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Messing, J

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Jeon YJ, Kim JW, Park HM, Kim JO, Jang HG, Oh J, Hwang SG, Kwon SW, Oh D, Kim NK

12,13 While certain genetic disorders (eg, Kallmann syndrome) are linked to impaired function of the hypothalamus or pituitary gland from birth, toxic exposures and other environmental factors, both in utero and later in life, are also known to interfere with the activities of the gonadotropic hormones

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For observational studies reporting serum vitamin B12 levels, the certainty of evidence was upgraded from low to moderate due to the large and consistent magnitude of effect across studies, despite heterogeneity