GH is a 191 unit long amino acid sequence, this sequence is called primary protein structure. Next is the secondary structure of GH, this involves the "beta-pleated sheet" and "alpha-helix." Finally, there is tertiary protein structure, which is how these secondary structures are arranged in "3-D" shape (GH is folded into a ball shape). Critical to the tertiary structure of GH are 4 alpha-helix chains that are located all in the correct orientation, this leads to receptor activation and IGF-1 increases, if anything is wrong with the positioning of any one of these 4 alpha-helix structures, IGF-1 production will not occur. When you get a bloodtest for GH, the lab verifies the GH in your blood by its exact molecular weight, this does NOT measure anything about the protein secondary or tertiary structure, only the primary structure. When a liquid chromatograph (LC) is used on GH, it can see "one side" of the molecule in a two dimensional way, so it can verify that one or maybe two of the alpha-helix structures are intact, but it cannot look at all 4. There is no commercially available way to test the structure of GH completely. Now let's assume that a GH manufacturer does everything perfectly and produces well-folded growth hormone, it can still be denatured (unfolded) by environmental factors (usually heat) and thus be unable to produce IGF-1 in the body. Can you assume that GH that tests well but fails to increase IGF-1 is denatured or not folded correctly? No, because some people do not see IGF-1 increases from GH, I have no idea why, but you can google any GH study and see that there are non-responders. Can you assume that the manufacturer or sponsor is to blame if your GH tests as real on bloodwork but fails to increase IGF-1? No, because heat can destroy tertiary structure at any time, including during transport, as can time. Why does GH often give positive results even if it doesn't increase IGF-1 (and side effects)? Proteins "want" to form their correct structure, parts of every 191aa GH chain are probably formed correctly, and GH will be active to some degree even if only one of the alpha-helix secondary structures is complete (HGH Frag 176-191 ring a bell?). Let us hope all our hGH has proper tertiary structure and this is nothing to worry about, but my experience has shown me that much of the GH on the market is denatured or not folded correctly...