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10.1136/gut.29.8.1035 19 GaldovH.PolozsnyiZ.BreierA.imkoviM

PMID 40465419 characterised hexarelin as the primary hepatic metabolite of alexamorelin a structurally related compound from which hexarelin is generated by carboxypeptidase-mediated C-terminal alanine cleavage (alexamorelin signal decreased approximately 150-fold within 3 hours of hepatocyte incubation)

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Levels decline with age and stress, producing fatigue, brain fog and slower recovery