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ACKNOWLEDGEMENTS We would like to thank the employees of the Experimental Animal Unit, Faculty of Medicine, Kutahya Health Sciences University for their technical support.

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Weight loss outcomes associated with semaglutide treatment for patients with overweight or obesity, JAMA Network (2022) Changes in glucose metabolism and glycemic status with once-weekly subcutaneous semaglutide 2.4 mg among participants with prediabetes in the STEP program, Diabetes Care (2022) What causes obesity & overweight?, Eunice Kennedy Shriver National Institute of Child Health and Human Development (2021) Compounding and the FDA: Questions and Answers, Food and Drug Administration (2024) Semaglutide, a glucagon like peptide-1 receptor agonist with cardiovascular benefits for management of type 2 diabetes, Reviews in Endocrine and Metabolic Disorders (2022) FDA alerts health care providers, compounders and patients of dosing errors associated with compounded injectable semaglutide products, Food and Drug Administration (2024) Thinking of using a compounding pharmacy

At minimum, document: Date, time, and dose of each administration Injection site rotation schedule Batch and lot number of peptide used for each administration Storage temperature logs (daily minimum and maximum) Reconstitution dates and volumes for each vial Subjective observations (appetite changes, energy levels, GI effects) Objective measurements on a defined schedule (weekly, biweekly, or monthly depending on parameter) Good documentation transforms anecdotal experience into usable data

It is about accountability and trust that the patient is being supported, and checks and balances are in place. Last weeks TGA raid comes after semaglutide, peptides, and human growth hormones were seized from a Melbourne pharmacy in March, with the TGA alleging the medications were unlawfully manufactured

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