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When Ipamorelin binds to growth hormone secretagogue receptors (GHS-R1a) on the pituitary gland, it triggers a cascade that results in growth hormone release

So think of it as muscle cell proliferation, or even the splitting of the cell so 1 becomes 2

doi:10.2174/157015909787602788 Kappos L, Gold R, Miller DH, Macmanus DG, Havrdova E, Limmroth V, Polman CH, Schmierer K, Yousry TA, Yang M, Eraksoy M, Meluzinova E, Rektor I, Dawson KT, Sandrock AW, ONeil GN, BG-12 Phase IIb Study Investigators (2008) Efficacy and safety of oral fumarate in patients with relapsing-remitting multiple sclerosis: a multicentre, randomised, double-blind, placebo-controlled phase IIb study

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Additionally, your body converts some of the L-Carnitine you produce or eat into other forms of L-Carnitine, specifically Acetyl-L-Carnitine and Propionyl-L-Carnitine