Chapter 15 — Further Reading

A note on how this list is organized, because it is unusual and the organization is doing real work.

Sources in this book are sorted by how much you should trust the specifics as printed here, not by how important they are. A Tier 3 item may teach you more than a Tier 1 item; it just should not be cited as though it were a paper.

Tier 1 — Verified canonical

These exist, are findable by the descriptions given, and are the primary literature or primary regulatory record for the claims this chapter makes. Where a specific number appears in the chapter, this tier is where to check it.

The tesamorelin phase 3 program and its US regulatory record (2010). Two randomized, double-blind, placebo-controlled trials in adults with HIV-associated lipodystrophy, with CT-measured visceral adipose tissue as the primary endpoint, plus the FDA review documents and approved labeling that followed. This is the single most useful set of documents in the chapter. Read the label's indication statement first and notice how many qualifiers it contains; then read the clinical pharmacology section and notice what is said about glucose monitoring. Approval-package documents are public.

Fleming TR, DeMets DL. "Surrogate End Points in Clinical Trials: Are We Being Misled?" Annals of Internal Medicine, 1996. The chapter's epigraph comes from this literature, and §15.7 is essentially an application of its argument to one axis. If you read one methodological paper in your life about why a moving biomarker is not a moving patient, read this one. It is short, plain, and thirty years old, which is itself the lesson.

The 2008 two-year randomized trial of MK-677 in healthy older adults, published in a major internal medicine journal. The trial described in Figure 15.1. Worth reading in full rather than in summary, because the honesty of the reporting is part of the education: the surrogate results and the functional results are given equal prominence, and the metabolic findings are not buried.

Standard endocrinology reference chapters on the growth hormone axis — any current major textbook of endocrinology or medical physiology. For the accelerator/brake structure, the pulsatile secretion pattern, IGF-1 as the integrated measure, and negative feedback. If you find yourself arguing about what the axis does, the disagreement is almost always resolvable here rather than in the peptide literature.

The clinical literature on GnRH receptor agonists in prostate cancer, including any current oncology reference on androgen deprivation therapy and the flare phenomenon. This is the documentary basis for Case Study 15.2 and for the claim that continuous stimulation of a pulsatile axis can invert the intended effect.

Tier 2 — Attributed, specifics unverified

These are real bodies of work that this chapter describes accurately in direction but where you should verify any specific number, date, or effect size before repeating it. The chapter deliberately used hedged language ("on the order of," "roughly") for the same reason.

Early-phase human pharmacokinetic and pharmacodynamic work on CJC-1295 with DAC (published in an endocrinology journal in the mid-2000s). Reported sustained GH and IGF-1 elevation for days following single administration in healthy adults. The direction of the finding is well attested; treat the magnitudes with care, and note that this is phase 1 pharmacology, not outcome evidence.

The pharmacological characterization literature on ipamorelin, from the development program that produced it. This is where the selectivity claim originates. Read it for what was actually measured — GH release versus cortisol, prolactin, and food intake — and notice how much narrower the measured claim is than "safe."

Characterization work on GHRP-6 and GHRP-2 / pralmorelin, including the diagnostic-agent literature. Useful for understanding that these compounds have a real pharmacology and a real history that is nonetheless entirely separate from the claims they are currently sold under.

Reviews of growth hormone secretagogues as a class, in endocrine and geriatric journals from roughly 2000 onward. These are a good corrective in both directions: they take the mechanism seriously and they are consistently more cautious about outcomes than any consumer source you will encounter.

Post-approval tesamorelin work in adjacent questions, including studies of liver fat in HIV-associated fatty liver disease. Cited in Case Study 15.1 as an example of what legitimate, incremental indication expansion looks like. Verify the current state before relying on specifics; as of this writing (2026) this remains an area of active investigation rather than a settled second indication.

Tier 3 — Illustrative and constructed

Nothing in this tier is a citation. These are the chapter's own devices, listed so you can tell them apart from the literature — a distinction that a surprising number of sources in this field do not bother to make.

The seven-step diagram in §15.7. Constructed for this chapter as an instantiation of Chapter 2's general sequence. The step labels and the placement of the surrogate/outcome line are the author's, not a standard framework you can cite. The underlying distinction is entirely standard; the diagram is a teaching device.

The "two doors into the same gland" figure in §15.1. A simplification. The real axis includes inputs this diagram omits, and the receptors are represented as doors because that image makes the GHRH-versus-GHS-R split memorable, not because pharmacologists talk that way.

The claim types paraphrased throughout — the clinic email, the website copy, the training-partner report. These are composites written to be representative. No real advertisement, person, or post is quoted anywhere in this chapter, by design.

The three positions on pulsatility in Case Study 15.2. An analytical scaffold constructed to make the argument tractable, not a taxonomy from the literature.

If you only do one thing

Read the tesamorelin approved label's indication statement, out loud, slowly.

It takes forty seconds. Count the qualifiers: which fat compartment, which population, which condition. Then go and read any consumer page selling a growth hormone secretagogue and count the qualifiers there.

The difference between those two documents is the whole chapter. One of them is what it looks like when someone finished the work and was allowed to say only what they proved. The other is what it looks like when nobody had to.