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The cohort was recruited from 2 internet-based groups in 2005 and 2006 after both Wakefield et al

This creates practical challenges: Storage requirements : Most reconstituted peptides require refrigeration between 2-8C Limited shelf life : Once mixed with bacteriostatic water, most peptides degrade within weeks, not months Travel complications : Bringing peptides on flights requires coolers, prescriptions, and navigating TSA with medical supplies Contamination risk : Repeated needle insertions into vials increase bacterial contamination risk Peptides don't come in convenient pill form

Management: Rotate injection sites daily

e Tang and Yang, 2013