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tesamorelin if visceral fat is the primary target Starting dose — 50% of standard adult dose, titrated up over 4–6 weeks based on IGF-1 response and side effect tolerance Administration — subcutaneous injection, typically at bedtime to align with natural GH pulsatility 8-week reassessment — IGF-1, fasting glucose, HbA1c, symptom review, body composition measurement Ongoing monitoring — every 8–12 weeks