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The mechanisms behind B12 deficiency in metformin users are multifactorial but are probably related to intestinal absorption, so it seems sensible to assume that oral B12 replacement may be less effective, although there is little evidence in this area
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It is typically inferred from plasma glycerol (glycerol cannot be re-used by the adipocyte, so its release tracks true lipolysis) or free-fatty-acid levels, or measured directly in adipose tissue or isolated adipocytes
Hormonal changes, vaginal dryness, painful intimacy, sleep loss, stress and mood changes can all affect sexual desire
