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It not only increases the tumorigenesis potential but also creates an immunosuppressive environment for tumor metastasis by impacting chemokine/chemokine receptor signaling (CXCL12-CXCR4 being the primary one)

When injected subcutaneously, the absorption bypass makes the conversion issue less relevant since the B12 enters the bloodstream directly, bypassing the gut entirely

However, a later trial reported improved safety with continuous glucose monitoring 10 and a meta-analysis of 13 RCTs found no increased risk of severe hypoglycemia 13

These effects are not unique to retatrutide but are a recognised consequence of rapid or substantial weight reduction by any means

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