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Slowing the ramp to the label cadence (2.5 mg start, 2.5 mg steps, four-week holds) dropped that to mid-single digits at every maintenance dose, at no cost to the 12-week result, and the dedicated slow-titration trial reached placebo range. Reaching 15 mg is not the problem

Insulin resistance present in approximately 6580% of cases, independent of body weight, and the primary driver of the androgenic environment in the ovary.[2] Androgen excess elevated testosterone, DHEA-S, or androstenedione, driving most of the visible symptoms: hirsutism, acne, scalp hair thinning, cycle disruption

Response time may be longer, requiring patience before dose adjustment

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Acute injuries may be 80-90% healed, while chronic injuries show substantial improvement but often require additional weeks for complete resolution

The main problem is that AMPs are easily hydrolyzed by proteases and they have certain hemolytic toxicity in vivo