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This primarily stems from internal differences, like the amount of intrinsic factor released in the stomach or genetic defects (much like an MTHFR mutation)

DOI: 10.1016/j.pneurobio.2010.01.012

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The most important factor in safe, effective HRT is working with experienced practitioners who specialize in hormonal health and can develop a personalized protocol based on your comprehensive blood panel results, unique biochemistry, symptoms, risk factors, and overall health history