increases aromatase activity, converting testosterone to estrogen Nutritional status: Deficiencies in zinc, vitamin D, and magnesium impair testosterone synthesis This is where BPC-157 becomes relevant to the conversation not because it directly produces testosterone, but because it may influence several of these upstream factors

and in combination with basal insulin with or without metformin (SURPASS-5)