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We can also use Calcium-D-Glucarate to block estrogen recycling from the gut

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Referral to endocrinology is appropriate in three situations: IGF-1 levels that remain suppressed despite adequate sermorelin dosing (raising concern for pituitary pathology), new-onset diabetes or HbA1c rising above 6.5% after starting sermorelin, or clinical suspicion of cortisol deficiency (fatigue, hypotension, hyponatremia) that may be unmasked by GH-axis stimulation