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(PubMed) Aune D, Keum N, Giovannucci E, et al

10.1210/endo-127-5-2343

The review concludes that combining different approaches is the most effective way to treat hyperpigmentation

Fatigue (92%) and liver pain (86%) were reported most frequently, with fatigue (30%) and fever/chills (24%) having highest severity during AC (Fig 1A)