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It increases the risk of: Type 2 diabetes MASLD (metabolic dysfunction-associated steatotic liver disease, formerly called NAFLD) Cardiovascular disease The loss of estrogen also accelerates sarcopenia, the loss of lean muscle mass, which further slows metabolism and reduces energy expenditure

This is the single most important safety consideration with this drug

They may also be necessary when certain medications interfere with B12 absorption or in any other diagnosed condition specifically impacting B12 uptake