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SULT Polymorphisms SULT1A1 has a common variant, Arg213His (rs9282861), that reduces enzyme activity and thermal stability

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Factors Indicating Need for Dose Escalation Increase doses when minimal subjective improvements after 3-4 weeks at current dose, IGF-1 levels show minimal or no meaningful increase from baseline after an adequate trial period (e.g., 812 weeks), good tolerance without significant side effects suggesting room for higher dosing, and treatment goals require more aggressive approach than current dose provides

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