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A hormonal workup belongs in any evaluation of a midlife woman with significant sleep disruption: estrogen and progesterone alongside thyroid function, cortisol, and fasting insulin

Similarly, another study found that hydroxo-B12 (1000 g i.m

Extra caution is appropriate in patients with active cancer, recent cancer, unexplained masses, unexplained weight loss, pregnancy, breastfeeding, known allergy to peptide products, active infection, immune compromise, significant liver or kidney disease, active inflammatory or autoimmune disease flares, unusual clotting history, uncontrolled cardiovascular disease, use of chemotherapy or immune-modifying biologic therapy, and competitive athletes subject to anti-doping rules

This has potential relevance for circulatory conditions, but human data is limited