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10.1111/acel.12768 91 LiX.GengJ.ZhaoJ.NiQ.ZhaoC.ZhengY.et al (2019)

So ask your doctor about vitamin B12 before any symptoms you notice start to worsen

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Why One Therapy Alone May Not Be Enough Many patients start TRT and experience significant improvements in energy, libido, and strength, but still report: Persistent poor sleep quality Slower-than-expected recovery Incomplete body composition changes Plateau in fat loss despite improved muscle mass These residual symptoms often reflect concurrent GH deficiency that TRT protocols alone cannot address