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Yes, ipamorelin and sermorelin may be combined in select cases

Effects of GLP-1 RAs on gut microbiota: preclinical and clinical evidence The gut microbiota plays a central role in metabolic regulation, particularly in lipid and energy homeostasis, and its alteration is increasingly recognized as a risk factor for obesity, T2D and cardiovascular disease ( Bacillota (formerly Firmicutes ), Bacteroidota (formerly Bacteroidetes) , and Proteobacteria , with obesity-associated patterns often reflecting decreased microbial diversity and loss of beneficial taxa ( Given this evidence, targeting the gut microbiota has emerged as a potential strategy for preventing or ameliorating metabolic diseases, including T2D and dyslipidemia ( Bacillota and Bacteroidota , may influence insulin sensitivity partly through modulation of GLP-1 secretion

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