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During the intensive lifestyle intervention lead-in period, lifestyle instruction was delivered 8 times over 12 weeks by a dietician or dietician-equivalent, with all patients receiving instruction to exercise for at least 150 minutes per week and to reduce their caloric intake to approximately 1,200 kcal/day (females) or 1,500 kcal/day (males)

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Furthermore, treatment allocation was not randomized, and residual confounding cannot be fully excluded despite multivariable adjustment

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Estrogen shifts, testosterone fluctuations, and the metabolic consequences of sustained caloric deficit all influence sexual function during this period

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