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The MHRA recommends considering periodic B12 monitoring in patients on metformin who have risk factors for deficiency, and testing if symptoms develop

Exogenous testosterone also exerts negative feedback on the hypothalamic-pituitary-gonadal axis: it suppresses pituitary release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), leading to reduced endogenous testosterone production and diminished spermatogenesis

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