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In response to the concerns noted above that reduce the sensitivity and specificity of serum B12 and confound the diagnosis of B12 deficiency, many investigators now recommend measuring one functional B12 biomarker (serum methylmalonic acid or serum homocysteine) if serum B12 concentrations appear inadequate to ensure a more accurate assessment of B12 status

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My personal approach is to perform a blind injection in the vast majority of impingement and bursitis cases

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Estrogen replacement partially restores the metabolic infrastructure, including insulin sensitivity, fat oxidation capacity, and mitochondrial function, that allows peptides to work more effectively