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Several groups face higher risk, including: Older adults (due to reduced stomach acid production) Vegans and vegetarians (limited dietary sources) Individuals with pernicious anaemia (an autoimmune condition affecting B12 absorption) People with gastrointestinal disorders such as Crohn's disease or coeliac disease Those who have undergone gastric surgery People taking certain medications long-term, particularly metformin and proton pump inhibitors Individuals with recreational or medical nitrous oxide exposure (which can inactivate B12 and cause acute neurological symptoms) Vegans and vegetarians should ensure adequate B12 intake through fortified foods (such as some plant milks, breakfast cereals, and yeast extracts) or supplements

Oxidative stress is another factor that can damage reproductive health

2011 Jan 25;4:105-13

The 2022 ASMBS/IFSO guidelines also support consideration in patients with BMI 30 kg/m with metabolic disease

The peptide enters circulation directly, bypassing digestive processes that can reduce effective doses even for stable compounds