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To increase the plasma half-life by avoiding renal elimination, GLP-1 analogs were modified by adding acyl groups (liraglutide and semaglutide) or large molecules such as albumin (albiglutide) and the Fc portion of IgG (dulaglutide)

They might need synthetic hormones to keep their metabolism right

One reason is that 503A pharmacies can continue compounding so long as the product is not essentially a copy. Second, although compounding of semaglutide will now be allowed in a narrower set of circumstances, it would be the responsibility of the FDA and the States to enforce compounding lawsa potentially tall order given the recent FDA cuts and limited State capacity for oversight

That means 99 percent of any orally ingested semaglutide gets destroyed in the digestive tract before reaching the bloodstream