Peptide therapy, graded on the evidence

What is peptide therapy?

Peptide therapy is treatment with peptides: short chains of amino acids, typically 2 to 50 of them linked together¹. Semaglutide, for example, is a chain of 31¹¹¹². Definitions differ at the edges: US federal rules count any chain of more than 40 amino acids as a protein, so tesamorelin, a chain of 44, falls under the separate rules for biological products¹³¹⁴¹⁵.

Peptide drugs are not new: by 2021, more than 80 had reached the market, for diseases including diabetes, cancer, osteoporosis, multiple sclerosis and HIV infection².

Today the term covers two very different things: approved prescription drugs tested in large trials⁵⁷, and mostly unapproved peptides sold by clinics, telehealth companies and websites for weight loss, injury recovery, muscle, skin or slower aging^91016171819. Some products sold alongside them, such as NAD+, are not peptides at all²⁰.

Which peptides are approved drugs?

Semaglutide, tirzepatide, tesamorelin and bremelanotide are FDA-approved peptide drugs, each a prescription medicine for specific conditions^11212223.

• Semaglutide, a lab-made version of the gut hormone GLP-1, is sold as Ozempic and Rybelsus for type 2 diabetes and as Wegovy for weight management, heart-risk reduction in adults with heart disease and excess weight, and MASH, a fatty liver disease with inflammation¹¹²⁴²⁵.
• Tirzepatide was approved as Mounjaro for type 2 diabetes on 13 May 2022 and as Zepbound for weight management on 8 November 2023, then for obstructive sleep apnea (repeated blocking of the airway during sleep) in adults with obesity on 20 December 2024²¹²⁶.
• Tesamorelin was approved as Egrifta on 10 November 2010 to reduce excess belly fat in adults with HIV and lipodystrophy, an abnormal shift in where the body stores fat; its labels say it is not for weight loss¹³²²²⁷.
• Bremelanotide was approved as Vyleesi on 21 June 2019 for low sexual desire that causes distress in women before menopause; its label says it is not for men or for enhancing sexual performance²³²⁸. Vials sold online under its code name, PT-141, are unapproved drugs in FDA’s view²⁹.

Sermorelin was approved in 1997, as Geref, for children who make too little growth hormone, but its maker stopped selling it in 2008; FDA later found this was not for safety or effectiveness reasons³⁰³¹³². Novo Nordisk expects an FDA decision on CagriSema, which pairs cagrilintide with semaglutide, in late 2026, and Eli Lilly plans to seek approval for retatrutide, which is not approved anywhere, in the first quarter of 2027³³³⁴³⁵.

What do clinics and online sellers offer?

Clinics, med spas and telehealth companies sell compounded peptides, which are versions made by pharmacies rather than drug companies¹⁶³⁶³⁷. FDA says compounded drugs are not FDA-approved, so it does not check their safety, effectiveness or quality before they are sold³⁷.

In a secret-shopper study from August to October 2025, researchers found 75 clinics and med spas in West Virginia and Oklahoma still offering compounded GLP-1 drugs after the shortages of the approved versions ended³⁶. They identified 23 compounding facilities as suppliers, and 4 of 21 were not licensed for sterile compounding³⁶. In August 2026 the telehealth company Hims & Hers told investors it would sell NAD+, sermorelin and glutathione by the end of the year¹⁶. It has also begun stability and validation testing for BPC-157¹⁶.

Websites also sell peptide vials labeled “for research purposes” or “not for human consumption”¹⁷²⁹. These “research use only” (RUO) labels do not make the products legal for people: in August 2026, FDA warning letters said sellers’ own websites, including a “peptide calculator”, a “peptide guide” and comparison posts, showed the vials were really sold for human use^17383940.

Does peptide therapy work?

It depends on the peptide and the use: some have large randomized controlled trials, in which people are assigned by chance to the drug or a placebo (a dummy treatment), while for others FDA found no study in people at all⁵⁹.

• Large trials, large effects: semaglutide cut body weight by 14.9% over 68 weeks, versus 2.4% on placebo, and tirzepatide’s top dose by 20.9% over 72 weeks, versus 3.1%⁵⁷. Retatrutide’s top dose cut weight by 25.0% over 80 weeks, versus 3.9%, in a trial published in September 2026, but it is not approved anywhere³⁴⁴¹.
• Large trials, narrower effects: tesamorelin cut deep belly fat in adults with HIV and lipodystrophy by about 15% more than placebo, but the fat returned after stopping^13424344. Bremelanotide raised sexual desire slightly more than placebo, but not the number of satisfying sexual events⁴⁵.
• Small or negative human studies: the only placebo-controlled trial of BPC-157 in patients that FDA found showed no clear benefit, and neither did the only published patient trial of ipamorelin that we found⁸⁴⁶. Two 2026 reviews found no good evidence that NAD+ drips or shots work for energy or anti-aging⁴⁷⁴⁸.
• Little or nothing in people: FDA found no published study that gave MOTS-c to humans and no study that gave TB-500 to people, and healing claims for BPC-157 rest on animal studies⁸⁹¹⁰⁴⁹.

A trial result applies only to the product tested: we found no published trial of research-labeled or compounded tirzepatide, for example. A registered study with groups taking compounded tirzepatide had not started recruiting on 8 October 2026⁵⁰. The evidence table near the end of this guide sorts every compound covered here by its best human evidence.

Is peptide therapy safe?

Risks are best known for approved drugs, whose labels list problems found in large trials¹¹⁵¹. The labels for semaglutide and tirzepatide open with a boxed warning, a warning printed in a box, because both drugs caused thyroid tumors in rodents, with the risk in people unknown; they also warn of pancreatitis (an inflamed pancreas) and gallbladder disease¹¹⁵¹. Bremelanotide raises blood pressure after each dose, and 40% of women in its large trials had nausea²³. Long-term effects are less certain: tesamorelin’s labels say its long-term heart safety is not established, and retatrutide’s safety data run to about two years¹³²²⁵².

Many peptides sold online have little or no safety data in people: FDA found no human safety data and no animal safety studies for MOTS-c or TB-500, and says it lacks enough information to know whether BPC-157 or DSIP would cause harm in people⁹¹⁰⁵³. Quality is another risk: Finnrick, a testing company, failed 92 of its latest 200 BPC-157 samples and 63 of its latest 200 retatrutide samples, as of 30 September 2026⁵⁴⁵⁵. People choose which samples to send, so the results are not a random survey⁵⁶. In a 2024 study, endotoxin, a bacterial toxin, was found in all three semaglutide vials bought online, at a raised level in one⁵⁷⁵⁸. Fake “semaglutide” that contained insulin put two people into a coma⁵⁹. Our guide to peptide side effects covers these risks in more detail, from the labels of approved drugs to research peptides and the risks of injecting.

• Victoria, Australia, warned in June 2026 of acute liver injury linked to products labeled retatrutide; a seventh case was reported by 24 August 2026⁶⁰⁶¹.
• At least 30 people developed fever, chills or shock-like illness after IV drips made with supplement-grade glutathione, FDA said in August 2026⁶².
• Reuters reported in September 2026 that FDA’s adverse-event reporting system held 10 serious reports involving BPC-157 since 2021, eight of them from 2026, though a report does not prove the product caused the harm⁶³.
• An NBC News investigation of US states found that, in many cases, no one is tracking the risks from peptides⁶⁴.

Is peptide therapy legal?

In the US, approved peptide drugs are legal with a prescription, but unapproved peptides cannot legally be sold as drugs for people unless a pharmacy compounds them within FDA’s rules¹¹¹⁷⁶⁵. Pharmacies compound under section 503A of US drug law unless they register with FDA as outsourcing facilities, which follow section 503B³⁷⁶⁵. Under 503A, a pharmacy may use only ingredients that have an official quality standard, are part of an approved drug, or are on FDA’s list of allowed bulk substances⁶⁵. Our legal tracker shows each compound’s FDA, compounding, sport and Australian status.

• While FDA reviews nominated ingredients, it does not intend to act against pharmacies that use those in its Category 1, such as glutathione, NAD+ and GHK-Cu (except as an injection), under an interim policy that is not approval⁶⁵⁶⁶. BPC-157, TB-500, MOTS-c, CJC-1295 and ipamorelin are in no 503A category, so US pharmacies may not compound them⁵³⁶⁶. Under the separate 503B policy for outsourcing facilities, ipamorelin is in Category 2, the list of ingredients that may present significant safety risks⁵³.
• In July 2026 FDA’s advisory committee on compounding voted in favor of allowing six peptides, including BPC-157, TB-500 and MOTS-c, but the vote is only advice, and no proposed rule had appeared by 8 October 2026^67686970.
• The shortages that allowed mass compounding of semaglutide and tirzepatide are over, and FDA says retatrutide and cagrilintide cannot be used in compounding under federal law¹⁷⁷¹.
• Selling “research use only” vials for human use is illegal¹⁷. In July 2026 prosecutors in Michigan announced a 21-month prison sentence for a seller whose websites sold semaglutide and tirzepatide “for research purposes only”⁷². Prosecutors in Indiana also announced a 70-month sentence for the owner of Paradigm Peptides, which sold peptides and other unapproved drugs for human use⁷³.
• Health Canada says research-use-only labeling “does not make these products legal”, and in Australia possessing BPC-157, TB-500, CJC-1295, ipamorelin and others without authority is illegal⁷⁴⁷⁵.
• The World Anti-Doping Agency (WADA) bans BPC-157 in sport at all times as an unapproved substance, and tesamorelin, sermorelin, CJC-1295 and ipamorelin as growth hormone releasers⁷⁶⁷⁷⁷⁸.

What does peptide therapy cost?

As of 6 February 2026, the White House said Ozempic, Wegovy and Zepbound injections averaged about $350 a month on its TrumpRx.gov website, down from $1,028 to $1,349⁷⁹. Some doses cost less: as low as $199 for Ozempic and Wegovy and $299 for Zepbound, with the Wegovy pill from $149⁷⁹.

Paying is hard for many users: in a KFF poll taken from 27 October to 2 November 2025, 56% of GLP-1 users said the drugs were difficult to afford, and 27% of those with health insurance paid the full cost themselves⁸⁰.

Prices for compounded and unapproved peptides vary by clinic and seller and are not published in a comparable way, so this page does not quote them. A low price is no reassurance: FDA lists “deep discounts or prices that seem too good to be true” among the warning signs of an unsafe online pharmacy⁴.

How can you check a peptide claim?

Public records can show whether a product is approved, what for, and whether a study reported results³²²⁸¹.

• Approval: FDA’s Drugs@FDA database lists drugs approved for human use in the US and, for brand-name prescription drugs, usually their latest label and FDA staff reviews of safety and effectiveness³.
• Approved use: a label states what a drug is approved for, and Egrifta’s labels, for example, say tesamorelin is not for weight loss¹³²².
• Trials: a listing on ClinicalTrials.gov, the US government’s trial registry, is not a result; an industry study of BPC-157 gummies finished in November 2025 without posting results, and one sponsor of BPC-157 and TB-500 listings has a record that calls itself “fictional”⁸¹⁸²⁸³.
• Lab tests: a result describes only the sample tested; Finnrick’s samples are chosen by its users, not drawn at random, and FDA found that one public certificate of analysis (a supplier’s test report) for TB-500 covered only appearance, identity and purity⁹⁵⁶⁸⁴.

The evidence at a glance

A tier grades the best human evidence for any use, not whether a compound is safe. Whether each one works for the use people take it for, and its legal status: the evidence table. How we grade: our method.

Questions people ask

Go deeper

• Collagen peptides: what the trials show, and who paid for them
• Compounded semaglutide, tirzepatide and microdosing: what the evidence says
• Peptide blends, checked against the evidence
• Peptide injection sites: what the approved labels say
• Peptide side effects: what trials, labels and safety alerts show
• Peptides for hair: what the trials show, and how they compare with minoxidil
• Peptides for women: what the labels and trials say
• Peptides in skincare: what the trials and labels show
• What are peptides? The science in plain English
• Every peptide, graded: the evidence table
• Best peptides for weight loss, ranked
• Best peptides for healing, ranked
• Best peptides for skin and tanning, ranked
• Best peptides for growth hormone, ranked
• Best peptides for libido, ranked
• Best peptides for longevity, ranked
• Best peptides for focus and sleep, ranked
• Best peptides for immune support, ranked
• Are peptides legal? The legal tracker
• Peptides compared, head to head
• The 2026 gray-market briefing

Sources

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34. 34Lilly calls on online platforms, payment companies and regulators to shut down the illegal retatrutide black market Eli Lilly and Company (PR Newswire), 12 Aug 2026. prnewswire.com
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49. 49Emerging Use of BPC-157 in Orthopaedic Sports Medicine: A Systematic Review HSS Journal, Nov 2025. pubmed.ncbi.nlm.nih.gov
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53. 53Certain Bulk Drug Substances for Use in Compounding that May Present Significant Safety Risks U.S. Food and Drug Administration, 22 Apr 2026. fda.gov
54. 54BPC-157 Safety Testing Results & Vendor Ratings Finnrick, 29 Sep 2026. finnrick.com
55. 55Retatrutide: vendor test results Finnrick, 29 Sep 2026. finnrick.com
56. 56We’d Rather Buy the Future Than Wait For It Finnrick, 10 Jun 2026. finnrick.com
57. 57Multifactor Quality and Safety Analysis of Semaglutide Products Sold by Online Sellers Without a Prescription: Market Surveillance, Content Analysis, and Product Purchase Evaluation Study Journal of Medical Internet Research, 2024. pubmed.ncbi.nlm.nih.gov
58. 58Safety and Risk Assessment of No-Prescription Online Semaglutide Purchases JAMA Network Open, 1 Aug 2024. pubmed.ncbi.nlm.nih.gov
59. 59[Insulin intoxications caused by falsified semaglutide] Nederlands Tijdschrift voor Geneeskunde, 29 Jun 2026. pubmed.ncbi.nlm.nih.gov
60. 60Toxicity linked to unapproved peptide product labelled Retatrutide Department of Health, Victoria, 19 Jun 2026. health.vic.gov.au
61. 61Doctors fear possible contaminated counterfeit peptide batch after seventh case of acute liver damage ABC News (Australia), 24 Aug 2026. abc.net.au
62. 62FDA reminds compounders not to use dietary supplement grade glutathione for injectables U.S. Food and Drug Administration, 27 Aug 2026. fda.gov
63. 63Use of experimental ‘Wolverine’ peptide backed by RFK Jr is on the rise, study finds The Independent (Reuters), 16 Sep 2026. independent.co.uk
64. 64Who’s tracking the risks from peptides? In many cases, no one NBC News, 27 Aug 2026. nbcnews.com
65. 65Bulk Drug Substances Used in Compounding Under Section 503A of the FD&C Act U.S. Food and Drug Administration, 14 May 2026. fda.gov
66. 66Bulk Drug Substances Nominated for Use in Compounding Under Section 503A of the Federal Food, Drug, and Cosmetic Act (categories list) U.S. Food and Drug Administration, 14 May 2026. fda.gov
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68. 68PEPTIDE-L WAVE! PCAC Approves Four Bulk Drug Substances for the 503A List FDA Law Blog (Hyman, Phelps & McNamara), 24 Jul 2026. thefdalawblog.com
69. 69The PEPTIDE-L Wave Rolls On! PCAC Adds Two More Bulk Drug Substances for the 503A List FDA Law Blog (Hyman, Phelps & McNamara), 28 Jul 2026. thefdalawblog.com
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71. 71FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize U.S. Food and Drug Administration, 1 Apr 2026. fda.gov
72. 72Gobles Man Sentenced for Selling Chinese Drugs Without FDA Approval U.S. Attorney’s Office, Western District of Michigan, 23 Jul 2026. justice.gov
73. 73Illinois Man and Indiana Woman Sentenced Respectively to 70 Months and 16 Months in Prison For Selling Unapproved Drugs in Interstate Commerce U.S. Attorney’s Office, Northern District of Indiana, 30 Jul 2026. justice.gov
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77. 77WADA publishes 2027 Prohibited List World Anti-Doping Agency, 21 Sep 2026. wada-ama.org
78. 78World Anti-Doping Code International Standard: Prohibited List 2027 World Anti-Doping Agency, 21 Sep 2026. wada-ama.org
79. 79President Trump Launches TrumpRx.gov, Delivering Massive, Immediate Savings to Millions of Americans The White House, 6 Feb 2026. whitehouse.gov
80. 80Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford KFF, 14 Nov 2025. kff.org
81. 81A Clinical Trial to Evaluate the Effects of Peptide Gummies on Markers of Inflammation, Physical Performance, and Recovery (NCT07752381) ClinicalTrials.gov, 7 Aug 2026. clinicaltrials.gov
82. 82BPC 157 for Acute Hamstring Muscle Strain Repair (NCT07437547) ClinicalTrials.gov, 27 Feb 2026. clinicaltrials.gov
83. 83TB-500 (Thymosin Beta 4 17-23 Fragment) for Cardiovascular Biomarkers in Stable ASCVD (NCT07487363) ClinicalTrials.gov, 23 Mar 2026. clinicaltrials.gov
84. 84Tirzepatide: vendor test results Finnrick, 29 Sep 2026. finnrick.com
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