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Hwa V, Haeusler G, Pratt KL, Little BM, Frisch H, Koller D, Rosenfeld RG: Total absence of functional acid labile subunit, resulting in severe insulin-like growth factor deficiency and moderate growth failure

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In contrast to phytoestrogens such as soy isoflavones, black cohosh does not seem to produce estrogenic type stimulation of breast or uterine tissues and its effects may be mediated by serotonergic and dopaminergic pathways, antioxidant sources, or anti-inflammatory actions (98)