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GH is a counter-regulatory hormone to insulin, so prolonged use at higher doses can impair glucose tolerance

Mayo Clinics ENDO 2025 study of 120 postmenopausal women found tirzepatide plus HRT produced 17% weight loss vs 14% alone over 18 months, with 45% of HRT users hitting 20%+ loss vs 18% of non-users (see our tirzepatide vs semaglutide analysis)

When combined with potential microvascular issues that block the microscopic capillaries delivering oxygen and nutrients to the tissues, this can induce a state of cellular hypoxia (low oxygen), as the mitochondrial Electron Transport Chain requires oxygen to function

Here is a quick overview of the main differences: Injections are single-hit, with no IV lines or pumps, smaller microdoses of NAD+ are given this way

Dehydration itself trended toward a significant increase in the semaglutide trials (RR 2.16, p = 0.071)