It can result from elevated estrogen production (excess adipose aromatase activity), reduced estrogen clearance (impaired hepatic Phase I or Phase II metabolism), low SHBG (leaving more biologically active free estrogen), xenoestrogen exposure, or progesterone insufficiency
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The diabetic environment often results in impaired wound healing processes for DFU, mainly attributed to excess oxidative stimulation, prolonged inflammation, dysfunction of immune cells, delayed reinnervation, and reduced angiogenesis at the wound site [113, 114]
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