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However, the use of these medications is controversial because they are not approved by the U.S
Yang W-C, et al
In particular, increased plasma insulin concentrations stimulate the gonadotropin releasing hormone (GnRH) pulsatility and potentiate the LH-dependent effect on the ovarian theca cells, leading to the enhanced synthesis of androgens and to the arrest of pre-antral follicle development [13]
This is likely due to structural differences: ipamorelin Aib/D-2-Nal backbone produces a different binding mode at GHS-R1a that may favor specific downstream signaling pathways (biased agonism) compared to the His/D-Trp backbone of GHRP-6
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