If I recall correctly, I have come across this explanation a few times:
Essentially, you have serum IGF-1 levels circulating in your blood, and you have tissue-specific IGF-1 that is actively working within certain bodily tissues. It is the tissue IGF-1 that is responsible for things like muscle growth/repair, bone development, etc. The only one we are able accurately test for is serum IGF-1, so that is the number you'll see on blood tests, irrespective of your tissue IGF-1 levels. So, basically, a blood test is a relatively poor indicator of how effective or potent your rHGH is.