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However, NADPH can also be formed directly in the mitochondria by NAD(P) + transhydrogenase, mitochondrial/cytosolic NADP-dependent isocitrate dehydrogenase, or cytosolic malate dehydrogenase [125]

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It disrupts the hypothalamic-pituitary-gonadal (HPG) axis, resulting in decreased levels of testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) ( 2.3 Decreased sperm motility DM impairs sperm motility through a complex interplay of hormonal imbalance, oxidative stress, metabolic dysfunction, and inflammation (32)