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Contact your GP for B12 testing if you have: Symptoms suggesting deficiency (persistent fatigue, pins and needles, memory problems, glossitis) Risk factors for deficiency (vegan diet, gastric surgery, long-term metformin or proton pump inhibitor use) [1] [4] Concerns about whether your current supplementation dose is appropriate Underlying conditions affecting B12 metabolism (kidney disease, liver disease) Unexplained high B12 levels on a blood test when not taking supplements Routine monitoring is essential for patients receiving therapeutic B12 injections

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CO-197 Precertification or Authorization Absent Most common cause: IV iron infusions or ESA therapy administered without prior authorization

Practical steps that may help include: Nutritional assessment : A GP can arrange blood tests to check for deficiencies in ferritin, iron, vitamin B12, folate, vitamin D, and thyroid function all of which can contribute to hair loss independently of tamoxifen