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    Compound Guide · Tier 2 · Oral GH Secretagogue

    Ibutamoren:
    The Honest Guide
    You've Been Looking For

    What the research actually shows on MK-677. What the gray market doesn't tell you. Why we don't offer it, and what that says about everyone else who does.

    FDA Status

    Research Compound / Never Approved

    Source

    Gray Market Research Chemical Only

    Physician Pathway

    None Exists

    VitalRx Offers

    Injectable Alternative Available

    📋

    Our promise: This guide tells you what Ibutamoren can't do as clearly as what it can. We disclose non-response rates, reversibility data, and side effect frequencies other sources skip. Where evidence is limited (mostly rodent data, Phase III failures), we say so explicitly. We also explain clearly why VitalRx does not offer MK-677. That decision has a clinical rationale. It's in Section 10.

    01 · Compound Profile

    What Ibutamoren Actually Is

    Ibutamoren (MK-677) is a non-peptide growth hormone secretagogue. It is not a SARM, not a steroid, and not technically a peptide. It is a synthetic ghrelin receptor agonist: a small molecule that binds the GHS-R1a receptor, the same receptor activated by the hunger hormone ghrelin, and instructs the pituitary to release growth hormone.

    This distinction matters clinically. Unlike peptide-based GH secretagogues such as CJC-1295 or Ipamorelin, MK-677 is orally active. One capsule daily. No needles. No reconstitution. No cold-chain shipping. That convenience is the entire source of its popularity. And it is the source of its primary clinical problem.

    1995

    Discovered. Original indication: age-related muscle wasting and GH deficiency. Never approved by FDA.

    24h

    Half-life (oral, once daily). vs. peptide secretagogues: 2-4 hour half-life, subcutaneous.

    Phase 3

    Trials completed: hip fracture, Alzheimer's, sarcopenia. No approved indication.

    ⚖️This Is a Research Chemical

    MK-677 completed Phase III clinical trials for two indications: hip fracture recovery and Alzheimer's disease. It failed or was abandoned in both. The FDA has never approved it for any use. Every capsule sold online is a research chemical sold under a legal fiction. The physicians who "prescribe" it online are operating in a regulatory gray zone that is increasingly being scrutinized.

    02 · Patient Profile

    Who Actually Uses MK-677

    Community research and forum analysis identifies five consistent user profiles for MK-677. Understanding them matters because the compound's appeal is inseparable from its mechanism, and its mechanism has consequences that vary by individual metabolic baseline.

    The Hard Gainer (18-28 male)

    Goal: Adding lean mass without gear. Drawn to MK-677 by hunger stimulation and oral convenience. Primary complaint post-use: fat gain alongside muscle gain, lethargy, and water retention. Typical source: SARMs vendor. Typical dose: 25mg/day.

    The Recovery Patient (35-55, post-injury or surgery)

    Goal: Accelerating healing, improving sleep quality, reducing recovery time. Often physician-adjacent: has asked their doctor and been told 'no.' Metabolic risk is highest in this group if there is pre-existing insulin resistance. Typical dose: 10-12.5mg/day.

    The Biohacker / Longevity Seeker

    Goal: Elevating IGF-1 to 'optimal' levels, improving skin and body composition. Reads Peter Attia, follows longevity Twitter. Often runs low-dose, long-duration protocols. Most likely to track blood work. Typical dose: 10mg/day.

    The Anti-Aging Patient (50+)

    Goal: Reversing age-related GH decline (somatopause). Has tried GHRH/GHRP peptides but prefers oral convenience. Highest risk group for metabolic side effects due to age-associated insulin resistance. Often takes MK-677 alongside metformin. Typical dose: 12.5mg/day.

    The WADA-Risk Athlete

    Goal: Off-season recovery and body composition. Often unaware that MK-677 is prohibited by WADA under S2 (Growth Hormone Secretagogues). Faces potential career consequences if tested. Detection window: up to 3 months post-cessation.

    ⚠️WADA Prohibited: S2 Classification

    MK-677 is explicitly listed on the WADA Prohibited List under S2: Peptide Hormones, Growth Factors, Related Substances and Mimetics. It is prohibited both in-competition and out-of-competition. Any competitive athlete, from weekend race circuits to professional leagues with anti-doping programs, faces real testing risk.

    03 · Mechanism

    The Ghrelin Pathway: Why Convenience Has a Cost

    MK-677 binds the GHS-R1a receptor: the ghrelin receptor. Ghrelin is the hunger hormone. Activating its receptor does two things simultaneously: it stimulates pituitary GH release, and it signals hunger. This is not a side effect. It is the mechanism. You cannot have one without the other.

    Unlike peptide-based GH secretagogues (CJC-1295, Ipamorelin, Tesamorelin), MK-677 achieves sustained, around-the-clock GH and IGF-1 elevation. The half-life is approximately 24 hours. This creates a continuous signal, which is pharmacologically very different from the pulsatile GH release that characterizes normal physiology.

    W0-2

    Onset

    GH and IGF-1 begin to rise. Hunger increases notably. Sleep quality often improves within the first week. Water retention begins.
    W2-6

    Adaptation

    IGF-1 reaches new baseline. Appetite normalizes somewhat. Body composition changes begin (lean mass gain alongside some fat/water gain).
    W6-12

    Clinical Window

    The period where most user-reported body composition changes occur. Blood glucose elevation is measurable by this point in susceptible individuals.
    W12+

    Tolerance Considerations

    Some users report receptor downregulation. Cycling strategies emerge to address this (5-on/2-off, 8-weeks-on/4-off).

    🔬Why Pulsatile vs. Continuous Matters

    The body's natural GH secretion is pulsatile: large bursts, primarily during deep sleep, separated by near-zero GH periods. This pulsatility is not incidental. It is how GH receptor sensitivity is maintained. MK-677's sustained IGF-1 elevation disrupts this pattern. The clinical consequence is not always harmful, but it is why some endocrinologists are more comfortable with pulsatile-mechanism secretagogues (CJC-1295/Ipamorelin) than with continuous oral ghrelin activation.

    📊The Ghrelin Receptor and Blood Sugar

    The GHS-R1a receptor is expressed in the pancreas, hypothalamus, and adipose tissue, not just the pituitary. Systemic ghrelin receptor activation has downstream effects on insulin secretion and glucose metabolism. This is not theoretical. Every major MK-677 clinical trial documented fasting blood glucose elevation. The Nass 2008, Smith 1997, and Svensson 1998 trials all reported this finding. It is a mechanism-linked effect, not a dosing artifact.

    04 · Honest Outcomes

    What MK-677 Actually Does, and What It Doesn't

    The gap between MK-677 forum mythology and clinical trial data is significant. Both directions exist: some claimed benefits are real, some side effects are overstated, and some risks are systematically underreported in community discussion.

    🔴Non-Responder Rate: 25-35%

    At 10mg/day, approximately 25-35% of users see no measurable IGF-1 elevation, based on clinical trial variation data. This is not discussed on most vendor sites or forum guides. If you run 8 weeks without baseline and follow-up IGF-1 labs, you have no way of knowing whether you are responding. This is a testable question. The answer should inform whether you continue.

    What the Evidence Supports

    • Statistically significant IGF-1 elevation in responders (50-90% above baseline in multiple trials)
    • Improved sleep quality, including increased REM and slow-wave sleep, documented in controlled studies
    • Lean mass gains in GH-deficient populations (elderly, post-surgical patients)
    • Improved nitrogen retention

    What the Evidence Does Not Support

    • Fat loss as a primary effect. Most trials show maintained or increased fat mass alongside lean mass gains
    • Cognitive enhancement (one small Alzheimer's trial; results inconclusive)
    • Anti-aging outcomes (no long-term RCT data in healthy populations)
    • "Permanent" gains post-cessation (IGF-1 and GH return to baseline within 4-6 weeks of stopping)

    ⚖️Effects Are Fully Reversible

    IGF-1 returns to baseline within 4-6 weeks of cessation. Any lean mass gains retained post-cycle are due to the training performed during the cycle, not a pharmacological carryover. The compound does not permanently alter the GH axis. This is a feature (safety) and a limitation (no permanent enhancement) simultaneously.

    ⚠️Side Effects That Are Common, Not Rare

    Water retention: reported in 40-60% of users. Increased hunger: near-universal at doses above 10mg. Lethargy and fatigue (particularly in the first 2-4 weeks): reported in approximately 30% of forum discussions. Fasting blood glucose elevation: documented in every major clinical trial. Morning cortisol blunting: reported in subset of users, mechanism unclear. Carpal tunnel-type symptoms at higher doses (25mg+): associated with IGF-1-driven fluid retention.

    05 · Dosing

    Dosing: What the Community Uses vs. What Trials Used

    There is a significant gap between community dosing norms and clinical trial doses. Understanding both is necessary context.

    ProtocolDoseTimingIGF-1 TargetNotes
    Conservative Start10mg/dayBedtime150-250 ng/mLMinimizes side effects; recommended for first cycle
    Standard Community25mg/dayBedtime250-400 ng/mLMost common dose; increased hunger and water retention
    Clinical Trial Doses10-25mg/dayVariableProtocol-dependentNass 2008 used 25mg; Smith 1997 used 25mg
    High Dose (Not Recommended)50mg+BedtimeSupraphysiologicalNo additional benefit; significant side effect increase
    VitalRx ProtocolCJC-1295/IpamorelinBedtime, 5-on/2-offPulsatile IGF-1Physician-supervised, pharmaceutical-grade, legally prescribed

    Protocol

    Conservative Start

    Dose

    10mg/day

    Timing

    Bedtime

    IGF-1 Target

    150-250 ng/mL

    Notes

    Minimizes side effects; recommended for first cycle

    Protocol

    Standard Community

    Dose

    25mg/day

    Timing

    Bedtime

    IGF-1 Target

    250-400 ng/mL

    Notes

    Most common dose; increased hunger and water retention

    Protocol

    Clinical Trial Doses

    Dose

    10-25mg/day

    Timing

    Variable

    IGF-1 Target

    Protocol-dependent

    Notes

    Nass 2008 used 25mg; Smith 1997 used 25mg

    Protocol

    High Dose (Not Recommended)

    Dose

    50mg+

    Timing

    Bedtime

    IGF-1 Target

    Supraphysiological

    Notes

    No additional benefit; significant side effect increase

    Protocol

    VitalRx Protocol

    Dose

    CJC-1295/Ipamorelin

    Timing

    Bedtime, 5-on/2-off

    IGF-1 Target

    Pulsatile IGF-1

    Notes

    Physician-supervised, pharmaceutical-grade, legally prescribed

    Conservative Start

    Dose: 10mg/day · Bedtime

    Target: 150-250 ng/mL

    Standard Community

    Dose: 25mg/day · Bedtime

    Target: 250-400 ng/mL

    Clinical Trial

    Dose: 10-25mg/day · Variable

    Target: Protocol-dependent

    VitalRx Protocol

    Dose: CJC-1295/Ipamorelin · Bedtime, 5-on/2-off

    Target: Pulsatile IGF-1

    🔬Why Bedtime Dosing Is Consensus

    GH secretion peaks during the first phase of deep sleep (slow-wave sleep). Taking MK-677 30-60 minutes before sleep amplifies this natural nocturnal pulse rather than working against it. The same logic applies to CJC-1295/Ipamorelin. Bedtime administration is the clinically-supported dosing window for all GH secretagogues.

    ⚖️Dose and Side Effect Relationship

    The community frequently pushes toward 25mg because it "feels like more is happening." The clinical data does not support dose-dependent benefits above 10mg in most individuals. What does scale with dose: water retention, hunger, blood glucose elevation, and carpal tunnel-type symptoms. The 10mg dose achieves meaningful IGF-1 elevation in responders with a more manageable side effect profile.

    06 · Cycling

    Cycling MK-677: Why the Community Invented Workarounds

    MK-677 was designed in clinical trials as a continuous-use compound. Trials ran 6 months to 2 years of uninterrupted use. The community cycling culture (5-on/2-off, 8-weeks-on/4-off) is not derived from clinical evidence. It emerged from two practical observations: some users report diminished response at 3-4 months of continuous use, and blood glucose management becomes progressively more difficult with extended continuous exposure.

    5-on / 2-off

    Adapted from the CJC-1295/Ipamorelin protocol. No clinical evidence for this with MK-677 specifically. Rationale is GHS-R1a receptor sensitivity maintenance. Minimal impact on IGF-1 elevation continuity.

    8 weeks on / 4 weeks off

    More conservative. Allows blood glucose markers to normalize during the off period. Most commonly used by community members with mild glucose concerns who are unwilling to stop entirely.

    Continuous use (no cycling)

    Closer to clinical trial design. Requires active blood glucose monitoring. Less practical for users without physician oversight.

    ✅Why Injectable Protocols Don't Have This Problem

    The CJC-1295/Ipamorelin 5-on/2-off protocol isn't a workaround. It's the designed administration schedule. Pulsatile GHRH/GHRP activation with regular rest periods maintains receptor sensitivity by design. The cycling question with MK-677 exists because continuous ghrelin receptor activation was never the intended long-term endocrine strategy: it was a pharmaceutical convenience that created its own management challenges.

    07 · Sourcing Reality

    Gray Market Reality: What's Actually in That Capsule

    Every MK-677 capsule sold online is sold under one of two claims: "for research purposes only" or, increasingly, through "telemedicine clinics" whose physicians are operating without a legally defensible prescribing pathway. There is no 503B compounding pharmacy in the United States that can legally compound MK-677. There is no FDA-approved drug. There is no legal prescription pathway.

    ⚖️Third-Party Testing Data Is Inconsistent

    The gray-market research chemical industry produces third-party Certificates of Analysis (CoA) that are routinely cited by vendors as evidence of quality. Independent testing by community members has found: underdosed compounds (70-85% of stated dose in many samples), mislabeled compounds, incorrect isomers, and in some cases, contaminated fillers. A CoA from the same manufacturer who filled the capsules is not independent verification.

    ⚠️The Adulteration Risk No One Discusses

    Several documented cases in community forums involve MK-677 products contaminated with actual SARMs (LGD-4033, RAD-140). This is not theoretical. A user taking what they believe is a research chemical with a known risk profile may unknowingly be consuming an androgen receptor modulator with a very different safety profile and WADA status.

    ✅What VitalRx Does Instead

    VitalRx does not offer MK-677. Not because of demand: MK-677 has significant consumer interest. Because there is no legal pathway to offer it with physician oversight in the United States. What VitalRx does offer: CJC-1295/Ipamorelin through licensed 503B compounding pharmacies, with a physician prescription, pharmaceutical-grade quality verification, cold-chain shipping, and accountability. The comparison is not equivalent compounds. It is the difference between a research chemical and a supervised medical protocol.

    08 · Lab Monitoring

    Labs You Should Run on MK-677 (That Most Guides Don't Mention)

    If you are using or considering MK-677, these are the labs that matter. The glucose-related markers are not optional: they are clinically warranted by the mechanism.

    Primary Efficacy Marker

    IGF-1 (Insulin-Like Growth Factor 1)

    100-300 ng/mL (age-adjusted)

    Run at baseline and day 28. Identifies non-responders early. Identifies supraphysiological elevation in high-dose users.

    Metabolic Safety

    Fasting Blood Glucose

    70-99 mg/dL

    MK-677 elevates fasting glucose in a significant proportion of users. Documented in every major clinical trial. Run at baseline and every 4 weeks.

    Long-Term Glucose

    HbA1c (Glycated Hemoglobin)

    Below 5.7%

    Reflects average blood glucose over 90 days. Provides context for whether fasting glucose readings are an outlier or a pattern.

    Insulin Resistance

    Fasting Insulin / HOMA-IR

    Fasting insulin <10 uIU/mL; HOMA-IR <2.0

    Direct measure of insulin resistance. More sensitive than fasting glucose alone for catching early metabolic changes.

    GH Response

    GH Stimulation / Random GH

    Protocol-dependent

    Rarely run by community users, but relevant if trying to verify response. Random GH is highly variable. IGF-1 is the preferred proxy.

    Hormonal Baseline

    Testosterone (Total + Free) + LH/FSH

    Age and sex-dependent

    MK-677 does not suppress the HPG axis. Running these confirms no suppression and provides baseline for long-term tracking.

    ⚖️The Monitoring Gap in Gray Market Use

    The majority of gray-market MK-677 users run zero lab work. The primary metabolic risk, blood glucose elevation, is asymptomatic at mild-to-moderate levels and will not be caught without testing. Users with pre-existing insulin resistance or family history of T2DM are at measurably higher risk and represent the group most likely to experience progressive glucose dysregulation that goes undetected.

    09 · Stacking

    Stacking MK-677: What Gets Combined and Why

    MK-677 is one of the most frequently stacked compounds in the gray-market community, primarily because its oral convenience makes it easy to layer on top of injectable or SARM protocols.

    StackRationaleAdded RiskNotes
    MK-677 + CJC-1295/IpamorelinDual GH axis stimulationRedundant mechanism; increased costNot recommended: GH axes overlap; choose one pathway
    MK-677 + LGD-4033 (Ligandrol)Lean mass + anabolic stackingHPG axis suppression from SARM; WADA riskMost common gray-market 'beginner stack'
    MK-677 + RAD-140Strength + recoveryRAD-140 is suppressiveHigh WADA risk; limited combination data
    MK-677 + MetforminGlucose management adjunctMetformin requires prescriptionUsed to blunt MK-677 glucose elevation
    MK-677 + BPC-157Tissue repair + GH axisBPC-157 is also a research chemicalNo human trial data on combination
    MK-677 + TB-500Recovery accelerationResearch chemical; no approved pathwayStacked for injury recovery protocols

    Stack

    MK-677 + CJC-1295/Ipamorelin

    Rationale

    Dual GH axis stimulation

    Added Risk

    Redundant mechanism; increased cost

    Notes

    Not recommended: GH axes overlap; choose one pathway

    Stack

    MK-677 + LGD-4033 (Ligandrol)

    Rationale

    Lean mass + anabolic stacking

    Added Risk

    HPG axis suppression from SARM; WADA risk

    Notes

    Most common gray-market 'beginner stack'

    Stack

    MK-677 + RAD-140

    Rationale

    Strength + recovery

    Added Risk

    RAD-140 is suppressive

    Notes

    High WADA risk; limited combination data

    Stack

    MK-677 + Metformin

    Rationale

    Glucose management adjunct

    Added Risk

    Metformin requires prescription

    Notes

    Used to blunt MK-677 glucose elevation

    Stack

    MK-677 + BPC-157

    Rationale

    Tissue repair + GH axis

    Added Risk

    BPC-157 is also a research chemical

    Notes

    No human trial data on combination

    Stack

    MK-677 + TB-500

    Rationale

    Recovery acceleration

    Added Risk

    Research chemical; no approved pathway

    Notes

    Stacked for injury recovery protocols

    MK-677 + CJC/Ipamorelin

    Risk: Redundant mechanism

    Choose one pathway

    MK-677 + LGD-4033

    Risk: HPG suppression + WADA

    Most common 'beginner stack'

    MK-677 + RAD-140

    Risk: Suppressive + WADA

    Limited combination data

    MK-677 + Metformin

    Risk: Requires prescription

    Blunts glucose elevation

    MK-677 + BPC-157

    Risk: Both research chemicals

    No human trial data

    ⚖️The Stacking Problem Is a Monitoring Problem

    Every stack compounds the monitoring complexity. Add a SARM and you need testosterone panel tracking. Add metformin and you need renal function tracking. Run all of these without physician oversight and you have no accountability structure when something shifts. The community's normalization of multi-compound stacking without labs is a population-level experiment with no safety monitoring.

    10 · Pricing Reality

    The Number That Changes How People Think About This Compound

    ⚖️The Number Most Guides Hide

    $15 to $20 per month. That is the cost of 10mg/day MK-677 capsules from a gray-market research chemical vendor. At 25mg/day, you are looking at $60-80/month. This is the price anchor that makes every physician-supervised alternative look expensive by comparison. We are not going to pretend this isn't a real consideration. The question is what you get for the premium, and what risks you're absorbing that aren't priced into the capsule cost.
    SourceProductCostPhysician OversightQuality Verification
    Gray Market VendorMK-677 10mg caps$15-20/monthNoneVendor-issued CoA only
    Gray Market VendorMK-677 25mg caps$60-80/monthNoneVendor-issued CoA only
    "Online Clinic""MK-677 'prescribed'"$80-150/monthNominal503A compounding (questionable legal basis)
    VitalRxMK-677NOT OFFEREDN/ANo legal 503B pathway exists
    VitalRxCJC-1295/IpamorelinMonth 1: $199 all-in / Month 2+: $169Board-certified physician503B licensed pharmacy

    Source

    Gray Market Vendor

    Product

    MK-677 10mg caps

    Cost

    $15-20/month

    Physician Oversight

    None

    Quality Verification

    Vendor-issued CoA only

    Source

    Gray Market Vendor

    Product

    MK-677 25mg caps

    Cost

    $60-80/month

    Physician Oversight

    None

    Quality Verification

    Vendor-issued CoA only

    Source

    "Online Clinic"

    Product

    "MK-677 'prescribed'"

    Cost

    $80-150/month

    Physician Oversight

    Nominal

    Quality Verification

    503A compounding (questionable legal basis)

    Source

    VitalRx

    Product

    MK-677

    Cost

    NOT OFFERED

    Physician Oversight

    N/A

    Quality Verification

    No legal 503B pathway exists

    Source

    VitalRx

    Product

    CJC-1295/Ipamorelin

    Cost

    Month 1: $199 all-in / Month 2+: $169

    Physician Oversight

    Board-certified physician

    Quality Verification

    503B licensed pharmacy

    Gray Market: MK-677 10mg

    Cost: $15-20/mo

    Oversight: None

    Gray Market: MK-677 25mg

    Cost: $60-80/mo

    Oversight: None

    VitalRx: MK-677

    Cost: NOT OFFERED

    Oversight: N/A

    VitalRx: CJC-1295/Ipamorelin

    Cost: $199 M1 / $169 M2+

    Oversight: Physician

    💊What $199 Month 1 Includes

    Physician consultation and protocol design. Baseline IGF-1 lab draw. Pre-constituted vials (CJC-1295 + Ipamorelin), syringes, and alcohol wipes. Cold-chain shipping. 28-day follow-up check-in. A physician accountable for your care who has access to your labs. Compare that to a capsule in an unmarked bag from a research chemical vendor. The price comparison is real. The comparison of what you're buying is not equivalent.

    12 · Community Questions

    The Questions This Community Actually Asks

    13 · The Alternative

    What VitalRx Offers Instead, and Why It's Not Just a Sales Pitch

    We don't offer MK-677. That decision costs us search traffic and conversion from every person who arrives at this page intending to buy it. We made it anyway. The reason is clinical, not moral.

    The mechanism comparison that actually matters: MK-677 activates ghrelin receptors continuously. CJC-1295/Ipamorelin stimulates GH through the GHRH and GHRP pathways in short, pulsatile bursts. The pulsatile approach more closely mirrors natural GH physiology. It produces IGF-1 elevation without the continuous ghrelin receptor activation that drives blood glucose concerns. For most of the population profiles described in Section 02, the injectable protocol produces a comparable GH axis response with a meaningfully better metabolic risk profile.

    💊

    Pharmaceutical-Grade Sourcing

    CJC-1295/Ipamorelin through a licensed 503B compounding pharmacy. Every vial is manufactured to USP standards, independently tested, and shipped cold-chain. No vendor CoAs, no gray-market supply chain, no guessing.
    ⚕️

    Physician Supervision, Not an Algorithm

    Licensed physician consultation before protocol initiation. 28-day check-in after the first cycle. Protocol adjustment based on lab results, not community forum dosing charts. Available in all 50 states via telemedicine.
    📊

    Labs Included, Not Optional

    Baseline IGF-1 before starting. Follow-up IGF-1 at day 28. Non-responders are identified in the first month, not at month three after spending $600 on gray-market capsules. Metabolic markers reviewed by the prescribing physician as part of the protocol.
    ⚖️

    Legal Access, No Regulatory Ambiguity

    CJC-1295/Ipamorelin has a defined legal pathway through 503B compounding. Every patient receives a physician prescription for a pharmaceutical-grade compound sourced from a licensed facility. There are no "research use only" disclaimers on VitalRx packaging.

    🔬The Mechanism Comparison That Matters

    CJC-1295 (no DAC) + Ipamorelin stimulates GH through the GHRH and GHRP pathways: short, pulsatile GH release that mimics natural physiology. The bedtime protocol (5-on/2-off) amplifies the body's natural nocturnal GH pulse. There is no ghrelin receptor activation, no appetite stimulation, and no sustained IGF-1 elevation that carries the glucose burden documented in MK-677 trials. The metabolic profile of pulsatile injectable GHRH/GHRP secretagogues is meaningfully different from continuous oral ghrelin receptor activation.

    Physician-Supervised Protocol · All 50 States

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    Our CJC-1295/Ipamorelin protocol starts at $199 Month 1, all-in. Physician consult, baseline labs, pre-constituted vials, supplies, and cold-chain shipping included.

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