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Pulsatile versus tonic GH release biology: Studies comparing the downstream biological consequences of pulsatile GH release (produced by short-acting GHRH analogues and GHRPs) versus tonic GH elevation (produced by long-acting GHRH-DAC variants or continuous GH infusion) established that pulsatile GH patterns are more potent drivers of hepatic IGF-1 production and anabolic GH signalling than equivalent total GH doses delivered continuously providing the physiological rationale for preserving pulsatile GH release characteristics in GH secretagogue research designs

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But it also explains why transition periods can look like worsening

5,306 These treatments typically provide rapid relief, but are not recommended for long-term use as they can cause electrolyte imbalances by enhancing the excretion of fluids

Kim SJ, Uehara H, Karashima T, McCarty M, Shih N, Fidler IJ