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[52] found that volunteers receiving 600 mg of ALA isomers had plasma concentrations of R-ALA nearly 1.5 times higher, although this enantiomer was cleared more rapidly [3]

This can look like staying at a lower dose of the drug for maintenance therapy or maintaining their regular dosage

The problem is blood supply

In the process, they actually lose more musculature, get a slower metabolism and can permanently plateau. Sleep and stress matter here, too

Pain may shift from constant to activity-related, then diminish further

Compounded medications are not FDA-approved but are prepared by pharmacies regulated by state boards of pharmacy