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Gao X, et al

[1] [3] The medication primarily targets metabolic and appetite-regulating pathways rather than the hormonal pathways typically associated with hot flushes, such as oestrogen or testosterone regulation, or the neurotransmitter systems involved in thermoregulation

A Cochrane review comparing oral and intramuscular B12 found comparable effects on blood levels, and the same principle of good absorption applies to the subcutaneous route