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They're put together by third parties that decide which ingredients to add and in what quantities

Advanced imaging, including total-body computed tomography (CT) and 68 Ga-edotreotide positron emission tomography/CT, revealed no lesions suggestive of insulinoma or other neuroendocrine tumors

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doi: 10.1001/jama.2021.1831 [DOI] [PMC free article] [PubMed] [Google Scholar] 25

The concern is that temperature cycling promotes condensation and aggregation, reducing stability more than consistent storage at either temperature

Do not increase the dose early, even if you feel fine