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Ethics declarations Ethics approval and consent to participate The study protocol was conducted according to the guidelines contained within the Declaration of Helsinki and was approved by the ethics committees of Yokohama City University and Kyoto Prefectural University

Example gradual titration (5/5 vial, once daily SC) - research reference only Weeks 1-2 Tesamorelin 167 mcg Ipamorelin 167 mcg Units (0.10 mL = 10u) 10 units (0.10 mL) Weeks 3-4 Tesamorelin 333 mcg Ipamorelin 333 mcg Units (0.10 mL = 10u) 20 units (0.20 mL) Weeks 5-8 Tesamorelin 500 mcg Ipamorelin 500 mcg Units (0.10 mL = 10u) 30 units (0.30 mL) Weeks 9-16 Tesamorelin 667 mcg Ipamorelin 667 mcg Units (0.10 mL = 10u) 40 units (0.40 mL) Illustrative titration for the 5/5 vial only