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Intramuscular (IM) B12 injections using hydroxocobalamin, the preferred licensed form in the UK are recommended when: Oral supplementation has failed to correct a documented deficiency The patient has difficulty adhering to daily oral regimens Serum B12 levels remain persistently low despite adequate oral dosing There is clinical evidence of neurological or haematological complications In line with BNF guidance, the standard IM regimen for confirmed deficiency without neurological involvement is a loading course of 1 mg hydroxocobalamin on alternate days for two weeks , followed by maintenance of 1 mg every three months

This muscle-sparing effect is valuable for body recomposition goals and maintaining metabolic rate during fat loss phases

It is also used in hospitalized patients to prevent infections

Growth Hormone (HGH) Replaces GH directly Bypasses pituitary regulation Can suppress endogenous GH production May raise IGF-1 excessively Higher risk of edema, insulin resistance, and carpal tunnel syndrome Tesamorelin Stimulates the pituitary gland Preserves physiologic pulsatility Maintains feedback control Lower risk of GH excess Improves IGF-1 within normal ranges From a functional medicine standpoint, tesamorelin is a restorative therapy , whereas HGH is a replacement therapy

This can be important to help correct negative energy balance and ketosis in fresh cows