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Visual inspection Clear solution should remain clear: Any cloudiness = discard Particles floating = discard Color change = discard (especially important for copper peptides) Separation or layers = discard Exception: Some peptides may have slight natural color

A reputable clinic should not simply offer a standard protocol or sell peptides without evaluation

Referral to endocrinology is appropriate in three situations: IGF-1 levels that remain suppressed despite adequate sermorelin dosing (raising concern for pituitary pathology), new-onset diabetes or HbA1c rising above 6.5% after starting sermorelin, or clinical suspicion of cortisol deficiency (fatigue, hypotension, hyponatremia) that may be unmasked by GH-axis stimulation