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It gradually wears away over time due to hormones, vaginal discharges, general physical activity, sex and masturbation and or childbirth. In other words, cGMP per se simultaneously increases and decreases PGC1 signaling by distinct mechanisms, with crosstalk with cAMP pathways probably determining whether PGC1 is activated or inhibited overall. There are cases where the patient does not experience any side effects at all.