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It upregulates genes involved in collagen synthesis (COL1A1, COL3A1, COL5A1), extracellular matrix remodeling (decorin, fibromodulin), and antioxidant defense (superoxide dismutase, glutathione peroxidase) while simultaneously suppressing genes associated with inflammation (IL-6, TNF-alpha), fibrinogen production, and tissue destruction (several MMPs)

IGF-1 elevation is the primary mechanism through which full HGH increases the risk of insulin resistance, fluid retention, and certain growth-related effects at high doses

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FIGURE 1 The studies included in the qualitative synthesis (Table 2) (Yamane et al., 1995

Site rotation (abdomen, thighs, upper arms) is the commonly reported approach to reduce this reaction