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Metformin is a well-recognized cause of low B12 with long-term use, and almost nobody gets tested for it

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164 In a randomized crossover trial in 50 subjects with male infertility, one month of treatment with a supplement containing pine bark extract plus L-arginine (an amino acid precursor to nitric oxide which regulates blood vessel function) increased semen volume, sperm number and concentration, motility, and vitality, and improved sperm morphology compared with placebo