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Hormonal fluctuations are another key consideration: Rapid weight loss can significantly alter SHBG and free testosterone levels, potentially leading to symptoms of androgen excess or deficiency even when the prescribed testosterone dose remains unchanged

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A recent analysis of the USFDA Adverse Event Reporting System revealed that patients taking both metformin and a PPI experienced significantly higher rates of hospitalizations and life-threatening complications related to B12 deficiency (such as severe neuropathy and cognitive decline) compared to those on monotherapy

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At doses of 1 mg or less (the typical usage range), side effect rates were similar to placebo

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