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Drug families known to disrupt HPG axis signaling and/or decrease fertility by other mechanisms include 23 : Chemotherapy drugs (such as cisplatin, doxorubicin (Adriamycin, among others), 5-fluorouricil (5-FU), cyclophosphamide) 52 Psychiatric medications 23 Corticosteroids and other immune suppressants 23,69 Some blood pressure-lowering drugs including calcium channel blockers, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme inhibitors (ACEi)

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For patients who have difficulty absorbing vitamin B12 from food or oral supplementssuch as older adults or those with certain digestive conditionsvitamin B12 injections offer an effective solution

Key differences in bioavailability: Prescription injections: High bioavailability due to direct delivery into the bloodstream OTC oral supplements: Variable bioavailability due to gastrointestinal absorption factors Understanding the differences between prescription B12 injections and OTC supplements helps healthcare providers tailor treatments