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The detailed inclusion and exclusion criteria are shown in Table S2

Start with a low dose, stay consistent, and partner with a pharmacy that prioritizes your safety

In those that have had failed blind injections or I need more diagnostic accuracy or previous bursal surgery I perform an ultrasound guided subacromial injection

Bacteriostatic Water for Injection is supplied in a multiple-dose 30 mL plastic vial with a flip-top lid and is not pressurized

The mitochondrial origin means MOTS-c acts at the cellular energy level in a way no GHRH analog, tissue-repair peptide, or cognitive peptide does

However, annual review with your GP is advisable to: Ensure adherence to the injection schedule Monitor for any new or worsening symptoms Consider testing for other autoimmune conditions if symptoms develop (particularly thyroid function, as thyroid disease is commonly associated with pernicious anaemia) [2] Gastric cancer risk: Pernicious anaemia is associated with a slightly increased risk of gastric cancer