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If follow-up IGF-1 testing at week 4 shows no elevation above baseline (or an increase of less than 10%), three causes are most likely: the peptide was degraded due to improper storage (sermorelin must be refrigerated at 28C after reconstitution and used within 30 days), the dose is insufficient for your body weight and baseline GH secretion capacity, or you have primary pituitary dysfunction that prevents response to GHRH stimulation