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doi:10.2217/whe-2016-0018 (source) Kim S, Cho MC, Cho SY, Chung H, Rajasekaran MR

Older research on rats suggests that it works by activating the melanocortin 4 receptor (MC4R), which then stimulates the cavernous nerve in the penis, which helps men get an erection (8)

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It's what it doesn't actually do

A review of several clinical and case studies of people who use Melanotan concluded that the side effects observed in clinical trials are largely minor [16]