Side by side

1. 1.Binds GHRH receptors in the pituitary, prompting the gland to release growth hormone in its natural pulsatile pattern.
2. 2.Growth hormone then raises IGF-1, mainly produced in the liver.
3. 3.Unlike continuous growth hormone exposure, pulsatile release favours fat mobilisation over fluid retention.
4. 4.Visceral fat — the fat around internal organs — falls preferentially, while subcutaneous fat changes little.

• HIV-associated lipodystrophy with excess visceral fat (the approved indication)
• Liver fat in people living with HIV
• Visceral adiposity in the general population (studied, not approved)
• Muscle mass and physical function in older adults (small studies)
• Cognitive outcomes in small trials

• Roughly 15–18% reduction in visceral adipose tissue at 26–52 weeks in randomised trials
• Sustained rises in IGF-1
• Reduced liver fat in a subset of participants
• Little change in subcutaneous fat or total body weight
• Improved triglyceride levels in some trials

• Injection-site reactions, sometimes with nodules or bleeding
• Joint pain and peripheral swelling
• Carpal tunnel symptoms
• Raised IGF-1, which requires monitoring
• Possible effects on blood glucose
• Theoretical concern about growth promotion in existing tumours with sustained GH and IGF-1 elevation

Research context only — dosing is set by the prescribing physician. Trials used 2 mg subcutaneously once daily for 26–52 weeks, with IGF-1 monitored periodically. This is not a weight-loss protocol and it is not a general-purpose GH protocol.

Research context only