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The 2024 NICE NG239 guideline on vitamin B12 deficiency in over-16s lists the main groups who need injections: Autoimmune gastritis (pernicious anaemia)

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He is also a member of the International Society for the Study of Womens Sexual Health and the former president of the American Society of Mens Health

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This is a later sign, appearing when B12 deficiency has persisted for a long time

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