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dual pathway GH stimulation mechanisms Endocrine Reviews Growth Hormone Secretagogues Synergistic amplification of GH release with combined GHRH and ghrelin mimetics NCBI LiverTox Tesamorelin Synthetic GHRH analog

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The authors note that GHSs likely behave as functional somatostatin antagonists while enhancing GHRH-secreting neurons, that their GH-releasing effect is independent of gender but undergoes marked age-related variation, and that their activity is not fully specific for GH: they also produce slight prolactin release and, in Cushing disease, ACTH and cortisol responses

A few tiny bubbles might reduce your dose by a negligible amount, but a large air bubble could mean you are getting noticeably less medication than intended