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Its bioavailability is titrated moment-to-moment by the abundance of IGFBP-1 (which fluctuates with insulin and nutritional state), by IGFBP-3 and ALS levels (which are GH-dependent), and by IGFBP proteases that release bound IGF-1 in specific tissues

Start at lower doses to reduce side effects

[4] Mechanistically, the GHRH component recruits and primes the releasable pool of GH inside the somatotroph, while the ghrelin-receptor component triggers release and blunts the somatostatin brake that would otherwise cap the pulse

In a study in which experimental bed rest was imposed on healthy men for 35 days, 60% developed constipation (Iovino 2013)