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[20] Pernicious anemia may be present without a person experiencing symptoms at first, over time, feeling tired and weak, lightheadedness, dizziness, headaches, rapid or irregular heartbeat, breathlessness, glossitis (a sore red tongue), poor ability to exercise, low blood pressure, cold hands and feet, pale or yellow skin, easy bruising and bleeding, low-grade fevers, tremor, cold sensitivity, chest pain, upset stomach, nausea, loss of appetite, heartburn, weight loss, diarrhea, constipation, severe joint pain, feeling abnormal sensations including tingling or numbness to the fingers and toes ( pins and needles ), and tinnitus, may occur

These reactions typically resolve with continued use as the skin acclimates, or with dose reduction

Ishiko et al

Peptide drugs affect the body's functions and are often used for bodybuilding, anti-aging, or enhancing athletic performance