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Severe adverse events are rare but may present with allergic responses and unanticipated endocrine changes when the dose is too elevated

In the 2016 report to Congress on Social Risk Factors and Performance Under Medicare's Value-Based Purchasing Programs, ASPE reported that beneficiaries with social risk factors, including dual enrollment in Medicare and Medicaid as a marker for low income, residence in a low-income area, Black race, Hispanic ethnicity, disability, and residence in a rural area, had worse outcomes and were more likely to be cared for by lower quality providers

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Curr Top Med Chem 15(14):13721384 Felty Q, Xiong W-C, Sun D, Sarkar S, Singh KP, Parkash J, Roy D (2005) Estrogen-induced mitochondrial reactive oxygen species as signal-transducing messengers