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What it does WELL: Consistently elevates IGF-1 in randomized controlled trials and restores GH secretion to young-adult levels Increases fat-free mass over weeks and months in two-year double-blind RCT data Improves nitrogen retention and protein balance Enhances REM sleep and total sleep duration an approximately 50% increase in stage IV sleep and 20% increase in REM versus placebo Stimulates appetite via central ghrelin signaling What gets ignored: Consistently worsens insulin sensitivity and raises fasting glucose in multiple human trials a repeatable and replicable finding Commonly causes edema and joint discomfort The ensuing appetite dysregulation often leads to unwanted fat gain (i.e

Preservation of iBAT and muscle, alongside preferential loss of white fat, is a favorable outcome, suggesting that weight loss occurred mainly through depletion of excess adipose tissue ( Supplementary Fig

The most important unknowns (cardiovascular safety, evidence on hard kidney outcomes, head-to-head tirals etc) all report between now and 2028

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