Because the last step leaves an unstable semiquinone at the Q i site, the reaction is not yet fully completed. A second Q cycle is necessary, with the second electron transfer from cytochrome b H reducing the semiquinone to ubiquinol. The ultimate products of the Q cycle are four protons entering the intermembrane space, two from the matrix and two from the reduction of two molecules of cytochrome c. The reduced cytochrome c is eventually reoxidized by complex IV . The process is cyclic as the ubiquinone created at the Q i site can be reused by binding to the Q o site of complex III.
It should be noted that in theory if one was to consistently suppress your natural estrogen levels for a long period of time, this would negatively impact your health, including your cholesterol. Due to the ability of Letrozole- to inhibit estrogen so much, this should definitely be a concern to most users. However the research that has focused on the relationship between use of letrozole and cholesterol levels is rather inconsistent in it's findings. Many studies have concluded that the compound is detrimental to both a user's HDL and LDL cholesterol levels, while other research has found no link. Obviously individuals are best served to monitor their cholesterol while using any compound via blood tests however barring that, letrozole should simply not be run for extended periods of time if at all possible. Doing so could cause serious medical complications.
Along with the issues related to blood lipids is the fact that many users complain that their libido is dramatically reduced when using the compound. This is related to the fact that estrogen is partly responsible for the regulation of an individual's sex drive. Since Letrozole- is so potent it can often drive estrogen levels too low and this inhibits a user's libido. To avoid this users can lower dosages, but some anecdotally report that even extremely low doses of the drug can cause problems. If this is the case a less potent compound such as exemestane or anastrozole may be a more appropriate option.