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By binding to GLP-1 receptors throughout the body, they produce a powerful, sustained version of what your natural hormone does but for hours or days at a time rather than minutes
sustained growth-hormone-axis stimulation also carries a theoretical, class-wide concern for worsened insulin resistance, a recognized effect of excess growth hormone exposure generally Evidence snapshot: The strongest available evidence is a small 1997 randomized, placebo-controlled human trial (19 adults aged 55-71) testing a closely related GHRH(1-29) analog over 16 weeks, which found increased IGF-1 in both sexes, a significant lean-mass increase in men only, and increased skin thickness in both sexes
In practice, many obesity specialists have found themselves deviating from the label slowing down titration, adding intermediate doses, maintaining lower doses longer, or skipping weeks to help patients stay on therapy
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