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One key factor is internal resistance

Journal of Clinical Investigation,103, 14891498

Schneider LS, Thomas RG, Hendrix S, Rissman RA, Brewer JB, Salmon DP, et al

Benefits of Nighttime Administration: Synergy with Natural Rhythms: Maximizes the peak GH release that occurs during sleep

We confirm the underlying drivers before recommending a plan, ruling oxidative stress in or out so the therapy targets a real need instead of a guess