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The MHRA (2022) recently issued guidance on the increased risk of vitamin B12 deficiency in people treated with metformin, highlighting increased risks with higher metformin doses, longer treatment duration and in patients with risk factors for B12 deficiency, including the following: Existing low B12 levels

You may also have a substantial elevation in heart rate or blood pressure, but this is less common

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Testosterone is the major sex hormone in men

Agarwal S, Highton-Williamson E, Caga J, Matamala JM, Dharmadasa T, Howells J, Zoing MC, Shibuya K, Geevasinga N, Vucic S, Hodges JR, Ahmed RM, Kiernan MC (2018) Primary lateral sclerosis and the amyotrophic lateral sclerosisfrontotemporal dementia spectrum