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These drugs have a lower systemic availability owing to extensive pre-systemic metabolism within the mucosa of the small intestine and the liver and are therefore known as topically acting even though they are taken orally[34]

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doi: 10.1146/annurev-immunol-100919-023531 6 NapolitanoMFabbrociniGPotestioLFontanellaGPiconeVBennardoLet al

When you add tyrosine to the N-terminus of the 176-191 fragment, the numbering technically shifts making AOD-9604 more accurately described as Tyr-hGH 177-191