IF you shoot with auto focus and in aperture-priority or program mode with primes, you could custom make a metal, resin, wood left hand grip that could screw into the side tripod mount, but I think ergonomically that will put more stress on your wrists than if you held the 645N as designed with your left hand palm up cradling the camera underneath, with the base of your palm and fingers around the lens for grip and/or focus, focal length, or aperture changes.
Holding it correctly, your left upper arm rests against your torso and helps brace the camera for stability. On your profile, you're shooting with primes which helps a lot to reduce weight (vs. zooms).
The number one thing that has helped me hike or walk for hours with my 645 is a wide neoprene camera strap. The wide strap distributes the weight while the neoprene stretches to absorb the weight. There are fingerless gloves or neoprene wrist sleeves with velcro that help reduce stress to your hands and wrists that may also help more than adding more weight with a left hand grip accessory.
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