This increasingly popular form of treatment is based on an established body of scientific knowledge. It has been a subject of great interest, with many well established treatments (e.g. HCG for weight loss) becoming prescription only. However, the bulk of treatment with peptides is carried out with unproven combinations of research chemicals on unsupervised self-administration. To ensure treatment with peptides is carried out safely, it is essential to establish a number of critical criteria for the practitioners and clinic operators alike.
Regulatory status is the first filter, not an afterthought
All peptides are not made equally, and it would be a mistake to consider approved therapeutic peptides, highly researched peptide treatments, and untested research chemicals (even those sold with disclaimers regarding use) in one category. Much of the risk of adverse exposure to peptides in clinical use comes from treating all of these differently.
Additionally, the regulatory status of many peptides has recently changed, including being placed in restricted categories, removed from compounding lists and even characterized as being insufficiently characterized to be used for certain purposes. Such changes can occur within a short time frame (3 years), and often the clinics that have been using a particular peptide as part of a standing order for that compound are not informed of the change by the pharmacy until they are unable to fill the order.
Questions worth asking your compounding pharmacy
- What is the current regulatory standing of this compound, and when was that last verified?
- Can you provide a certificate of analysis for the specific lot, including purity and endotoxin testing?
- What is the documented beyond-use date for the reconstituted product under patient storage conditions?
- Is the active pharmaceutical ingredient sourced from a registered facility?
The pharmacist should be able to answer all four of these questions very quickly. If not, they are not the kind of pharmacist you would want to have as a long-term partner for your practice.
What a defensible consultation captures
It is common for patients to have read about a certain compound before coming to the clinician’s consultation and to want this for their therapeutic outcome. This has to be rigorously resisted by the clinician, as this is not an assessment of whether the specified treatment would be suitable for the patient’s stated symptoms and medical history.
Determine a baseline measurement of the client’s physical symptoms and attempt to quantitatively measure them prior to treatment. Have the client list out previous attempts to improve their physical symptoms and reasons why they failed. Have the client make a list of all of the medications that they currently take, including over the counter supplements, and explain the reasons for their use. Clearly establish an outcome that would constitute success for the client prior to treatment and clearly establish a protocol for determining when to stop using a particular peptide on long-term protocols.
Contraindications that are easy to miss
Do ask about malignancy, as most peptides are contraindicated in growth hormone secretagogues, but remember to ask about ALL undiagnosed symptoms and investigate before treating. Diabetic retinopathy, active, untreated thyroid disease and significant renal impairment would indicate caution or avoidance of peptide therapy. Note that in the absence of data, it is best to err on the side of caution and avoid treating pregnant or breast-feeding women.
Laboratory screening, before and during
Baseline testing serves two purposes. It identifies those who should not be treated with peptides in the first place. Secondly, it provides a basis for comparison later on. Without it, monitoring is useless.
| Stage | Typical panel | Decision it informs |
| Baseline | CBC, comprehensive metabolic panel, IGF-1, fasting glucose and insulin, HbA1c, lipids, thyroid function | Whether to treat at all, and at what starting dose |
| Early review, around 6 to 12 weeks | IGF-1, fasting glucose, targeted repeats of any abnormal baseline | Dose titration or discontinuation |
| Maintenance, every 3 to 6 months | IGF-1, metabolic panel, HbA1c | Continued justification for therapy |
| Exit | Repeat of baseline abnormalities | Documentation of resolution or persistence |
The fact that IGF-1 levels are moving toward the upper end of normal is not evidence that a particular protocol is working and must be continued. In fact, growth hormone secretagogues can cause a marked increase in glucose levels that may be detected gradually over time. Therefore, it is far better to monitor glucose levels on a regular basis (e.g. Every few weeks) than to rely on symptoms that will surely report that things are getting worse.
Why supervision is a structural requirement
Most peptides are administered by injection, are highly dose sensitive, and are typically given in combination with other peptides. The failure modes for these types of treatments are easily exposed by unsupervised self-administration. Most adverse events are due to reconstitution errors (e.g. Wrong diluent volume used, old product accidentally used because it was stored in the wrong location).
Supervising patients on peptide therapy can bring to light many behaviors, such as dose escalation, use of additional compounds and continued use of therapy for indefinite periods of time because no clear end point for treatment has been established by the practitioner. For patients who are already searching for a peptide clinic near me on their own, it is worth steering them toward a provider that builds this kind of ongoing oversight into the protocol rather than one that simply dispenses vials.
Choosing where to refer
You may want to consider a number of markers when referring patients for peptide therapy, or searching for a clinic to send your own patients to for peptide therapy near me. These can include whether the practitioner undertakes any sort of assessment of the patient (as opposed to simply handing them a questionnaire to complete), whether the patient has any sort of bloodwork taken as part of an initial assessment (preferably prior to any products being dispensed by the clinic’s pharmacy), whether the clinic in question uses a named compounding pharmacy, and whether the practitioner sets out a review to be held at a certain time in the future (and what that review will entail).
Setting expectations that survive contact with reality
While there are some positive indicators of response to peptide therapy, it’s generally difficult to predict. Share with your patients a realistic time frame for expected improvement and define the level of improvement supported by existing evidence. Most of all, clearly define the circumstances under which you will cease administration of a given protocol. A well-designed, reasonable peptide therapy protocol typically includes a defined review time and a clear point at which the practitioner will cease administration of said protocol.