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So if AOD-9604 isn't acting through the growth hormone receptor, what's the mechanism

It did not outperform lifestyle interventions significantly

Laboratory studies using 5-amino-1MQ in aged animal models have revealed that NNMT inhibition modulates many age-associated metabolic parameters, including alterations in muscle tissue metabolism and cellular stress response pathways

UK guidelines recommend monitoring clinical response and full blood count (typically at around 2 months) to ensure treatment adequacy, rather than routinely rechecking B12 levels after replacement has started