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Heffernan MA et al

For patients with clinical deficiency, effective replacement therapy should lead to a normal blood count after two months of treatment, while improvement in neurologic symptoms begins within one week after initiation of therapy and is usually complete within 6 weeks to 3 months.13 For patients with an asymptomatic biochemical deficiency (ie, subclinical disease), measurement of serum B12 or MMA levels should be done 2 to 3 months after initiation of replacement therapy.12 Once metformin is started, this medication is seldom discontinued unless advanced renal impairment develops

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We can also use the micro-needling technique to open up and stimulate the follicles and apply the PRP to these areas for an enhanced outcome

More serious side effects, although rare, can include allergic reactions, chest pain, severe dizziness, or numbness in extremities

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