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Importantly, nuclear-localized FOXO4-positive Leydig cells in elderly testes showed reduced expression of 3-HSD, a rate-limiting enzyme in testosterone synthesis, implying a connection between nuclear FOXO4 and age-related decline in testosterone production [1]

The ASMBS recommends Roux-en-Y patients take 350 mcg to 500 mcg sublingual B12 daily OR 1000 mcg B12 injections once a month

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Sublingual semaglutide formulations have also emerged as compounded alternatives, dissolving under the tongue for direct absorption through the oral mucosa

IGF-1 activates multiple signaling pathways in bone cells including the PI3K/Akt pathway, which promotes osteoblast survival and function, and the MAPK pathway, which enhances collagen and non-collagenous protein synthesis