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Basic laboratory evaluation is appropriate for patients with persistent or severe fatigue and should include complete blood count, comprehensive metabolic panel, thyroid-stimulating hormone, ferritin/iron studies, and vitamin B12 and vitamin D levels

Studies show that women with low B12 may face challenges in conceiving

Common recommendations include: 1 injection every 4 weeks for consistent energy and cognitive support

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A 2021 review (Fink 2021) frames HCG as a viable option for secondary hypogonadism because it raises testosterone while supporting, rather than suppressing, sperm production