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Strongest clinical evidence a double-blind trial with 120 participants demonstrated 93% reduction in shedding and a mean increase of 12 hairs per cm after 150 days

[16] Although cyanocobalamin lacks a defined upper-toxicity threshold due to its water solubility and renal elimination, exceptionally high cumulative doses have been temporally associated with acneiform eruptions, altered potassium homeostasis, and theoretical thrombotic risk, emphasizing the importance of evidence-based dosing

There is also the slight risk of nerve injury with IM shots

Most individuals start to experience positive changes within the first week, with optimal results developing over two to four weeks of consistent use