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In this context, by potentially interfering with the transcription of steroidogenic genes including 3-HSD and 17-HSD , ATZ may have an anti-androgenic impact 39

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So people at greatest risk for deficiency include those with low stomach acid (e.g., older adults and people on proton pump inhibitors or antacids) or low IF production (known as pernicious anemia), people on medications that interfere with B12 absorption (such as metformin), people who have had gastric surgery, those with GI conditions that impair nutrient absorption (like celiac or Crohn's disease), and people on vegan and vegetarian diets

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Kumashiro N, Erion DM, Zhang D, Kahn M, Beddow SA, Chu X, et al

In summary, the path forward for retinal medicine lies in the creation of a predictive, personalized, and participatory model of care