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The biosynthesis of Sec and its subsequent incorporation into seleno-GPxs are regulated by the bioavailable selenium pool (hydrogen selenide)

Some species can metabolize pentose sugars such as ribose, [28] alcohols, and organic acids

Less commonly, systemic conditions like secondary syphilis, lymphoma, or chronic lymphocytic leukemia can enlarge these nodes

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The trade-off is borne entirely by the patient: higher rates of severe nausea, increased early dropout, and greater likelihood of metabolic adaptation (the body down-regulating GLP-1 receptors in response to abrupt dose increases)