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Because large randomized human trials have not been completed

doi: 10.3389/fimmu.2021.689044

That distinction matters because ipamorelin is studied for its ability to trigger a receptor-mediated pulse, not for acting like a bulk replacement hormone

Studies by Da Broi et al

Composition and Ingredients Bacteriostatic water consists of sterile, highly purified non-pyrogenic water combined with 0.9% benzyl alcohol acting as a preservative