Editor's Note: This content was originally published in USA Today.
Ask any physician in longevity medicine and you’ll hear the same thing: Patients are showing up every day already taking peptides. They order them from sketchy sites that call them “research chemicals.” They’re dosing based on Reddit threads. And they might not have a trusted medical provider to contact if they have questions or, even worse, if something goes wrong.
These people aren’t fringe health nuts. They’re your friends, relatives, neighbors and coworkers who heard there was real promise here, couldn’t find a doctor willing to take it seriously, and did their best with what the internet told them. That's the peptide market right now. It’s unregulated, unsupervised and almost impossible to navigate safely.
There's a lot of conversation about the efficacy of some peptides, their safety and whether they should be allowed. But I'd argue the real issue is much more nuanced.
Let’s break it down.
When regulators and medical institutions refuse to engage with something patients are seeking, it doesn’t make the demand disappear – and it doesn’t make it safer. It just pushes people into an unsafe gray market. We can't pretend that is a sustainable solution, especially in a world where peptides are part of the future of medicine.
Peptides themselves are not to blame for safety concerns. The real problem is the misinformation and regulatory vacuum around many of them.
Some of the most important medicines we already have are peptides: Insulin has kept people with diabetes alive for a century, and semaglutide is the blockbuster of the decade. Peptides are short chains of amino acids that act as the body's own signaling molecules. Through one pathway, they impact many systems. All peptides work this way.
GLP-1 drugs are a clear example: They target a single signaling system yet can help improve obesity, diabetes, heart disease and kidney disease all at once.
However, not all peptides have that track record yet.
BPC-157, one of the compounds that was under review at the Food and Drug Administration's Pharmacy Compounding Advisory Committee hearing July 23-24, appears in preclinical studies to speed tissue repair and reduce inflammation. We now have nearly a decade of real-world experience indicating it can result in a variety of benefits for patients, from faster recovery from injury to reduced inflammatory bowel disease symptoms through nitric-oxide signaling.
However, these findings are not yet backed by large human trials. So the real divide isn’t proven versus bogus; it’s proven versus not-yet-proven.
For many peptides, randomized controlled trials do not exist and may never come. These compounds are often old, cheap or unpatentable, so no company has a financial incentive to spend the hundreds of millions of dollars a trial costs.
And while these trials are important to understanding the safety and efficacy of drugs, "no randomized controlled trial" is not the same as "no evidence."
We have the accumulated experience of thousands of clinicians who have prescribed these compounds for nearly a decade and watched real patients get better in real time. In a field moving this fast, dismissing these signals because no randomized controlled trial exists leaves patients without options they want and need now.
This is an opportunity to find a new way forward to advance medical innovation by leveraging real-world data, instead of relying on expensive and time-consuming trials whose limitations are growing more and more apparent.
The FDA is in the midst of deciding whether to allow the seven peptides that were considered by the advisory committee to be compounded by licensed pharmacies. Those committee members who made the recommendations are practicing pharmacists, physicians and patient representatives whose hands-on, real-world experience and expertise complement the regulatory knowledge of FDA's career staff.
While FDA's internal reviewers excel at policy analysis, traditional research and enforcement, the compounding advisory committee exists to inject the kind of frontline clinical and industry perspective that comes only from working outside the agency with real patients. Its recommendations to the FDA should be taken seriously.
The committee's recommendation to approve the majority of these peptides is a critical step forward in helping determine whether millions of Americans have safer, supervised access to these therapies. This also includes suggested pathways and safeguards for quality and safety, along with better education about the peptides in real time.
And that’s exactly what I advocated for when I spoke before the committee.
The right path isn't to disavow emerging science or oversell it. We must meet patients where they already are. Ignoring demand doesn't eliminate it; it makes it more dangerous. Whether to use peptides is ultimately a decision between a patient and a physician. For people where the conventional playbook hasn't worked, that calculus may look different, and we shouldn't stand in the way of informed, clinician-guided choices.
But the real question isn't which list any peptide lands on. It's whether medicine meets a new science with rigor, curiosity and innovation instead of dismissal. Bring it inside the system, build the infrastructure to allow responsible access and let it grow into real medicine. That’s when clinical experience stops being anecdotal. It becomes evidence – the exact human data this field still lacks and the market will never fund.
We have a chance to get this right. The government should heed the guidance of the real-world experts on the advisory committee and allow compounding of these peptides with real clinical potential. Build the guardrails, and let physicians and researchers do our jobs.
