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There are very few instances where this treatment would not be a viable option

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Important note: human safe dosing has not been established for any of these compounds

Lariviere F, Kupranycz DA, Chiasson J-L, Hoffer

WARNINGS Hypersensitivity Reactions Serious hypersensitivity reactions, including anaphylaxis, laryngeal edema, and bronchospasm have been reported following levocarnitine administration, mostly in patients with end-stage renal disease (ESRD) who are undergoing dialysis

The usual mechanistic explanation is that the GHRH arm drives somatotroph cAMP signalling while the GHRP arm additionally attenuates somatostatin tone, so the two are acting on different limbs of the same axis rather than competing for one receptor