drtbear1967
Musclechemistry Board Certified Member
WOMEN & DRUGS
Clenbuterol
Clenbuterol is prescribed as a bronchodilator for asthma, but also has theadditional effect of increasing metabolism. The claim is a 10% increase inmetabolism over ECA, which claims a 3% increase in metabolism. (I have seen thisoften quoted but never found an original study to back this up.) Clenbuterolhas a 36-39 hour half-life – meaning if you take it, or worse, too much, youhave to ride it out for about a day and a half. Some people panic if they taketoo much, and head to the Emergency Room, where the doctors will still justtell you that you need to ride it out until it wears off. There is nothing youcan take to “make it stop” before then.
Clenbuterol has also been called “anti-catabolic” – meaning it does not promotemuscle loss as part of the increase in metabolism to reduce bodyfat. Here are acouple studies that imply that clenbuterol, interestingly on a restricted diet,does promote some amount of muscle growth (or preservation) in researchanimals:
Some additional considerations when using clenbuterol
Supplement with (3-5g/day) l-taurine –clenbuterol tends to inhibit l-taurine in your system, producing cramps usingKetotifen with clenbuterol (2-3mg ED) Note Ketotifen is prescribed as ananti-histamine. It can make you sleepy so better to take it at night. Effectsof ketotifen and clenbuterolon beta-adrenergic receptor functions oflymphocytes and on plasma TXB-2 levels of asthmatic patients: Using Benedrylwith clenbuterol “Bro-telligence” has often recommended using Benedryl to allowyou to run clenbuterol longer without an "off” cycle to reduce downregulation of receptors. This is NOT true. Benedryl will only help you sleep ifyou’re overstimulated by a clen cycle. Ketotifen is the better choice for longerclen cycles.
With regard to cycling clenbuterol, Isuppose this falls under bro-telligence. Following are two common cycles: 2weeks ‘on’ / 2 weeks ‘off’ for 8-12 weeks Starting at 20 mcg, increasing by 20mcg units as you can handle, until what you can handle or a maximum of100 mcgper day, and then stay at that amount for the duration of the two weeks. Thenstop and go off for 2 weeks, substituting your favorite OTC thermo, and thenrepeating the 2 weeks ‘on’, again starting at 20 mcg. Continued ‘on’ for 8-12 weeks, includeketiotifen Starting at 20 mcg for a week, increase by 20 mcg per week untilwhat you can handle or a maximum of100 mcg per day, and then stay at that amount for the duration of cycle.
Thyroid Medication: T3 and T4
The thyroid hormones thyroxine (T4) and triiodothyronine (T3),are tyrosine-based hormones produced by the thyroid gland primarily responsiblefor regulation of metabolism. T4 converts to T3, with T3 being 3-4 timesstronger than T4. Synthetic T4 (Synthroid) is often prescribed for peoplediagnosed with hypothyroidism (“sluggish thyroid”).
On a side note, thyroid disease is not uncommon in women. I would hesitate toblame “can’t lose weight” on the thyroid, as people often look for pills-basedsolutions or some excuse before they’ll spend the time revisiting their diet& training programs. But that said, if you feel there is an issue, by allmeans, talk to your doctor about it and get a thyroid panel done.
T3 is frequently suggested as part of a fat-loss protocol. It is important tobe conservative with use of T3 if you choose to go that route. You aremanipulating your thyroid via self-medication. Too much and you willimmediately feel lethargic. General guidance also suggests to be slow in yourdosing – taper off when you are coming off instead of just dropping it cold.The body generally can adapt to small changes but tends to rebound with large,sudden changes.
Another very important consideration with T3 is that bumps up metabolism… butthat means metabolism of everything – both lean muscle mass and bodyfat. Womentend to be so focused on “fat loss” that they forget about the importance ofmuscle mass. Building and preserving muscle mass has nothing to do with“looking like a man” or “getting huge”, but rather about the keeping the bodycomponent that helps you burn bodyfat more efficiently, and it also goes intowhat makes up a bodyfat percentage. “What’s your bodyfat?” means what is theratio of lean muscle mass to bodyfat in your body? It is great to drop bodyfat,but if you are sacrificing muscle mass, your overall bodyfat percentage willnot drop the way you want it to. The lack of muscle mass can contribute to ahigher bodyfat percentage (what we often call “skinny-fat”) just as higherbodyfat percentage.
To this end it is not generally recommended to cycle T3 without an anabolicsupport. Either an AAS or, a very common stack is with clenbuterol, which hasbeen shown to be anabolic, or at least anti-catabolic.
Typical Cycle:
It is not recommended to run T3 by itself. Combine either of the following withan AAS or a clen cycle. 25-50 mcg per day, for the duration of your cycle –this keeps it very simple and is not aggressive. Start at 12.5 mcg for a week,increase by 12.5 mcg per week until a maximum of 75 mcg. Then taper back downby 12.5 mcg every 3 days.
“Anti-estrogens”
There are two classes of estrogen manipulators that often fall under the term“anti-estrogens”. The first are Selective Estrogen Receptor Manipulators(SERMs). The only current example out there is Tamoxifen Citrate (brandname: Nolvadex). This operates specifically on the ovarian-driven estrogenprocess. The second category that falls under “anti-estrogens” are AromataseInhibitors (AI’s) that operate not on ovary-originating estrogen, butrather that resulting from aromatization (or conversion to estrogen) oftestosterone. Examples of testosterones that convert are exogenoustestosterones (anabolic androgenic steroids) such as Testosterone Propionate,Nandrolone Decoanate (“Deca”), or Dianabol (“d-bol”). There is also a naturalsource of androgen that converts to estrogen – that produced by the adrenalglands, in both men and women. When women enter menopause and theirovary-originating estrogen is no longer produced, the only remaining source ofnaturally produced estrogen is that resulting from the adrenals. Examples ofAI’s are Arimidex, Aromasin and Letrozole. In practice, both these andNolvadex, are all primarily prescribed as breast cancer treatment forpost-menopausal women.
Women are more likely to use a SERM like Nolvadex to address the bodyfatassociated with estrogen – specifically the stuff that tends to collect aroundthe hips, thighs, lower abdomen and butt. It is important to note that eachperson has her own distribution of fat cells – estrogen tends to promote ahigher concentration of fat cells in those lower areas as part of a naturalpreservation strategy to protect a fetus and also to provide an extra storageof energy source (bodyfat) to help support a growing fetus and the mother if thereis any issue with available food sources (i.e. a drought scenario). This is bydesign and using an estrogen inibitor as a weight-loss strategy is not a goodidea. Estrogen is one of the three basic hormones that make up who we are, anddrive everything from moods to how we look and feel. Estrogen is there for apurpose and should not be completely suppressed only for the purpose of fatloss.
Nolvadex acts to fake out the estrogen receptors (envision a safety protectorthat you put into outlets as part of baby-proofing your house) and essentiallycutting off the estrogen process, instead of literally turning it off. Forcycle duration, it is recommended to keep it to 4-8 weeks maximum. Long-termuse of Nolvadex has the potential to introduce health issues as described inthis article: .In the extreme, full estrogen shut down in women can lead towhat is often referred to as the “Female Athlete Triad” – basically estrogenshutdown as a result of an eating disorder such as anorexia, which leads toreduction in calcium, and eventually to brittle bones and a host of otherissues related to a stopped period. Though this discussion is not focused oneating disorders, the end result, if someone decided to use medical estrogensuppression as a long-term weightloss protocol, is the same. This is just toreinforce that this is not a good idea.
The estrogen process tends to be fairly resilient so coming off a reasonableduration cycle can produce an estrogen rebound when the process is no longerinhibited. There isn’t much documentation about this rebound, but generalguidance is to taper off a cycle by reducing the dose (e.g. in half, every 3days).
In the context of this article, Aromatase Inhibitors are more specific to theestrogen produced as a result of using an aromatizing steroid. This means thatthe steroid cycle is more aggressive and will produce side effects such aswater retention and potentially more mood swings, as the converted estrogen maybe adding to natural estrogen levels, enhancing typical estrogen effects thatmight be experienced during a menstrual cycle. AI’s are more commonly used bymen who cycle as the increase in estrogen can produce such side effects in menas gynocomastia (enlarged breast tissue), water retention, mood swings, etc.For men, as well as women, full estrogen suppression is not helpful if the goalis to build muscle as water (e.g. from estrogen) is needed to create a “grow the environment” in the muscle. . (This article is more geared towards men and theuse of AIs to prevent gynecomastia, it still gives some context for value ofestrogen in building muscle: Estrogen suppression can help to create a tighterlook (e.g. for competition), but full suppression can produce too much dryness,including painful joints.
Generally speaking AI’s are not recommended for pre-menopausal women who arenew to steroid cycling or using non-aromatizing compounds. If they choose touse an AI, it needs to be very conservatively used, as it is very easy to shutdown estrogen with these compounds. The effects are similar to that noted abovefor long-term use of Nolvadex – hot flashes, etc.
Typical Use:
Primarily Nolvadex is used during the last 4-8 weeks of a contest prep to helpreduce bodyfat in the hips / thighs / waist area. Again, it will not do theheavy lifting, but will support a tight contest prep. It is possible toexperience either immediate interruption of menstrual flow, or breakthroughbleeding within 4 weeks of starting the cycle. Also once coming off, theeffects will not be maintained and the estrogen-pattern bodyfat depositing willcontinue again. “Estrogen rebound” is often experienced as well, thus the taperdown is recommended. Because of the potential of this rebound it is recommendedto cycle Nolvadex with a specific end / target date in mind, followed by anexpected rebound while your body recovers from the prep phase.
More aggressive aromatase inhibitors are not generally recommended unless youare an experienced cycler running aromatizing compounds such as NPP. If yourcycle is intended for a bulker phase, then don’t use the AIs as you need theestrogen to build muscle mass and the water gain is minimal with most compoundswomen use.
Typical Cycle: Nolvadex: 10- 20 mg per day, split in half AM and half PMfor maximum of 8 weeks. Arimidex: 0.5 mg EOD (only with an aromatizing AAS) formaximum of 6-8 weeks AIs are very aggressive and will produce dry-feelingjoints. If you experience aggressive hot/cold flashes and feeling sick, taperoff over a couple days and stay off. Aromasin: 25 mg EOD (only with anaromatizing AAS) for a maximum of 6-8 weeks. AIs are very aggressive and willproduce dry-feeling joints. If you experience aggressive hot/cold flashes andfeeling sick, taper off over a couple days and stay off.
Human Growth Hormone (hGH)
Growth Hormone is often recommended for “fat loss”. It is not a “fat burner” inthe same sense as clen or ephedrine, but instead falls under the largercategory of “anti-aging” compounds or “hormone replacement therapy”. In thesecontexts, it is intended to be dispensed under the supervision of a qualifiedphysician based on constant monitoring of IGF-1 levels. This is the indicatorused to track growth hormone production by the hypothalamus. Essentially thisis what drives “youthfulness”. The hypothalamus produces optimal levels ofgrowth hormone around age 18-21. These levels begin to decrease after age 30-35as the hypothalamus shrinks with age. The idea behind supplementing with hGH isto return the levels of growth hormone to optimal levels, as if you were stillin the prime of your life.
In practical use, as mentioned above, hGH is used for its anti-agingproperties, as a maintenance protocol for older folks, or to promote thoseyouthful properties with specific interest in promoting fat loss, or rather notpromoting age-related fat depositing, or stacked with an AAS cycle to enhancethe overall effect. Please refer to the following profile link for a much morein-depth article written by Leigh Penman.
Typical Use:
GH is often recommended for women for ‘weight loss’. By itself, GH does NOTpromote muscle growth in the same sense as AAS, as it is not sex hormone.Instead, it will work to promote those youthful features such as healthy hair,improved skin elasticity, better sense of well-being, better healingcapability, and more optimized metabolism to promote a preference for lessbodyfat. It might also be viewed as a support during the extremes ofcompetition prep for the body. With a steroid cycle, such as anavar, it wouldwork to enhance the effects of that compound. The effects of a GH cycle are notimmediate and dramatic, but rather subtle and slow to show over time.
Typical Cycle: Dose:For non-competition use, and more for generalmaintenance and youthfulness: 1 iu per day For competition / with a cycle: 2-3iu per day Primarily for cost purposes, 5 days on / 2 days off is oftensuggested. Duration: 4-6 months is ideal. Very short cycles such as a month,are not really going to show any particular results for the cost.
Potential Sides: Some people experiencewater retention. The dose can be dropped or the dose increased but split across2 days instead of 1 day (i.e. E2D instead of E1D). At higher doses (e.g. 4 iu)wrist pain similar to carpal tunnel syndrome is commonly experienced Veryaggressive use may fall into the extreme category of acromegaly.
Clenbuterol
Clenbuterol is prescribed as a bronchodilator for asthma, but also has theadditional effect of increasing metabolism. The claim is a 10% increase inmetabolism over ECA, which claims a 3% increase in metabolism. (I have seen thisoften quoted but never found an original study to back this up.) Clenbuterolhas a 36-39 hour half-life – meaning if you take it, or worse, too much, youhave to ride it out for about a day and a half. Some people panic if they taketoo much, and head to the Emergency Room, where the doctors will still justtell you that you need to ride it out until it wears off. There is nothing youcan take to “make it stop” before then.
Clenbuterol has also been called “anti-catabolic” – meaning it does not promotemuscle loss as part of the increase in metabolism to reduce bodyfat. Here are acouple studies that imply that clenbuterol, interestingly on a restricted diet,does promote some amount of muscle growth (or preservation) in researchanimals:
Some additional considerations when using clenbuterol
Supplement with (3-5g/day) l-taurine –clenbuterol tends to inhibit l-taurine in your system, producing cramps usingKetotifen with clenbuterol (2-3mg ED) Note Ketotifen is prescribed as ananti-histamine. It can make you sleepy so better to take it at night. Effectsof ketotifen and clenbuterolon beta-adrenergic receptor functions oflymphocytes and on plasma TXB-2 levels of asthmatic patients: Using Benedrylwith clenbuterol “Bro-telligence” has often recommended using Benedryl to allowyou to run clenbuterol longer without an "off” cycle to reduce downregulation of receptors. This is NOT true. Benedryl will only help you sleep ifyou’re overstimulated by a clen cycle. Ketotifen is the better choice for longerclen cycles.
With regard to cycling clenbuterol, Isuppose this falls under bro-telligence. Following are two common cycles: 2weeks ‘on’ / 2 weeks ‘off’ for 8-12 weeks Starting at 20 mcg, increasing by 20mcg units as you can handle, until what you can handle or a maximum of100 mcgper day, and then stay at that amount for the duration of the two weeks. Thenstop and go off for 2 weeks, substituting your favorite OTC thermo, and thenrepeating the 2 weeks ‘on’, again starting at 20 mcg. Continued ‘on’ for 8-12 weeks, includeketiotifen Starting at 20 mcg for a week, increase by 20 mcg per week untilwhat you can handle or a maximum of100 mcg per day, and then stay at that amount for the duration of cycle.
Thyroid Medication: T3 and T4
The thyroid hormones thyroxine (T4) and triiodothyronine (T3),are tyrosine-based hormones produced by the thyroid gland primarily responsiblefor regulation of metabolism. T4 converts to T3, with T3 being 3-4 timesstronger than T4. Synthetic T4 (Synthroid) is often prescribed for peoplediagnosed with hypothyroidism (“sluggish thyroid”).
On a side note, thyroid disease is not uncommon in women. I would hesitate toblame “can’t lose weight” on the thyroid, as people often look for pills-basedsolutions or some excuse before they’ll spend the time revisiting their diet& training programs. But that said, if you feel there is an issue, by allmeans, talk to your doctor about it and get a thyroid panel done.
T3 is frequently suggested as part of a fat-loss protocol. It is important tobe conservative with use of T3 if you choose to go that route. You aremanipulating your thyroid via self-medication. Too much and you willimmediately feel lethargic. General guidance also suggests to be slow in yourdosing – taper off when you are coming off instead of just dropping it cold.The body generally can adapt to small changes but tends to rebound with large,sudden changes.
Another very important consideration with T3 is that bumps up metabolism… butthat means metabolism of everything – both lean muscle mass and bodyfat. Womentend to be so focused on “fat loss” that they forget about the importance ofmuscle mass. Building and preserving muscle mass has nothing to do with“looking like a man” or “getting huge”, but rather about the keeping the bodycomponent that helps you burn bodyfat more efficiently, and it also goes intowhat makes up a bodyfat percentage. “What’s your bodyfat?” means what is theratio of lean muscle mass to bodyfat in your body? It is great to drop bodyfat,but if you are sacrificing muscle mass, your overall bodyfat percentage willnot drop the way you want it to. The lack of muscle mass can contribute to ahigher bodyfat percentage (what we often call “skinny-fat”) just as higherbodyfat percentage.
To this end it is not generally recommended to cycle T3 without an anabolicsupport. Either an AAS or, a very common stack is with clenbuterol, which hasbeen shown to be anabolic, or at least anti-catabolic.
Typical Cycle:
It is not recommended to run T3 by itself. Combine either of the following withan AAS or a clen cycle. 25-50 mcg per day, for the duration of your cycle –this keeps it very simple and is not aggressive. Start at 12.5 mcg for a week,increase by 12.5 mcg per week until a maximum of 75 mcg. Then taper back downby 12.5 mcg every 3 days.
“Anti-estrogens”
There are two classes of estrogen manipulators that often fall under the term“anti-estrogens”. The first are Selective Estrogen Receptor Manipulators(SERMs). The only current example out there is Tamoxifen Citrate (brandname: Nolvadex). This operates specifically on the ovarian-driven estrogenprocess. The second category that falls under “anti-estrogens” are AromataseInhibitors (AI’s) that operate not on ovary-originating estrogen, butrather that resulting from aromatization (or conversion to estrogen) oftestosterone. Examples of testosterones that convert are exogenoustestosterones (anabolic androgenic steroids) such as Testosterone Propionate,Nandrolone Decoanate (“Deca”), or Dianabol (“d-bol”). There is also a naturalsource of androgen that converts to estrogen – that produced by the adrenalglands, in both men and women. When women enter menopause and theirovary-originating estrogen is no longer produced, the only remaining source ofnaturally produced estrogen is that resulting from the adrenals. Examples ofAI’s are Arimidex, Aromasin and Letrozole. In practice, both these andNolvadex, are all primarily prescribed as breast cancer treatment forpost-menopausal women.
Women are more likely to use a SERM like Nolvadex to address the bodyfatassociated with estrogen – specifically the stuff that tends to collect aroundthe hips, thighs, lower abdomen and butt. It is important to note that eachperson has her own distribution of fat cells – estrogen tends to promote ahigher concentration of fat cells in those lower areas as part of a naturalpreservation strategy to protect a fetus and also to provide an extra storageof energy source (bodyfat) to help support a growing fetus and the mother if thereis any issue with available food sources (i.e. a drought scenario). This is bydesign and using an estrogen inibitor as a weight-loss strategy is not a goodidea. Estrogen is one of the three basic hormones that make up who we are, anddrive everything from moods to how we look and feel. Estrogen is there for apurpose and should not be completely suppressed only for the purpose of fatloss.
Nolvadex acts to fake out the estrogen receptors (envision a safety protectorthat you put into outlets as part of baby-proofing your house) and essentiallycutting off the estrogen process, instead of literally turning it off. Forcycle duration, it is recommended to keep it to 4-8 weeks maximum. Long-termuse of Nolvadex has the potential to introduce health issues as described inthis article: .In the extreme, full estrogen shut down in women can lead towhat is often referred to as the “Female Athlete Triad” – basically estrogenshutdown as a result of an eating disorder such as anorexia, which leads toreduction in calcium, and eventually to brittle bones and a host of otherissues related to a stopped period. Though this discussion is not focused oneating disorders, the end result, if someone decided to use medical estrogensuppression as a long-term weightloss protocol, is the same. This is just toreinforce that this is not a good idea.
The estrogen process tends to be fairly resilient so coming off a reasonableduration cycle can produce an estrogen rebound when the process is no longerinhibited. There isn’t much documentation about this rebound, but generalguidance is to taper off a cycle by reducing the dose (e.g. in half, every 3days).
In the context of this article, Aromatase Inhibitors are more specific to theestrogen produced as a result of using an aromatizing steroid. This means thatthe steroid cycle is more aggressive and will produce side effects such aswater retention and potentially more mood swings, as the converted estrogen maybe adding to natural estrogen levels, enhancing typical estrogen effects thatmight be experienced during a menstrual cycle. AI’s are more commonly used bymen who cycle as the increase in estrogen can produce such side effects in menas gynocomastia (enlarged breast tissue), water retention, mood swings, etc.For men, as well as women, full estrogen suppression is not helpful if the goalis to build muscle as water (e.g. from estrogen) is needed to create a “grow the environment” in the muscle. . (This article is more geared towards men and theuse of AIs to prevent gynecomastia, it still gives some context for value ofestrogen in building muscle: Estrogen suppression can help to create a tighterlook (e.g. for competition), but full suppression can produce too much dryness,including painful joints.
Generally speaking AI’s are not recommended for pre-menopausal women who arenew to steroid cycling or using non-aromatizing compounds. If they choose touse an AI, it needs to be very conservatively used, as it is very easy to shutdown estrogen with these compounds. The effects are similar to that noted abovefor long-term use of Nolvadex – hot flashes, etc.
Typical Use:
Primarily Nolvadex is used during the last 4-8 weeks of a contest prep to helpreduce bodyfat in the hips / thighs / waist area. Again, it will not do theheavy lifting, but will support a tight contest prep. It is possible toexperience either immediate interruption of menstrual flow, or breakthroughbleeding within 4 weeks of starting the cycle. Also once coming off, theeffects will not be maintained and the estrogen-pattern bodyfat depositing willcontinue again. “Estrogen rebound” is often experienced as well, thus the taperdown is recommended. Because of the potential of this rebound it is recommendedto cycle Nolvadex with a specific end / target date in mind, followed by anexpected rebound while your body recovers from the prep phase.
More aggressive aromatase inhibitors are not generally recommended unless youare an experienced cycler running aromatizing compounds such as NPP. If yourcycle is intended for a bulker phase, then don’t use the AIs as you need theestrogen to build muscle mass and the water gain is minimal with most compoundswomen use.
Typical Cycle: Nolvadex: 10- 20 mg per day, split in half AM and half PMfor maximum of 8 weeks. Arimidex: 0.5 mg EOD (only with an aromatizing AAS) formaximum of 6-8 weeks AIs are very aggressive and will produce dry-feelingjoints. If you experience aggressive hot/cold flashes and feeling sick, taperoff over a couple days and stay off. Aromasin: 25 mg EOD (only with anaromatizing AAS) for a maximum of 6-8 weeks. AIs are very aggressive and willproduce dry-feeling joints. If you experience aggressive hot/cold flashes andfeeling sick, taper off over a couple days and stay off.
Human Growth Hormone (hGH)
Growth Hormone is often recommended for “fat loss”. It is not a “fat burner” inthe same sense as clen or ephedrine, but instead falls under the largercategory of “anti-aging” compounds or “hormone replacement therapy”. In thesecontexts, it is intended to be dispensed under the supervision of a qualifiedphysician based on constant monitoring of IGF-1 levels. This is the indicatorused to track growth hormone production by the hypothalamus. Essentially thisis what drives “youthfulness”. The hypothalamus produces optimal levels ofgrowth hormone around age 18-21. These levels begin to decrease after age 30-35as the hypothalamus shrinks with age. The idea behind supplementing with hGH isto return the levels of growth hormone to optimal levels, as if you were stillin the prime of your life.
In practical use, as mentioned above, hGH is used for its anti-agingproperties, as a maintenance protocol for older folks, or to promote thoseyouthful properties with specific interest in promoting fat loss, or rather notpromoting age-related fat depositing, or stacked with an AAS cycle to enhancethe overall effect. Please refer to the following profile link for a much morein-depth article written by Leigh Penman.
Typical Use:
GH is often recommended for women for ‘weight loss’. By itself, GH does NOTpromote muscle growth in the same sense as AAS, as it is not sex hormone.Instead, it will work to promote those youthful features such as healthy hair,improved skin elasticity, better sense of well-being, better healingcapability, and more optimized metabolism to promote a preference for lessbodyfat. It might also be viewed as a support during the extremes ofcompetition prep for the body. With a steroid cycle, such as anavar, it wouldwork to enhance the effects of that compound. The effects of a GH cycle are notimmediate and dramatic, but rather subtle and slow to show over time.
Typical Cycle: Dose:For non-competition use, and more for generalmaintenance and youthfulness: 1 iu per day For competition / with a cycle: 2-3iu per day Primarily for cost purposes, 5 days on / 2 days off is oftensuggested. Duration: 4-6 months is ideal. Very short cycles such as a month,are not really going to show any particular results for the cost.
Potential Sides: Some people experiencewater retention. The dose can be dropped or the dose increased but split across2 days instead of 1 day (i.e. E2D instead of E1D). At higher doses (e.g. 4 iu)wrist pain similar to carpal tunnel syndrome is commonly experienced Veryaggressive use may fall into the extreme category of acromegaly.
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