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Strengths, Limitations, and Implications for Future Research Key strengths of this review include a comprehensive and transparent search strategy, adherence to JBI and PRISMA-ScR standards, and structured appraisal using validated risk-of-bias tools (RoB 2 and ROBINS-I)

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This finding demonstrates that l-carnitine may have a positive effect on rat testicular tissue under a simulated high-altitude environment and indirectly indicates that l-carnitine may effectively eliminate ROS, participate in cell energy metabolism, inhibit apoptosis and protect sperm DNA integrity [36]

22 and in 9.8% of subjects receiving 1.8 mg/day (LEAD-5)