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Absolute contraindications include: Active malignancy of any kind (GH and IGF-1 are growth-promoting signals) Active diabetic retinopathy (IGF-1 may worsen retinal vascularity) Pregnancy or breastfeeding Known hypersensitivity to any component of the formulation Pituitary tumours or untreated hypothalamic disease Relative contraindications requiring careful evaluation include pre-existing insulin resistance, type 2 diabetes, uncontrolled cardiovascular disease, and sleep apnoea (GH elevation can worsen upper airway tone in susceptible individuals)