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Similar to how leaky gut contributes to autoimmunity, these pathogens reside in the body and cause a chronic inflammatory reaction by the immune system

Effects of warfarin and L-carnitine on hemostatic function and oxidative stress in streptozotocin-induced diabetic rats

It appears to activate the ghrelin receptors (GHSR) which appear to trigger growth hormone synthesis

Chinn IK, Blackburn CC, Manley NR, Sempowski GD

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A complete medical, surgical, social, and family history should be obtained from patients who present with this symptom, and they should undergo a physical examination that includes a pelvic examination