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Self-administration of PCT medicines was reported by 73% of men discontinuing AAS in Scotland between 2015 and 2022 (Grant et al., 2023a) and by 80% of 100 male athletes in the Netherlands between 2015 and 2018 (Smit et al., 2021)

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Several groups face higher risk, including: Older adults (due to reduced stomach acid production) Vegans and vegetarians (limited dietary sources) Individuals with pernicious anaemia (an autoimmune condition affecting B12 absorption) People with gastrointestinal disorders such as Crohn's disease or coeliac disease Those who have undergone gastric surgery People taking certain medications long-term, particularly metformin and proton pump inhibitors Individuals with recreational or medical nitrous oxide exposure (which can inactivate B12 and cause acute neurological symptoms) Vegans and vegetarians should ensure adequate B12 intake through fortified foods (such as some plant milks, breakfast cereals, and yeast extracts) or supplements

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Foundational clinical-trial data points include the SUSTAIN-1 trial for type 2 diabetes (PMID 28110911) and the STEP-1 trial for obesity (PMID 33567185), both of which documented body-weight and glycemic outcomes against placebo