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During the item generation and discussion and clarification phases, the experts identified 14 distinct challenges: costs, supply challenges, lack of evidence, polypharmacy, barriers to prescription, lack of knowledge, adherence concerns, aversion to injection therapy, clinical inertia, titration needs, perceived health state, fear of adverse effects, lack of clinical guideline recommendations, and lack of measurable outcomes to guide therapy

These mechanisms are complementary rather than competitive, potentially making combination use attractive for anti-aging focused researchers

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