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Such damage in ME/CFS is accompanied by formation of immunogenic oxidative modified neoepitopes, which, in turn, may cause an IgM-mediated immune response against neoepitopes such as malondialdehyde and azelaic acid (18)

Reduced testosterone levels can result in a decrease in libido, as well as other sexual concerns such as [erectile dysfunction]." But, he says, a "reduced libido can be influenced by various factors, including stress, anxiety, depression, relationship issues, hormonal imbalances and other health conditions, all of which can cause personality changes." But there may be changes beyond libido in men and women

Epidemiologic studies have shown a link between vitamin B12 and folate deficiencies and increased metabolic risk

We'll explain exactly why in the next section