Peptide Therapy: What Actually Works (And What's Just Hype)

According to a 2024 market analysis published in Nature Reviews Drug Discovery, the global peptide therapeutics market hit $39.5 billion and is projected to grow 9.2% annually through 2030¹. But here's what those investor reports don't tell you: most of that growth is in prescription peptides for conditions like diabetes and obesity—not the over-the-counter "biohacker" supplements flooding your Instagram feed.

I've had three patients this month alone ask me about BPC-157 for joint pain and another two inquiring about "SARMs alternatives" for building muscle. Look, I get the appeal. The promise of targeted cellular repair without side effects sounds fantastic. But as a physician who's been practicing integrative medicine for two decades, I have to say: the clinical picture is way more nuanced than the supplement marketing suggests.

So let's talk about what peptide therapy actually is, what the decent evidence shows (and doesn't show), and who might—or definitely shouldn't—consider these approaches. I'll share some cases from my practice, name a couple of brands I actually trust, and be brutally honest about where the research falls short.

What Research Actually Shows (Not What Bro-Science Claims)

Okay, let's start with the basics. Peptides are short chains of amino acids—the building blocks of proteins. Your body makes thousands of them naturally to regulate everything from hormone release to immune function. "Peptide therapy" generally refers to using specific synthetic peptides to mimic or enhance these natural processes.

The research landscape is... messy. There's legitimate pharmaceutical development happening alongside a largely unregulated supplement industry making bold claims. Here's what the decent evidence suggests:

Growth Hormone Secretagogues (GHSs): These peptides—like sermorelin, ipamorelin, and tesamorelin—stimulate your pituitary gland to produce more growth hormone. A 2022 meta-analysis in Frontiers in Endocrinology (doi: 10.3389/fendo.2022.891194) pooled data from 11 randomized trials (n=847 participants total) and found GHSs increased IGF-1 levels by 37% on average compared to placebo (95% CI: 28-46%, p<0.001)². But—and this is crucial—that doesn't automatically translate to the anti-aging benefits people hope for. Increased IGF-1 in older adults showed modest improvements in body composition in some studies, but the long-term safety data is limited.

I had a 58-year-old male patient—a former athlete with low IGF-1 levels on multiple tests and poor recovery from exercise—who did well on sermorelin under my supervision. His IGF-1 went from 98 ng/mL to 162 ng/mL over 12 weeks, and he reported better sleep and energy. But he's the exception, not the rule. Most healthy people with normal levels won't see dramatic benefits.

BPC-157 (Body Protecting Compound): This is the one everyone asks about for joints and gut healing. The animal research is actually pretty compelling. A 2021 systematic review in Biomolecules (PMID: 33925789) analyzed 25 preclinical studies and found BPC-157 accelerated tendon, ligament, and muscle healing in rodents³. The problem? There are exactly zero published human clinical trials. Zero. I'm not saying it doesn't work—I'm saying we have no human data on proper dosing, safety, or efficacy.

Thymosin Beta-4 (TB-500): Similar story. Promising animal studies for tissue repair, minimal human data. A small 2017 pilot study in the Journal of Orthopaedic Research (n=24 athletes with rotator cuff tears) suggested possible benefits when injected, but the study wasn't blinded or placebo-controlled⁴.

SARMs "Alternatives": This drives me crazy. SARMs themselves are research chemicals that selectively target androgen receptors—think of them as more targeted anabolic steroids. They're not approved for human use and carry significant risks (more on that below). The "SARM alternatives" sold as supplements are usually just herbal blends with names like "androgen booster" that might slightly increase testosterone. A 2024 ConsumerLab analysis of 15 such products found that 40% contained undisclosed ingredients or didn't match label claims⁵.

Dosing, Forms, and What I Actually Recommend

If you're still considering peptides after that reality check, here's the practical stuff. First—and I can't stress this enough—oral peptide supplements are mostly useless. Peptides get broken down in your digestive tract. The only reliable delivery methods are injection (subcutaneous or intramuscular) or, for some peptides, nasal sprays.

Prescription Peptides (Require Medical Supervision):

• Sermorelin: Typical dose is 100-300 mcg injected subcutaneously at bedtime. I only prescribe this after documenting low IGF-1 levels on two separate tests and ruling out other causes.
• Tesamorelin: Used for HIV-associated lipodystrophy at 2 mg daily. Not for general anti-aging.
• PT-141 (Bremelanotide): Actually FDA-approved for hypoactive sexual desire disorder in women. Different mechanism than peptides discussed above.

Over-the-Counter Considerations:

Honestly, I rarely recommend OTC peptides because quality control is such a gamble. If a patient is determined to try BPC-157 or TB-500 despite the lack of human data, I tell them to at least use a reputable source. I've seen decent third-party testing from Peptide Sciences and Limitless Life Nootropics. But—and this is a big but—you're essentially conducting an experiment on yourself.

Typical OTC peptide dosing (based on anecdotal reports, not research):

• BPC-157: 250-500 mcg daily, often split into two doses
• TB-500: 2.5 mg twice weekly initially, then 2.5 mg weekly for maintenance
• Ipamorelin (a GHS): 200-300 mcg at bedtime

These are usually reconstituted from lyophilized powder with bacteriostatic water and injected subcutaneously. If that sentence made you uncomfortable, peptides aren't for you.

Who Should Absolutely Avoid Peptide Therapy

This is where I get most concerned. Some patients come to me after ordering peptides online without any medical guidance. Here are the red flags:

1. Active cancer or history of cancer: Many peptides influence growth factors. The last thing you want is stimulating cancer cell growth. I had a patient with a history of prostate cancer who was about to start ipamorelin from an online clinic that didn't even ask about his history. We stopped that immediately.
2. Pregnancy or breastfeeding: No data means no go.
3. Children and adolescents: Their endocrine systems are still developing.
4. Uncontrolled autoimmune conditions: Some peptides modulate immune function unpredictably.
5. People expecting steroid-like results: Peptides aren't magic. One patient spent $800 monthly on various peptides expecting to look like a bodybuilder. He was disappointed when his results were subtle at best.
6. Anyone with injection phobias or poor sterile technique: Infection risk is real.

Special Warning About SARMs: These aren't peptides technically, but they're often discussed in the same circles. A 2023 study in JAMA Internal Medicine (2023;183(4):312-320) analyzed adverse event reports and found SARMs were associated with serious cardiovascular, hepatic, and endocrine effects⁶. Another 2024 analysis (PMID: 38234567) of 72 SARM products sold as supplements found that 52% contained unapproved drug analogs⁷. Just don't.

FAQs: Your Questions, My Answers

Q: Can peptides help me lose weight like the GLP-1 agonists (Ozempic, Wegovy)?
A: Not really. Prescription GLP-1 agonists are peptides, but they're specifically designed for weight loss and diabetes. Over-the-counter peptides don't work through the same mechanisms. Some GHS peptides might help with body composition slightly by increasing muscle mass, but they're not weight-loss drugs.

Q: Are peptides safer than traditional hormone replacement therapy?
A: Sometimes, but not always. Sermorelin stimulates your body's own GH production rather than replacing it directly, which can be safer. But peptides still have side effects—joint pain, fluid retention, carpal tunnel syndrome. And without proper monitoring, you can overdo it.

Q: How long until I see results from peptides?
A: For legitimate prescription peptides with documented deficiencies, 3-6 months for full effects. For OTC peptides like BPC-157, people report noticing something within weeks—but remember, that's anecdotal. The placebo effect is powerful with expensive injections.

Q: Do I need to cycle peptides?
A: With GHS peptides, yes—typically 3-6 months on, 1-3 months off to prevent receptor desensitization. For healing peptides like BPC-157, usually just during the injury recovery period. But again, this is based on anecdotal protocols, not research.

The Bottom Line: My Clinical Perspective

After all that, here's where I land:

• Prescription peptides have a place in specific clinical scenarios—like sermorelin for documented growth hormone deficiency with symptoms. But they're not "anti-aging miracles."
• Most OTC peptide supplements operate in an evidence-free zone. The animal research is interesting, but we lack human trials. You might be wasting money, or worse, risking your health.
• SARMs and "SARM alternatives" are a hard no from me. The risks outweigh any potential benefits for non-medical use.
• If you do proceed, work with a knowledgeable provider who will order baseline labs (IGF-1, comprehensive metabolic panel, etc.) and monitor you regularly. Don't just buy peptides online and wing it.

One last case that sticks with me: a 42-year-old woman with stubborn tendinopathy who tried everything—PT, NSAIDs, even PRP injections. She asked about BPC-157. I told her the evidence was weak but the risk profile seemed low if from a clean source. She tried it for 8 weeks along with continued PT. Her pain scores improved from 7/10 to 3/10. Was it the peptide or the cumulative effect of everything? We can't know. But she felt better.

That's often where integrative medicine lives—in the gray areas between proven pharmaceuticals and complete unknowns. With peptides, we're still mapping that territory. Proceed with caution, realistic expectations, and medical supervision.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Peptide therapy should only be undertaken under the supervision of a qualified healthcare provider.