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First, healthy-user bias is a major concern: individuals prescribed newer, more expensive agents such as semaglutide may systematically differ from comparator groups in terms of health behaviors, dietary patterns, physical activity, adherence to medical care, and access to healthcare resources

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The trade-off: you don't get the metabolic benefits of pulsatile GH (lipolysis spikes, acute insulin sensitivity modulation), and the constant IGF-1 elevation creates steady negative feedback to the hypothalamic-pituitary-somatotropic axis

A new commentary in the Journal of Managed Care & Specialty Pharmacy makes the distinction explicit