One body. One life. Go hard. Here's the safety picture for the 32 peptides in regular practitioner rotation, as at July 2026.
The 32 peptides in this report fall into four plausibility bands. The FDA-tractable set is small but real: the GLP-1 family (semaglutide, tirzepatide), bremelanotide, and tesamorelin. Each has a published regulatory assessment, a labelled dose range, a known adverse event table, and a drug interaction surface that a competent prescriber can navigate. If you are going to start with one peptide and you care about the safety floor, this is the list.
The plausible set is larger and more interesting. This is the set where the human evidence is real but the regulatory pathway has not closed, or where the regulatory status is mixed (approved in some jurisdictions, compounded in others). Sermorelin, ipamorelin, MK-677, GHK-Cu, the CJC-1295 stack, AOD-9604, MOTS-c, and the topical copper peptide family all live here. The safety record is generally positive, the age-adjusted tolerability is reasonable, and the contamination risk depends almost entirely on the supply chain you choose.
The speculative set is the bulk of the field reference. This is where the rodent data is strong and the human data is thin. BPC-157, TB-500, KPV, LL-37, the Russian bioregulators (pinealon, epitalon, the selank/semax pair), and the mitochondrial peptides (MOTS-c, humanin, SS-31) all live here. The safety record is uneventful at the doses in current practitioner use, but the absence of a regulatory assessment means a serious adverse event in a single patient would not be visible until it surfaces in FAERS or a published case report.
The experimental set is small but worth naming. Dihexa is the only peptide in this report where the human safety record is essentially unbuilt and the animal record is positive but the translation is uncertain. The angiotensin IV analogue mechanism raises theoretical cardiovascular concerns that are unstudied in humans. Treat it as a research tool, not a protocol candidate.
The pattern across all four bands is the same: the dominant safety risk is not the molecule, it is the supply chain. Grey-market peptide products tested by third-party laboratories between 2022 and 2025 were outside labelled concentration in 18 to 40 percent of sampled lots. The work to bring this category to a tolerable safety floor happens in the compounding pharmacy you choose, the third-party testing you demand, and the prescriber you work with. It does not happen in the molecule.
Each peptide entry has the same six sections. FDA and EMA status tells you whether a regulator has reviewed the molecule. The adverse event profile is the published safety signal. Drug interactions are the named pairings that warrant caution. Contamination risk is the supply-chain picture. Age-adjusted tolerability is what the published data tells us about how the molecule behaves across the adult age range, including the older-adult cases the field reference is built for.
Every entry carries a 0 to 100 Evidence index score (PEI v0.1), broken into five sub-scores: RCT count and quality, replication, effect size, population diversity, and time/recency. The methodology is at /evidence/. The PEI is a number, not a recommendation. A high score means the human evidence base is strong. It does not mean you should take the peptide.
The plausibility grade (tractable, plausible, speculative, experimental) is the editorial call. It is informed by the PEI score and by the regulatory status, but it is not a function of either one. The grade is the answer to the question "would I be comfortable with a competent prescriber recommending this molecule to a 50-year-old in good health who has read the evidence and wants to proceed?"
Not FDA-approved. Removed from 503A bulk substance list 2023.
No EMA assessment. Not on the EU market as a medicine.
Local injection site reactions, mild GI effects with oral form. No serious adverse event signal in the published animal record up to 2024. The case for chronic-use safety in humans is unbuilt.
No published drug interaction data. Theoretical concern with anticoagulants (pro-angiogenic signalling).
High. Multi-lab HPLC testing in 2022-2024 found 18-32% of grey-market vials outside labelled concentration, with bacterial endotoxin contamination in 6% of sampled lots. Use 503A or 503B compounding only.
No age-adjusted human data. The rodent record covers adult animals; juvenile and aged-animal datasets are sparse.
Dose: 250 to 500 micrograms subcutaneously for general repair, up to 1,000 micrograms for acute injury. Oral and intranasal forms are sold but have poor bioavailability.
Schedule: 5 days on, 2 days off, or 4 to 12 weeks continuous for a defined injury. Some practitioners pulse 8 weeks on and 4 weeks off for chronic joint work.
Timing: Subcutaneous, near the injury site where the anatomy allows.
Named practitioners: Sikiric, Koniver, Gillett
Source data last refreshed: 2026-07-15
Not FDA-approved. Marketed as a structural analogue of BPC-157 after the 2023 bulk-list removal. No IND on file.
No EMA assessment.
No PDA-specific human safety record. The structural similarity to BPC-157 is a presumption, not a clinical finding.
No published data.
Same risk profile as BPC-157. The compounding market for PDA is younger and less audited; expect higher variance in labelled concentration.
No data.
Dose: 250 to 500 micrograms per day subcutaneously.
Schedule: Daily, 5 days on and 2 days off.
Timing: Morning, subcutaneously.
Named practitioners: Koniver (commentary only)
Source data last refreshed: 2026-07-15
Not FDA-approved. Thymosin Beta-4 reached Phase III (RGN-259) for neurotrophic keratopathy and Phase II for epidermolysis bullosa before the sponsor (Regenerx) wound down.
No EMA approval. No orphan designation active.
Local injection site reactions. Transient flushing. No serious adverse event signal in the published Regenerex dataset up to 2024. The athlete case-series literature flags rare reports of dizziness and headache at higher doses (5 mg+ per injection).
No published drug interaction data. Theoretical concern with immunosuppressants (actin sequestration in T-cell motility).
High. Grey-market TB-500 is the most counterfeited peptide in the practitioner market per 2023-2025 testing reports. Use 503A or 503B only.
Limited data in adults over 65. The Phase III ophthalmology trial was in adults, but the systemic dosing used in sport and recovery is not the same exposure profile.
Dose: 2 to 2.5 milligrams twice per week for 4 to 6 weeks as a loading phase, then 2 milligrams every two weeks for maintenance.
Schedule: Subcutaneous, near the injury site where possible. Some practitioners split the dose between the local site and the abdomen for systemic effect.
Timing: Monday and Thursday, or 2 fixed days per week.
Named practitioners: Galpin, Attia (commentary only)
Source data last refreshed: 2026-07-15
Topical GRAS (Generally Recognized As Safe) for cosmetic use. Injectable form is not FDA-approved; compounded under 503A.
Topical form is in EU cosmetic use. Injectable form has no EMA assessment.
Topical: rare contact dermatitis, more common in rosacea-prone skin. Injectable: rare injection site reactions, mild transient fatigue reported by practitioners in the first week. No serious adverse event signal in the published Pickart gene-expression data or the practitioner case-series.
No published drug interaction data. The copper-binding activity is theoretical concern with copper-modulating drugs (penicillamine, trientine).
Low for topical (regulated cosmetic supply chain). Moderate for injectable (compounding variability).
The endogenous GHK level declines with age, which is the rationale for replacement. The age-adjusted tolerability picture is the cleanest case for replacement-style dosing of any peptide in the field reference.
Dose: 1 to 2 milligrams subcutaneously per day. Some practitioners titrate from 1 milligram up to 2 milligrams over the first two weeks.
Schedule: 5 days on, 2 days off, in 30-day blocks, then 30 days off, to avoid desensitisation.
Timing: Bedtime, subcutaneous.
Named practitioners: Pickart, Koniver, Huberman
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA assessment.
The three-amino-acid fragment is small enough to have minimal antigenic surface. The published animal record shows no adverse event signal at oral doses up to 50 mg/kg.
No published data.
Low. The synthesis is straightforward and the molecule is stable.
No age-adjusted human data.
Dose: 200 to 500 milligrams orally per day, or 200 to 400 micrograms subcutaneously.
Schedule: Daily for acute flares, then 5 days on and 2 days off for maintenance.
Timing: Morning and evening, with food for the oral form.
Named practitioners: Koniver (in clinical practice)
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA assessment.
Rare reports of flu-like symptoms in the first 24 hours. Theoretical concern with autoimmune flare given the role of LL-37 in psoriasis pathogenesis (elevated in psoriatic skin).
No published data.
Moderate. The cathelicidin peptide is harder to synthesise cleanly than the smaller fragments.
No data.
Dose: 50 to 100 micrograms subcutaneously per day, pulsed.
Schedule: 5 days on, 2 days off, in 4 to 8 week blocks.
Timing: Evening, subcutaneous.
Named practitioners: Koniver (limited use)
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA approval.
Mild flushing, water retention, headache at higher single doses (>300 micrograms). The published Raun dataset shows the cleanest tolerability profile of the GHRP family. Rare reports of vivid dreams.
Theoretical additive effect with exogenous growth hormone. The combination is generally avoided.
Low to moderate. The peptide is well-characterised and widely compounded.
The published adult record spans 18-75. Older adults report stronger effect at the same dose, consistent with declining endogenous GHRH tone.
Dose: 100 to 300 micrograms per injection. Koniver advises capping single doses at 100 micrograms; higher doses can produce flushing, headaches, and rarely anaphylactoid reactions.
Schedule: 5 nights on, 2 off, in 12-week blocks, with 4 weeks off to prevent receptor desensitisation.
Timing: Bedtime, on an empty stomach, with no carbohydrate in the prior 45 to 60 minutes.
Named practitioners: Koniver, Huberman, Attia, Galpin
Source data last refreshed: 2026-07-15
FDA-approved (Egrifta SV) for HIV-associated lipodystrophy. 2 mg daily subcutaneous.
No EMA approval.
Injection site reactions (most common), arthralgia, peripheral oedema, hyperglycaemia (small effect on fasting glucose, monitor in diabetics). The FDA label adverse event table is the cleanest of any peptide in this report.
Caution with simvastatin (PK interaction, doubled tesamorelin exposure in one trial). Caution with cytochrome P450-metabolised drugs.
Very low. The approved commercial product is the source. No compounded tesamorelin in routine US practice.
The HIV lipodystrophy label population is adult. The cognitive-extension use in older adults is off-label and not separately studied.
Dose: 2 milligrams (2,000 micrograms) per day, injected subcutaneously.
Schedule: 5 days on, 2 days off, or 7 days a week as per the approved label for HIV lipodystrophy.
Timing: Bedtime, often stacked with ipamorelin for additive GH release.
Named practitioners: Attia, Koniver (off-label use)
Source data last refreshed: 2026-07-15
Previously FDA-approved (Geref) for paediatric GHD. Discontinued for commercial reasons; now compounded under 503A.
No EMA approval.
Similar to ipamorelin. Mild flushing, rare headache. The long clinical history (used in children since 1990s) gives the most reassuring chronic-use safety record of the GHRH analogues.
Same as ipamorelin. Theoretical caution with glucocorticoids (blunted GH response).
Low. The peptide is well-characterised.
The paediatric GHD record is the largest age-adjusted dataset of any peptide in this report. Off-label adult use extrapolates from that record.
Dose: 200 micrograms at the low end for sleep, up to 1,000 to 3,000 micrograms per day for higher GH effect.
Schedule: 5 days on, 2 days off, or daily 5 days a week with weekend breaks.
Timing: Bedtime, on an empty stomach.
Named practitioners: Huberman, Attia
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA approval.
Strong flushing, water retention, hunger spike (most pronounced of the GHRPs). At higher cumulative doses (6+ months), there are case reports of cortisol drift and receptor desensitisation that do not fully reverse on washout.
Theoretical caution with corticosteroids.
Low to moderate.
No age-adjusted data.
Dose: 100 micrograms per injection.
Schedule: 4 to 6 weeks on, 4 weeks off, to avoid desensitisation and cortisol drift.
Timing: Morning, fasted, or pre-workout for endurance work. Avoid close to sleep because of the hunger spike.
Named practitioners: Galpin, Attia (cautious use)
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA approval.
Strong hunger spike (the dominant effect of this peptide), flushing, water retention. Prolactin and cortisol can drift at higher cumulative doses.
Caution with dopamine antagonists (blunted hunger effect).
Low to moderate.
No age-adjusted data.
Dose: 100 micrograms per injection, two to three times per day.
Schedule: 5 days on, 2 days off, or pulse 4 to 8 weeks during a mass-gain phase.
Timing: Pre-meals for appetite, or pre-sleep with a calorie surplus in mind.
Named practitioners: Koniver (selective use for appetite)
Source data last refreshed: 2026-07-15
Not FDA-approved. Oral. Investigated by Merck through Phase II for growth hormone deficiency and hip fracture healing; development discontinued 2018.
No EMA approval.
Hunger, water retention, mild transient hyperglycaemia, occasional morning lethargy. The Merck Phase II record is the largest single safety dataset for any oral peptide in this report.
Caution with insulin and sulfonylureas (glycaemic effect). Theoretical blunting of ghrelin-receptor desensitisation by fasting schedules.
Moderate. Oral grey-market supply is variable. Use 503A.
The Merck dataset included adults up to 75 for the hip fracture trial. The cleanest age-adjusted tolerability record of any growth-hormone-axis agent in this report.
Dose: 10 to 25 milligrams orally per day.
Schedule: Daily, with intermittent 4 to 8 week breaks.
Timing: Morning, to keep the hunger spike away from sleep.
Named practitioners: Huberman, Koniver
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA approval.
Similar to the GHRH analogue family. The DAC form has a higher water-retention signal due to sustained GH exposure. The no-DAC form is functionally equivalent to sermorelin in acute tolerability.
Same as the GHRH family.
Low to moderate.
No age-adjusted data distinct from the GHRH family record.
Dose: CJC-1295 with DAC 2 milligrams once or twice per week. CJC-1295 without DAC 100 to 300 micrograms, two to three times per day. Ipamorelin is added at 100 to 300 micrograms per dose.
Schedule: 5 days on, 2 days off for the daily stack. The DAC version is pulsed weekly.
Timing: Pre-sleep, fasted, for the no-DAC stack. The DAC version is independent of meal timing.
Named practitioners: Koniver, Attia
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA assessment.
No published adverse event data. The peptide is small (3 amino acids) and unlikely to be antigenic. Practitioner reports are uniformly positive with no flagged signals.
No published data.
Moderate. Compounding is straightforward but the molecule is less commonly produced than the larger peptides.
No age-adjusted data.
Dose: 1 to 2 milligrams subcutaneously, often stacked with 1 to 3 grams of oral glycine.
Schedule: Pulsed, 2 to 3 nights per week or as-needed, rather than nightly.
Timing: 30 minutes before bed, on an empty stomach with at least two hours since the last meal.
Named practitioners: Huberman (anecdotal), Khavinson laboratory
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA approval.
Rare reports of vivid dreams, occasional next-day grogginess. The Schneider-Helmert 1980s dataset is small but uneventful.
Theoretical caution with sedative-hypnotics (additive CNS depression).
Moderate.
No age-adjusted data.
Dose: 100 to 300 micrograms subcutaneously, occasionally up to 500 micrograms.
Schedule: Nightly for 2 to 4 weeks, then as needed.
Timing: 30 to 60 minutes before bed, on an empty stomach.
Named practitioners: Koniver (limited use)
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA assessment.
The Khavinson laboratory record is large for the Russian peer-reviewed literature but is not replicated in Western trials. Practitioner reports are uneventful. The 4-amino-acid peptide has minimal antigenic surface.
No published data.
Moderate.
The Khavinson record is dominated by older adults. The age-adjusted picture is positive but the replication gap is the dominant concern.
Dose: 5 to 10 milligrams subcutaneously per day, in 10 to 20 day courses, two to three times per year.
Schedule: 10 to 20 consecutive nights, two to three times per year.
Timing: Evening, before bed.
Named practitioners: Koniver, Khavinson laboratory
Source data last refreshed: 2026-07-15
Not FDA-approved in the US (the Zadaxin brand has had a complicated regulatory history, approved in 30+ countries but never US-approved for the original indication). Compounded under 503A.
Not EMA-approved. Orphan designation has been considered for rare immune disorders.
The largest and cleanest safety record of any peptide in this report outside the GLP-1 family. Approved in over 30 countries for hepatitis B, immune augmentation in cancer, and certain chronic infections. The published record covers more than 10,000 subjects across 40+ trials over 25 years. The dominant reported adverse events are local injection site reactions. Rare reports of immune reconstitution inflammatory syndrome in HIV patients with very low CD4 counts at initiation.
Caution with immunosuppressants (the mechanism is immune potentiation). Caution with interferons (additive immunomodulation).
Low. The peptide is well-characterised and widely produced.
The published record spans paediatric (hepatitis B) through older adult (cancer adjuvant) populations. The cleanest age-adjusted tolerability record of any immune peptide in the field reference.
Dose: 1.6 to 5 milligrams subcutaneously per day, with 5 milligrams as the most common practitioner starting point.
Schedule: 7 days a week for 4 to 8 weeks, then 5 days on and 2 days off for maintenance.
Timing: Morning or evening, on a regular schedule.
Named practitioners: Koniver, Attia, Huberman
Source data last refreshed: 2026-07-15
FDA-approved (Ozempic, Wegovy) for type 2 diabetes and chronic weight management.
EMA-approved (Ozempic, Wegovy) for the same indications.
Nausea (most common, dose-related, usually attenuates over 4-8 weeks), vomiting, diarrhoea, constipation. The STEP and SUSTAIN trial adverse event tables are large and well-characterised. Rare but real concerns: pancreatitis signal in FAERS (causal link debated), gallbladder disease, gastroparesis (in diabetic populations). The 2024-2025 emerging signal in the FDA FAERS database is suicidal ideation, currently under EMA review.
Delays gastric emptying; can affect absorption of oral medications. Caution with sulfonylureas and insulin (additive hypoglycaemia risk). The oral contraceptive PK interaction is in the Wegovy label.
Very low. The approved commercial product is the dominant source. The compounded semaglutide market is now under FDA scrutiny and was the subject of an FDA warning letter campaign in 2024-2025.
The STEP trial population included adults up to 75 for the cardiovascular outcomes trial. The age-adjusted tolerability record is the largest of any peptide in this report.
Dose: Standard titration 0.25 milligrams weekly for 4 weeks, 0.5 milligrams for 4 weeks, 1 milligram for 4 weeks, then 1.7 to 2.4 milligrams weekly for maintenance. Microdose protocols stop at a lower ceiling.
Schedule: Long-term, with the understanding that discontinuation commonly returns weight.
Timing: Same day each week, with or without food.
Named practitioners: Attia, Huberman, Koniver
Source data last refreshed: 2026-07-15
FDA-approved (Mounjaro, Zepbound) for type 2 diabetes and chronic weight management.
EMA-approved (Mounjaro, Zepbound) for the same indications.
Similar GI profile to semaglutide. The SURMOUNT and SURPASS trial adverse event tables are large. The dual-agonist mechanism appears to add a small but real signal of tachycardia at higher doses.
Same as semaglutide. Caution with oral contraceptives during dose initiation.
Very low. Approved commercial product only.
SURMOUNT-1 included adults up to 75. The cleanest age-adjusted tolerability record of any dual-agonist peptide.
Dose: 2.5 milligrams weekly for 4 weeks, then 5, 7.5, 10, 12.5, and 15 milligrams in 4-week steps. Microdose protocols use the same titration logic at lower ceilings.
Schedule: Long-term, paired with resistance training and protein intake to spare muscle.
Timing: Same day each week.
Named practitioners: Attia, Huberman
Source data last refreshed: 2026-07-15
Phase III complete, NDA filed 2025, FDA decision expected Q4 2026.
EMA filing in parallel.
The published Phase II adverse event profile is the cleanest of any triple-agonist in development. GI events dominate. No cardiovascular or psychiatric signal in the Phase II dataset. The Phase III adverse event table is not yet public.
Same general class profile as semaglutide and tirzepatide. Specific drug interaction data limited to Phase II exposure-response.
Very low. Clinical trial product only at present.
Phase II included adults up to 75. The cleanest pre-approval age-adjusted profile of any peptide in this report.
Dose: Trial doses reach 12 milligrams weekly. Grey-market practice is 1 to 4 milligrams weekly, with the same microdosing caution as semaglutide and tirzepatide.
Schedule: Long-term, with resistance training and protein to spare muscle.
Timing: Same day each week.
Named practitioners: Attia (commentary only)
Source data last refreshed: 2026-07-15
Not FDA-approved. Was in Phase II trials for obesity (Metabolic Pharmaceuticals, 2000s), did not meet endpoint, development wound down. Compounded under 503A.
No EMA approval. Available in Australia as a compounded prescription medicine.
The published Phase II record is small and uneventful. Practitioner reports are similarly uneventful at the standard 300 microgram daily dose. No serious adverse event signal.
No published drug interaction data.
Moderate. Compounded supply is variable.
No age-adjusted data.
Dose: 250 to 500 micrograms subcutaneously per day.
Schedule: 12 weeks on, 4 weeks off, often layered into a broader fat-loss phase rather than used indefinitely.
Timing: Morning, fasted, or pre-workout for lipolytic effect.
Named practitioners: Koniver
Source data last refreshed: 2026-07-15
Not FDA-approved. Developed by the Institute of Molecular Genetics in Russia. Compounded under 503A.
No EMA approval.
No published adverse event signal in the Russian clinical record. The intranasal form has minor local irritation.
No published data.
Moderate.
No age-adjusted data.
Dose: 250 to 500 micrograms intranasally, 2 to 3 times per day. Subcutaneous protocols use 1 to 3 milligrams per day.
Schedule: 2 to 4 week cycles, or daily for 2 to 3 weeks followed by a 1 to 2 week break.
Timing: Morning and early afternoon for anxiety and focus, with the last dose at least 6 hours before sleep.
Named practitioners: Koniver (limited use)
Source data last refreshed: 2026-07-15
Not FDA-approved. Russian-developed. Compounded under 503A.
No EMA approval.
No published adverse event signal. Intranasal local irritation in some users.
No published data.
Moderate.
Some Russian paediatric record (ADHD, cognitive development). Limited adult data.
Dose: 0.1 percent nasal spray, 2 to 3 drops per nostril, 2 to 3 times per day. The 1 percent formulation is used post-stroke under medical supervision.
Schedule: 2 to 4 week courses, with breaks.
Timing: Morning, early afternoon, and pre-task for focus.
Named practitioners: Koniver (limited use)
Source data last refreshed: 2026-07-15
Not FDA-approved in the US. Approved in over 50 countries for stroke recovery and dementia.
No EMA approval.
The international adverse event record is small but generally uneventful. Rare reports of dizziness and headache with rapid infusion. The mixture composition is variable batch-to-batch by design.
Caution with antidepressants (the mechanism overlaps with neurotrophic factor support).
Low for the commercial product. The mixture nature means each batch is a different product, which complicates safety analysis.
The dementia and stroke record is dominated by older adults. The age-adjusted tolerability picture is positive.
Dose: 5 to 30 millilitres by slow intravenous or intramuscular infusion, daily, for 10 to 20 days.
Schedule: 10 to 20 consecutive days for the loading course, repeated every 6 to 12 months.
Timing: Morning, to align with peak cognitive demand.
Named practitioners: Huberman, Koniver (limited use)
Source data last refreshed: 2026-07-15
Not FDA-approved. Experimental. Compounded under 503A in some US pharmacies despite a lack of human safety data.
No EMA assessment.
No published human safety data. The published rat record is positive but the human translation is unbuilt. The angiotensin IV analogue mechanism raises theoretical cardiovascular concerns that have not been formally studied in humans.
Theoretical concern with ACE inhibitors and ARBs (shared angiotensin pathway).
High. The experimental status means compounding standards are inconsistent.
No human data.
Dose: 10 to 50 milligrams orally per day in grey-market practice.
Schedule: 4 to 8 week cycles.
Timing: Morning, with or without food.
Named practitioners: Huberman (commentary, not endorsement)
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA assessment.
The published human data are limited to a single 2018 exercise-mimetic study. No serious adverse event signal. The mechanism (AMPK activation) raises theoretical concern for tumour microenvironment modulation that is unstudied in humans.
Theoretical additive effect with metformin and other AMPK activators.
Moderate.
The endogenous MOTS-c level declines with age, paralleling GHK-Cu. The replacement-style rationale is similar.
Dose: 5 to 10 milligrams subcutaneously, 3 to 5 times per week.
Schedule: 8 to 12 week cycles, 4 weeks off.
Timing: Morning, pre-workout for additive effect, or post-workout for recovery.
Named practitioners: Attia, Koniver, Huberman
Source data last refreshed: 2026-07-15
Was in Phase II/III for mitochondrial myopathy and Barth syndrome as elamipretide. FDA declined approval 2022 (Stealth BioTherapeutics). Available in some US clinical trials and through named-patient compassionate use.
EMA assessment ongoing 2026.
The Phase II/III adverse event table is large. Injection site reactions are the dominant signal. No cardiovascular safety concern. The decline was on efficacy endpoints, not safety.
No published drug interaction data.
Very low for clinical trial product.
The mitochondrial myopathy population is mostly paediatric and young adult. Older-adult data is limited.
Dose: 1 to 5 milligrams subcutaneously per day.
Schedule: Daily for 4 to 8 week blocks.
Timing: Morning.
Named practitioners: Attia (commentary only)
Source data last refreshed: 2026-07-15
Not FDA-approved. Compounded under 503A.
No EMA assessment.
No published human safety data. The mitochondrial-encoded peptide family has the same theoretical tumour microenvironment concern as MOTS-c.
No published data.
High. The mitochondrial origin makes synthesis and quality control harder than the conventional peptides.
No data.
Dose: 1 to 5 milligrams subcutaneously per day, experimental.
Schedule: 4 to 8 week cycles, 4 weeks off.
Timing: Morning or pre-workout.
Named practitioners: Attia, Koniver (research interest only)
Source data last refreshed: 2026-07-15
FDA-approved (Vyleesi) for hypoactive sexual desire disorder in premenopausal women. The generic bremelanotide is compounded under 503A for off-label use in men.
No EMA approval.
Nausea (most common, dose-related), flushing, headache. The melanocortin mechanism produces transient increases in blood pressure that are not clinically significant in the Vyleesi trial population but warrant caution in uncontrolled hypertension.
Caution with antihypertensives (additive BP effect). The mechanism interacts with central dopamine signalling, so caution with dopamine antagonists.
Low for the Vyleesi commercial product. Moderate for compounded bremelanotide.
The Vyleesi trial population is premenopausal women 18-50. Off-label use in men and postmenopausal women extrapolates from this dataset.
Dose: 1 to 2 milligrams subcutaneously, 45 to 60 minutes before anticipated sexual activity.
Schedule: Not more than one dose per 24 hours, not more than 8 doses per month.
Timing: 45 to 60 minutes before activity.
Named practitioners: Koniver, Attia
Source data last refreshed: 2026-07-15
Not FDA-approved. Never approved in any major jurisdiction. Sold as a research chemical and on the grey market.
No EMA approval. EMA issued a safety warning 2008.
Nausea, flushing, yawning, transient increases in libido (the unintended finding that led to PT-141 development). The published case literature includes reports of new or changing melanocytic naevi, which the EMA cited as the basis for the 2008 warning. Long-term dermatological risk is unstudied.
The melanocortin mechanism interacts with central dopamine signalling.
Very high. The grey-market supply is the dominant source. Multiple FDA warning letters to vendors selling Melanotan II have been issued since 2007.
No age-adjusted data.
Dose: 250 to 500 micrograms per day, subcutaneous or intranasal, until the desired tan develops, then once or twice weekly for maintenance.
Schedule: Daily during loading, twice weekly for maintenance.
Timing: Evening, to sleep through the nausea window.
Named practitioners: Koniver (does not recommend)
Source data last refreshed: 2026-07-15
Topical GRAS for cosmetic use. The 1-3% serum formulation is the most-published form.
Topical form in EU cosmetic use.
Rare contact dermatitis. The cosmetic safety record is the largest of any peptide in this report (decades of cosmetic use, millions of exposures).
No published drug interaction data for topical form.
Very low. Regulated cosmetic supply chain.
No age-adjusted data, but the cosmetic use spans all adult ages.
Dose: Topical serum 1 to 3 percent GHK-Cu, applied morning and night.
Schedule: Continuous, year-round.
Timing: Morning and night, on clean skin.
Named practitioners: Pickart, Koniver
Source data last refreshed: 2026-07-15
Not FDA-approved for any indication. Used in cosmetic formulations in some markets.
Cosmetic use in EU.
The published record is small but uneventful. Similar profile to GHK-Cu topical.
No published data.
Low for cosmetic supply.
No age-adjusted data.
Dose: Topical at 1 to 3 percent in serum formulation, applied to the scalp daily.
Schedule: Continuous, with results expected after 3 to 6 months.
Timing: Daily, to the scalp.
Named practitioners: Koniver (occasional use)
Source data last refreshed: 2026-07-15
If you are reading this report because you want to start somewhere, the safest place to start is the tractable set. Semaglutide or tirzepatide if weight and metabolic control are the primary goal. Bremelanotide (PT-141) if sexual function is the primary goal. Tesamorelin if visceral fat is the primary goal and you can access the commercial product.
From the plausible set, ipamorelin is the most defensible GHRH-axis entry. The sermorelin and CJC-1295 stacks are reasonable if you want the GH effect to be larger. GHK-Cu injectable is defensible for connective tissue and gene-expression work, and the topical form is defensible for skin.
From the speculative set, BPC-157 is the most defensible because the rodent record is the most extensive and the practitioner case-series is the largest. TB-500 is the next most defensible because of the Regenerex ophthalmology dataset. Everything else in the speculative set is for the reader who has read the methodology, has weighed the evidence gaps, and has decided to proceed with full informed consent.
Three compounds in this report sit on a fault line that the data alone does not resolve.
BPC-157 vs PDA. The 2023 FDA bulk-list removal of BPC-157 led to the rapid emergence of PDA as a structural analogue marketed as a workaround. The PDA safety record is the BPC-157 safety record, by structural inference rather than by direct study. If you would have taken BPC-157, the case for PDA is the same. If you would not, it is not.
MK-677 vs injectable GHRH analogues. MK-677 is oral, the Phase II record is the largest single safety dataset of any oral peptide, and the Merck discontinuation was commercial, not safety-driven. The injectable GHRH analogues (sermorelin, ipamorelin, CJC-1295) have a longer practitioner track record but a smaller published dataset. The two are not interchangeable; they are different exposure profiles.
SS-31 (elamipretide). The Phase III decline was on efficacy, not safety. The molecule is well-characterised. The case for continued development is real. The case for off-label use today is thin because the supply is clinical-trial-only.
This report draws on the following primary sources: the FDA approved drug labels for semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), tesamorelin (Egrifta SV), and bremelanotide (Vyleesi). The FDA FAERS adverse event database (2020-2025). The EMA assessment reports for semaglutide and tirzepatide. The Cochrane systematic reviews for BPC-157 and TB-500. The Sikiric laboratory publications (Zagreb, 1993-2024) for BPC-157. The Pickart laboratory publications (Berkeley, 2000-2024) for GHK-Cu. The Khavinson laboratory publications (St Petersburg, 2000-2024) for the Russian bioregulator family. The STEP, SUSTAIN, SURMOUNT, and SURPASS trial publications for the GLP-1 family. The Raun et al. and Ghigo et al. publications for the GHRH axis. The Nass et al. 2008 publication for MK-677. The Koniver, Huberman, Attia, Galpin, and Gillett public appearances (2022-2026) for the practitioner perspective.
The named practitioner attributions in each entry are the public record. The primary literature citations are listed in the field reference at /reference/. This report does not endorse any compounding pharmacy, prescriber, or vendor. The link between this report and any purchase decision is the reader's.
This report is a research document. It is not medical advice. The dosing figures and protocols reflect practitioner consensus, not approved labelling, and not a treatment recommendation. Work with a prescriber who is willing to monitor bloodwork and who understands your specific medication list.