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Those with a history of cancer Since growth hormone-related peptides can influence cell signaling, individuals with a history of tumors should exercise caution

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Genetic studies in patients and mouse models have shown that alopecia areata is a complex, polygenic disease

Other malabsorption causes include: Atrophic gastritis and reduced gastric acid production (common in older adults) Gastrointestinal surgery, particularly gastrectomy, ileal resection, or bariatric surgery (especially gastric bypass) Inflammatory bowel disease affecting the terminal ileum (Crohn's disease) Coeliac disease and other small bowel disorders Chronic pancreatitis affecting enzyme secretion Helicobacter pylori infection (may contribute to reduced absorption) Medication-related deficiency is increasingly recognised