is exendin 4 in tirzepatide Amino acid sequence of comparison to native GIP, GLP-1, Exendin‐4 from Heloderma suspectum venom:

However, once the drug shortage ended, the FDA heavily restricted the sale of compounded semaglutide, citing safety concerns from inconsistent dosing and a lack of rigorous testing

doi:10.1001/jamapsychiatry.2024.4789 Subhani M, Dhanda A, King JA, et al

Oral formulations may allow slightly more gradual absorption, potentially reducing rapid metabolic shifts, but this difference is subtle

Because these compounds affect inflammation and vessel formation, their interaction with the tightly controlled physiology of the peri-operative period is genuinely unknown

I dont know what else I can do. Thats when he suggested Zepbound, a GLP-1 drug for obesity