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It works by binding to the ghrelin receptor (GHS-R1a) in the hypothalamus and pituitary, triggering a calcium/PKC signaling cascade that releases stored growth hormone, while separately blunting somatostatin's inhibitory signal

Baltimore patients report sustained energy throughout caloric restriction periods, enabling consistent exercise adherence and improved training performance

But hitting a larger vessel can produce a hematoma, a raised, tender collection of blood under the skin that takes longer to heal

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A trial of T4 may be warranted in a few patients eg if they are symptomatic with goitre or planning pregnancy (see below)