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For men who do not respond to oral medications, second-line treatments include vacuum erection devices, intracavernosal injections (alprostadil), intraurethral therapy, or penile prosthesis surgery

Keep the vials in their original packaging to protect them from light exposure, which accelerates peptide degradation

Malabsorption Issues: Those with Crohns disease, Celiac, or those who have had gastric bypass surgery often cannot absorb B12 through the gut at all

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