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The two reasons are that CBS is activated by estradiol and betaine (Bet), which is twice as high in females compared to males because the enzyme PEMT [Figure 1] is activated by a factor of 2.3 in menstruating females

Thomas DA, Faderl S, Cortes J, OBrien S, Giles F, Garcia-Manero G, Kornblau S, Andreeff M , Beran M, Verstovsek S, Pierce S, Letvak L, Salvado A, Champlin R, Kantarjian H