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With that said, taking too much oral, intranasal, or intramuscular B12 may cause some of the following symptoms: Headaches Nausea and vomiting Diarrhea Tingling in the hands and feet Fatigue or weakness You should be aware of medication interactions with B12, such as metformin and proton pump inhibitors (PPIs)

take each drug at 250 mcg daily

In my clinic, we use validated questionnaires to invite dialogue: Androgen deficiency screening (e.g., ADAM-like tools) focusing on libido and erectile strength Sexual Health Inventory for Men (SHIM) to quantify erectile function Mood and sleep screeners to capture depression/anxiety and sleep apnea risk These tools create a comfortable on-ramp to meaningful, private conversations

It improved a tiny bit but was still persistent