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[6] [3] [10] A mild deficiency may not cause any discernible symptoms, but moderate deficiency can cause various symptoms, such as feeling tired, lightheadedness, headaches, cold intolerance, pale skin, sore tongue, upset stomach, loss of appetite, hair and skin color changes, numbness or tingling (pins and needles) of the fingers and toes, and tinnitus, and vision, cognitive or psychological problems

The pivotal SURMOUNT and SURPASS trial programs primarily focused on weight loss and glycemic outcomes, with reproductive health not designated as a primary endpoint