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Use a smaller tesamorelin + ipamorelin blend vial size or increase reconstitution volume to lower concentration

Monitoring Schedule Serum IGF-1 at baseline and at 8-12 weeks Fasting glucose at baseline and every 3-6 months (GH increases insulin resistance acutely) Thyroid panel at baseline (hypothyroidism blunts IGF-1 response) Blood pressure and fluid retention assessment at each visit The American Association of Clinical Endocrinology (AACE) recommends IGF-1 be kept within the age- and sex-adjusted reference range during any GH-stimulating therapy to minimize risk of adverse effects including fluid retention and glucose intolerance [9]

In most cases, it improves and resolves on its own as your body adjusts

Zhou M, Xie Y, Xu S, Xin J, Wang J, Han T, Ting R, Zhang J, An F