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Most compounded semaglutide and compounded tirzepatide should stay refrigerated between 36 degrees F and 46 degrees F (2-8 degrees C)

Im not saying that this is the only reason but it is a very interesting insight and very commonly doctors are not dealing well enough with what is happening in the gastro intestinal tract for these patients with these metabolic conditions
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doi: 10.1016/j.redox.2023.102849

Steinbrechs practice exists to take men across that line