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SERMs such as clomiphene citrate block the negative feedback on the hypothalamus and anterior pituitary to increase LH and FSH gonadotropic secretion

Optimal management of pernicious anemia

However, it is unclear whether this growth could cause cancer or exacerbate existing tumors

Other groups who may benefit include: Patients following gastric surgery (gastrectomy, bariatric procedures) where intrinsic factor production or absorption sites are compromised Individuals with malabsorption disorders such as Crohn's disease, coeliac disease, or chronic pancreatitis Strict vegans and vegetarians with dietary insufficiency, though oral supplementation is usually tried first Elderly patients with atrophic gastritis or reduced gastric acid production Patients on long-term metformin or proton pump inhibitors, which can impair B12 absorption [6] [8] Individuals with nitrous oxide exposure (recreational or medical), which can cause functional B12 deficiency Diagnosis typically involves serum B12 measurement, with levels below approximately 148 pmol/L (though thresholds vary between laboratories) generally indicating deficiency

The powder requires reconstitution with bacteriostatic water before administration