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And some are simply taking regulatory risk

PMID: 1809108

Stimulation at these sites is generally low at therapeutic ipamorelin doses, but patients with portal hypertension and altered gut physiology may experience more pronounced ghrelin-pathway effects, including appetite stimulation and gastric motility changes

Examples include 16 : Endometrial uterine polyps Uterine fibroids (leiomyomata) Endometriosis Congenital uterine malformations Intrauterine scarring and adhesions (synechiae), also known as Asherman syndrome 22 Abnormalities of the cervix, whether congenital or acquired through surgery or dysplasia (a precancerous condition), as well as decreased cervical mucous, can disrupt sperm progression and prevent fertilization