Lowe has a point, but the FDA has painted itself into a corner by (a) forcing up the costs and the various bureaucratic demands associated with clinical trials, (b) allowing drug advertising , but then forcing those comical "may cause death" disclaimers, both of which have become totally ubiquitous, and (c) inconsistently following its own rules, and in some cases flouting its own rules.
At this point, broscience is considered no less valid than actual clinical trials, and the FDA should blame itself for this. Not "human nature being what it is in this fallen world" in a sort of general or abstract sense.
Another point I could raise is that telemedicine has turned the entire prescription system into nothing more than a parasitic middleman/gatekeeper.
FDA reform is very badly necessary. That ought to come before harsher enforcement, and I think that much of the populace already intuitively understands this.
You don’t have to wonder. It’s public record that 45% of the FDA’s budget incomes from user fees that companies pay when they apply for approval of a medical device or drug.
In the drug division specifically, the number is about 75%.
Medicine doesn't ignore nutrition, you just don't like the answers.
And it shows on the research: e.g. does creatine help muscle building? No.[1] But cue some anecdote from someone where they also changed a dozen other things at the same time but are sure it was that.
But there's a core problem with this, in many states doctors are legally forbidden to give nutrition advice. The academy of nutrition and dietetics has worked very hard to make it so that only dietitians can provide nutrition advice. Take Ohio for example, a medical doctor in Ohio is legally forbidden and actually in jeopardy of losing their license and going to jail if they were to provide nutrition advice without a dietetics license. Dietitians are not doctors, but the academy of nutrition and dietetics wants you to think they are.
Doctors in the US receive an average of under 20 hours of training in nutrition over four years of medical school. What little they do receive is often focused on nutrient deficiencies rather than on meal planning for health and chronic disease prevention. Less than 15% of residency programs include anything on nutrition.
To become a registered dietician requires at least a Master's degree in dietetics or nutrition or a related field, and at least 1000 hours of supervised internships.
PS: before any Europeans hold this up as an example of the poor US health care system, doctors in Europe average 24 hours of nutrition training.
Aren't doctors actually exempted specifically from such regulations in almost all states? AFAIK they can actually give nutritional advice legally in nearly every jurisdiction in the US.
People want GLP-1 drugs. They can't get them without a prescription. They pay $$$ to a "telemedicine" "doctor", recite a list of well-known symptoms, and buy the prescription.
The system is that you can't buy these drugs without the piece of paper, and the piece of paper is basically something that anybody can buy regardless of whether or not they actually need the drug. Wanting it is usually enough.
I think access is a good thing. The issue isn't with telemedicine but the fact that there's a prescription wall for helpful meds like GLP-1 in a country where we've failed people by creating one of the worst food environments.
Also, most doctor's visits aren't any different from getting it if you want it except it's gated on the mood/attitude of the doctor, maybe your ability to sell some sob story. And then you book a different doctor until you get it. Telemedicine just makes the process easier an arbitrary system.
GLP-1 prescriptions are easy to get in the US. It's filling the prescription that is the problem, because insurance rarely covers it and it is beyond the disposable income of most Americans.
The prescription hurdle is absolutely necessary -- these are not drugs that anyone can safely take without guidance. It's the price that needs to be fixed.
I know a lot of people on GLP-1 meds and even took a dose myself out of curiosity.
You take a dose every two weeks. And if you accidentally double dose because you misread 1U to mean 1 dose, it just gives you some nausea.
Are we going to pretend it's hard to take this drug now too? Or that the doctor has some magical insight into your getting-on? Remember to eat. That's it. I guess a few people might need the doctor to go "you're eating, right?" but I don't believe in infantilizing everyone over that.
Weekly, if you are following guidelines correctly. The half-life of most GLP1 peptides is 5-6 days.
I otherwise agree with your point entirely. Though anecdotally, I may have given my brother-in-law a single small vial of tirzepatide at his request so that he could experience it, and the results were ... not good. Turns out he's an idiot, thought that 'more is better', 'drinking enough water is for weenies', and 'I am not an alcoholic even though I get plowed most evenings.' All against my very specific advice on how to give it a try. Whoops.
My fault, yes, I should have realized he was too stupid to do it without adult supervision. He made himself so sick he almost went to the ER. Nothing really dangerous, of course, tirzepatide is pretty safe stuff, but overdosing on it can make you feel very shitty for a few days until the blood concentration drops.
One dose is one thing -- but there are other risks that can lead to complication or death here if taken improperly for a long period of time. Musculoskeletal issues, cardiac issues, thyroid issues, etc.
Additionally, getting the correct dose is not straightforward for a layperson as it is for other OTC drugs with standard doses.
There are similar risks, and probably more likely, to all sorts of consumables that aren't regulated at all. It is reasonable to ask whether the prescription regime for GLP-1s makes sense. It isn't the only substance posing that conundrum! Ondansetron is OTC in a lot of countries, but not in the US, Canada, or UK. But ondansetron is arguably less dangerous and more helpful than pseudoephedrine.
Pseudoephedrine, of course, isn't BTC because it's dangerous to take or complicated to dose. It's there because of the war on drugs. But I do agree that not all drugs are regulated appropriately. Marijuana also comes to mind.
I do think GLP-1s are just about right. It is appropriate to take them under personalized professional guidance.
Right, and I actually see the logic of that (unlike virtually everyone else on HN, and let's not rekindle that debate; the search bar avails). The point is you don't need a prescription to get it. People might be better off if GLP1s were also BTC. Hard to say!
Certainly you can abuse a GLP1 and get yourself very sick, or not abuse it and still end up with pancreatitis. But smoking and alcohol presumably cause way more cases of pancreatitis, and you don't need a script for a handle of Popov.
There used to be prescriptions for alcohol products and cigarettes have been sold as medical products -- the reason we accept them in society today is not because we think they have relative less risk to other things, but that their acceptance as recreational vices outweighs the harm that we know they cause.
> smoking and alcohol presumably cause way more cases of pancreatitis
Indeed. In fact, I think just recently there were updated studies for at least one of the popular GLP1s that disclaimed entirely a link to pancreatitis.
> Or that the doctor has some magical insight into your getting-on beyond a couple questions they ask you in your visit? Remember to eat. That's it.
Apparently we have forgotten people who died from eating disorders (previously called anorexia nervosa)?
There is a VAST difference between someone who weighs 300lbs asking for GLP-1 to combat morbidity and someone who is barely 100lbs asking for a GLP-1 to take off weight for bikini season. That's what needing to ask a doctor for a prescription is for.
You're totally missing the point thought. The prescription hurdle effectively does not exist. It's just a paywall.
You pay your $100, get a 3 minute call with a NP/PA/whomever, and basically the robot writes you a prescription for whatever you want. The point is you pay and you get the prescription. Patient safety has nothing to do with anything.
It's cheaper for most people to get the prescription written at a PCP.
The advantage to a telehealth is not getting the prescription written -- it's that they'll fill it for cheap through a tiny compounding pharmacy that is making it, technically illegally, but are small enough to be off the FDAs enforcement radar for the moment.
I have used both my PCP and telehealth for prescription writing, never once have I used a compounding pharmacy.
It's slightly cheaper for me to use telehealth vs. billing through my insurance. The downside is it doesn't go towards my deductible of course.
The stuff you are describing are entire supply chains of a sort where you want a GLP-1 or perhaps a few other things like TRT. Those you are signing up for the drug itself, which happens to include the prescription part with it.
Telehealth can be used for any old medication you want. It removes the permission slip part of the process and replaces it with a payment gateway. If you have $75-150 you can just click some buttons and have a prescription for nearly anything you want at most a day later. This includes antibiotics, ADHD meds (getting harder on these), certain benzos, etc.
HIMS/HERS/etc. and their smaller ilk are super popular, but they are the tip of the iceberg.
Telehealth providers can certainly work with compounding pharmacies but not necessarily. If you are looking to get a prescription for Diazapam you are going to be getting that sent to your local Walgreens or whatnot.
Go to doctor, get prescription for restricted medicine, pick up prescription.
If you can call up a teledoc and they give you a prescription based on your description why could you not just go buy the meds yourself without a prescription. You have essentially diagnosed yourself and just asked the doctor for permission to buy the drug you want.
The "perscription system" used to be that you'd have to go see a doctor, the doctor knew who you were, and would make decisions on what prescriptions/medications you should be given.
Due to drug advertising rules, the prescription system has been turned on its head, and the patient now goes to their doctor asking for a specific prescription.
Telemedicine took advantage of this and has effectively removed the middleman (the doctor) in many cases and you just sign-up look at a person on a camera, and get your drugs sent to you.
I take certain medications--nothing interesting, nothing controlled, nothing abusable. I have to deal with a whole thing just to get refills, because my PCP forces me to come in every time--and even that is now just a telehealth call that is annoying.
In Mexico, for meds like mine, you can just buy them at the pharmacy. There's no reason for all this nonsense.
(Edit: same PCP refused to prescribe GLP-1s early, without any scientific or medical reason not to. Delayed my weightloss by months until I found a place that would.)
> I’m curious what you mean by this. I’m not sure what you mean by “prescription system” specifically.
They basically operate as a "pay for a prescription" service.
Figure out what drug you want, google the drug name and telehealth. You will be marketed in a wink wink sort of manner over how easy it is to get them, just hours away! Then if you are not a total idiot, you answer certain questions in the right manner on the intake form, the doctor (usually NP/PA or similar for most things) will quickly run through that and expect you to answer correctly - perhaps guide you a bit if you don't.
5 minutes later you have a prescription in the web portal and it's sent to your pharmacy of choice.
It really shows how the whole "permission slip" program is BS. I've used these services a couple times vs. my normal doctor just to save time and expense of an office visit. If I can click some buttons, have a call 30 minutes later, and be on my way to the pharmacy for $50 it's sometimes the path I take now vs. traditional route.
Someone used to the traditional doctor/patient relationship thing and prescriptions being "holy" would be shocked at how easy and gamed it all is.
To your first point, if you know where to look, you can get tens of vials of GLP-1s that have much higher dosing per vial for cheaper than you can get a third of the amount on the grey market. A lot of these sites even have purity testing to soothe consumers worries that they're getting garbage. For your third point, you have the FDA limiting HGH, yet you can buy the growth horomone releasing factor peptides (tesamorelin, sermorelin, ipamorelin) after doing a simple Google search.
As for broscience, moving into peptides was a logical next step after exhausting anabolic steroid "research". In fact, I'd say that biohackers are actually behind the bros when it comes to trying various peptides out and documenting experiences.
The author is missing a massive segment of that gray market: people who buy FDA-approved weight loss drugs (e.g., semaglutide or tirzepatide) at 2–5% of the brand-name price. This route carries some risk, but there are ways to mitigate it, such as performing third-party testing. I assume most people who do this couldn't realistically afford the brand-name drug anyway, making this their only viable treatment.
Won't be anywhere near that. I don't have prices handy, but Lilly sells tirzepatide (a bit better than sema, and usually a bit more expensive) at 500/mo (maybe a bit less now on the trump rx site, I don't recall). Depending on dose, that'll be about 10 bucks a mg give or take. At 50c/mg for sema you were paying a bit of a premium. These days even tirz is only about 30-35c/mg.
I used to buy from Peptide Sciences so I was certainly paying a premium for reputation at $20/mg. I think Semaglutide is now at a bit of a premium due to it falling out of favour and most people switching to Triz and Reta. I only take a low dose and am happy to stick with what's working.
There must be an irony that it was Trumps crackdown on peptides, I presume to prop up his prescription company, that forced me to switch to Chinese supply. By doing it all at once it created a critical mass for that market.
IIRC the biggest impetus for cracking down was Lilly throwing a fit about the gray market supplying reta well before it even becomes available via the normal channels (who knows when that will be). But as you say, it just pushes people to buy direct from Chinese vendors (and it is basically impossible to stop direct imports like that). Would be safer if more reputable US-based sellers could supply it semi-openly as before. Nexaph is still selling it, but I figure the clock is ticking on that.
I imagine it's legally risky to buy a large quantity, test it, and then resell smaller quantities. That's a shame because the alternative is probably that some folks settle for products of dubious quality and end up getting hurt.
Yes, I believe most people buy directly from somewhat shady Chinese factories. I tried contacting a few and they all refuse to meet or send samples from within China, so I assume what they're doing is illegal in China. In the US, it's legal to sell them as a "research chemical" but the FDA is cracking down on companies that are clearly engaging in b2c.
Right, but I don't know the people at those companies. I have local chemists that I trust. I'm just lamenting the fact that developing that kind of trust network everywhere, so everybody can be similarly sure of what they're putting in their body, is likely to run afoul of local laws.
FWIW, finnrick's claim to fame is being free. Someone is paying for it. They have also failed blind tests in the past, Janoshik (IIRC) never has. There are several US-based labs but none of them have the same reputation as Janoshik.
Actually, you just described most of the tele-health and compounding pharmacies that carry GLP1s!
Where do you think Hims, Ro, Brello, or the rest get the APIs they sell to their customers? They get them from grey market suppliers in China. They don't go to Ely Lilly or NovoNordisk and say, "politely sir, may I skirt around your IP and sell your drugs for 10x what they cost instead of 10,000x what they cost?" Hopefully, they test them and filter them and use sterile/pharma processes for what they sell to their customers. Well, except for the Medspas, those are just wild west snake oil farms.
Things have changed a little, but during the time that compounding was explicitly allowed, the licensed pharmacies were buying from FDA approved manufacturers, sometimes in China, and sometimes the same manufacturers who also do contract manufacturing for Lilly.
Today ... who knows? It might just be the same gray market stuff us plebes can get.
It probably is, but that does not stop people from effectively doing it. There are a number of groups that specialize in conducting group buys, doing a bunch of testing on randomized samples, and then shipping out the product to individuals.
Also, if you plan to be on it a good long time, you can buy a bunch of kits yourself (a kit is 10 vials), run a bunch of tests, and then just have a nice stockpile that will last you years. The testing will likely cost as much or more than the product itself, but given how inexpensive the product is, you still come out way ahead financially.
>I imagine it's legally risky to buy a large quantity, test it, and then resell smaller quantities
It is illegal, but it doesn't stop people from doing it. In fact, if you don't have any sort of test results for your peptides people will absolutely avoid buying your wares until you have them. Purity and mg/ml are the 2 basic test results that any shop worth their stuff will have.
To be fair, most everyone I know who is buying on the gray market considers vendor tests to be minimally required, but still insufficient -- there is no assurance they tested the product they shipped to you. Plan on testing it yourself. I'm sure some people do trust nexaph enough, though, to not worry so much. Whether that trust is well placed, that is a separate discussion.
With most of these you can really tell if they work or not and there is a pretty predicable dose dependent reaction profile. With slow meds like semaglutide you'd maybe not notice it in the first week but you will by week 3. I had mine tested but if that wasn't available I probably would have considered the anecdotal evidence to be sufficient. It appears that most of the scamming is just people taking the money and not shipping anything.
The most dangerous failures I've seen have been sending the wrong peptide. 15 mg of tirzepatide and 15 mg of semaglutide is a very different experience.
After nearly getting hosed in a group buy (I did get refunded, but that is far from a guarantee) because of a product mismatch, I decided to just pay for nexaph. Love him or hate him, his popularity relies on his reputation and he has been more careful than most suppliers to cultivate it with more extensive testing and quality control.
That makes sense, I don't like that the bottles are unlabelled so the first thing I have to do is label them. The box is labelled and this seems to be standard practice. Semaglutide is falling out of favour so I guess they're substituting. I have 4 years supply now so I guess I'll check back then and see where the market is at.
I know a bunch of people with multi-year stockpiles. I've got ~5 years of reta and ~6 years of tirz. This is too much, of course, but I determined a while back that under no circumstances do I ever intend to find myself unable to source it. My life is immeasurably better after losing 110 pounds.
Peptides are a revolution and you don't need to know how they work to know that they work (for various people for various conditions). There is a tension between empiricism and fundamentalism with much of medical science focusing on fundamentalism. Now with the ability to collect and search large amounts of empirical data and communicate it peer-to-peer people are picking up on a lot of things that work without knowing why they work. I think people are just going to circumvent the fundamentalist and chase after whatever works.
I owe my health to early adoption of experimental peptides, I have life long ME/CFS and there is no known treatment for this nor is there any on the horizon. At least they finally have a diagnostic test and know it's not psychosomatic but I could have told them that from day 1. Most doctors are not researchers and have little understanding on statistics instead preferring to rely on discrete classifications and simple decision tress. As someone with hEDS from TNXB I am a walking bag of symptoms and yet not a single doctor could figure it out. I had to research it myself which involved post-doc level textbooks and research journals. I came across the work done by Prof. Khavinson (USSR) and it did appear to me that peptides were incredibly under-explored. Given the poor quality of life with ME/CFS I was willing to take serious risks so previous trials were helpful to give an idea on dosing and lethality, I went through most of the research peptides one by one. I actually waited on semaglutide a bit because I suspected there was a small minority who would have hyper sensitivity and I both expected that to appear in the data, which it did, and I expected to have hypersensitivity, which I did. Others who were less careful ended up with pretty bad gastroenteritis. Semaglutide has been the most effective and with it and a few others I am largely able to lead a normal life. I was getting gray market from the US but now I get it direct from China.
I tried retatrutide for 10 weeks, here are my results:
Before:
5'7, ~182lb
Bench 1rm: 315
Squat: 5x10 225
Deadlift: 5x5 315
After:
same height lol, 154lb
Bench 1rm: 285
Squat: 5x10 205
Deadlift: 5x5 275
Suffered some anhedonia towards the end but that went away ~1wk after stopping.
Overall pretty good, not any side effects. Definitely fixed my food craving problem. I didn't have a high intake of protein during the 10 weeks, so I suspect thats why I lost muscle mass :/
I used a combo of low-dose retatrutide, tesamorelin, and ipamorelin and lost about 15lb over 45 days, including 60% of my visceral fat, and put on 4lb of muscle, per before-and-after DEXA scans. I lifted regularly, ate well, and prioritized protein, and while I definitely under-ate protein, I was very pleased to find that I was able to increase muscle mass while cutting the fat. My visceral fat was the primary target here, since I'd been unable to get it to budge despite consistent training and diet. Very pleased.
You lost muscle because you lost around 1.54% of body weight per week, which is way too aggressive. The maximum recommended amount for losing weight while retaining muscle is around 1%. You will also most likely experience a weight rebound.
Hasn't this mostly been debunked? You lose muscle mass because you lost mass overall, and whether you lost it too quickly or not is not the major factor. AFAIK maintaining muscle mass while losing fat is borderline impossible for anyone who isn't extremely fat and/or very disproportionate composition to begin with.
Did you work out during those 10 weeks any? TBH if you went from regular lifting to not for 10 weeks I'd expect a similar decrease in your lifting numbers (though not a .4lb/day weight loss of course)
I know a couple of people that should know better (phds in biosciences but now doing corporate management) taking expensive weird Chinese peptides that would probably be better off if they did some cardio a few days per week and ate better.
It seems we are treating Peptides like drugs here. It's my opinion that amino acids regardless of how they are chained do not belong under and stricter regulation than food given I eat peptides every day from my food. Then again I do not believe in the concept of prescription drugs. Everything with a NDC code should be at the grocery store and I should be able to stock up on it without permission especially given how fragile global shipping is these days. Drugs risks do not enter into the picture given the fact I can buy ammonia and bleach along with a myriad of other dangerous compounds. Worse, I could crush up apple seeds from the veggie isle. One can also make just about anything using fourth thieves vinegar. Maybe put expensive high demand things like cocaine behind locked glass along with the underwear and condoms.
As a side note more dangerous than any drug is stopping a prescription drug cold turkey. Watch what happens when global trade to/from China and India are cut off for a year. Attitudes will change.
This is briefly addressed in the article, but basically it's one thing to eat a peptide and quite another thing to inject it. Your digestive system is extremely adroit at taking peptides and proteins and breaking them down into individual amino acids, which are then absorbed via "transporters" in the gut. (e.g. SLC6A14 for glutamate and cysteine.)
If you eat insulin, absolutely nothing will happen. If you inject just a little bit too much, you're dead.
So, generally: Ingested proteins/peptides aren't drug-like, whereas they can be extremely potent drugs if administered via injection.
Granted, there are exceptions. If you accidentally get a drop of botox into your mouth, you'll be okay, but if you drink a vial, you'll be poisoned. And people have been trying to make orally-active peptides and proteins for decades, with some noteworthy successes, however few and far between in the general case.
I agree with some of this. There are most certainly orally active peptides such as BPC-157 and its replacement PDA penta deca arginate that can repair the gut and still circulate throughout the body especially in those with leaky gut. People with leaky gut should be able to buy a clean source of BPC-157 or PDA without a prescription and without visiting dark alleys. It is very safe and tolerable.
GLP's are all the rage these days. Doctors seem to be giving GLP peptides out like candy and those are injected. People are looking like zombies. That said if doctors are going to be so liberal with them I should be able to buy it in the grocery store and slap it down on the conveyor belt. Again I can buy things far more dangerous than any prescription drug. There are very dangerous supplements, some that are shilled heavily on youtube. For example, Glycine (for me specifically used without a specific process) is more dangerous than heroine and the vast majority of doctors would have no idea what I am talking about.
Also LOL at the notion "peptides are safe because GLP-1 exists".
Pretty much all venoms are mixes of short (10-15 base) peptide chains.
It's the naturalistic fallacy in an utterly perverse form ( and also goes to show why a regulatory system is good: the average person has no idea that they're dealing with or even common sense about it).
Injected BPC-157 to a wound is a magic healing potion as far as I'm concerned. That it's not more broadly available is a crime, imo. If I had a billion dollars, I'd push so many things through the FDA.
The regulation of drugs or most any consumer product is not due to the inherent danger of an item itself, but the danger presented to a consumer inside the context of societal mechanisms that influence behavior. You're right that many regulations don't make sense outside of a societal context -- but that's because they also don't exist outside of a societal context.
The reason we don't need tight regulations on bleach is because we don't have a societal issue causing people to drink it and hurt themselves... at least, not anymore: most of the locking lids on household cleaning chemicals are there by law.
I'm all for laxer regulation of substance control e.g. buying cocaine at the grocery store, but I think its also a bit misleading to describe arbitrary sequences of amino acids as if they're meaningfully comparable to food.
That's like saying that since neither one nor zero requires regulation, neither does software. Maybe software does or doesn't, but in either case its best based on the nature of the aggregate, not the nature of its components.
> It's my opinion that amino acids regardless of how they are chained do not belong under and stricter regulation than food given I eat peptides every day from my food.
I mean, why regulate anything? Everything is just different arrangements of hydrogen and time. It's so weird that certain arrangements of hydrogen and time try to claim to have things like "morals", and try to force other arrangements of hydrogen and time to not do arbitrary contrived concepts like "murder".
All is one. Just hydrogen and time. Therefore everything should be legal.
> It seems we are treating Peptides like drugs here
That’s exactly what some biological drugs are too - peptides!
And peptides are just short chains of amino acids. Almost all the other biological drugs are just longer chains of amino acids - antibodies, enzymes, antigens, some hormones, and others.
Derek is right that the safety risks are exponentially higher when you inject peptides - you basically skip a bunch of protective mechanisms like enzymes that quickly break them down if taken orally or routes.
As a former R&D scientist there is no way I’d inject any peptide that hasn’t at least gone through a phase 1 safety study in humans. Otherwise you have no idea what it could be doing to your body.
A good example was a drug that was quickly pulled from market for causing fatal anaphylactic reactions. It wasn’t even caught in the clinical trials!
At the same time, I think people have the right to take whatever substance they want. But I worry a lot of people aren’t aware of the risks.
>As a former R&D scientist there is no way I’d inject any peptide that hasn’t at least gone through a phase 1 safety study in humans. Otherwise you have no idea what it could be doing to your body.
A lot of people do not understand the trial system or the value of Phase 0/1 tests when it comes to the substances that they put into their body. And thanks to the influencer/grifter/biohacker ecosystem that exists, more people would put their trust in accidental evidence, from people who's incentive it is to make money off of them, while complaining about the pharmaceutical industry operates off of a profit motive.
> Drugs risks do not enter into the picture given the fact I can buy ammonia and bleach along with a myriad of other dangerous compounds.
This is a deeply weird take. You think anyone ought to be able to buy, for instance, warfarin and freely take it without a doctor’s involvement? We should let parents self-diagnose diabetes and administer insulin without a prescription or discussion? We should just hope that patients heard their doctor say hydralazine and not hydroxyzine?
> As a side note more dangerous than any drug is stopping a prescription drug cold turkey.
Abject nonsense. It was very easy to stop my prescribed amoxicillin. It’s clear you don’t have any actual idea what “prescription drugs” are, in aggregate, and that should maybe inform your decision to have Big Opinions about them.
Your argument is even worse lol. Obviously he's proposing that you can take your doctors note to the pharmacy and get what the doctor prescribed in addition to being allowed to self purchase behind the counter drugs.
> This is a deeply weird take. You think anyone ought to be able to buy, for instance, warfarin and freely take it without a doctor’s involvement? We should let parents self-diagnose diabetes and administer insulin without a prescription or discussion? We should just hope that patients heard their doctor say hydralazine and not hydroxyzine?
Weird examples. You can buy insulin without a prescription today in the USA.
In much of the world -- including almost all of Asia, Africa, and much of Eastern Europe -- you can buy almost any drug without a prescription. The only exceptions are potent CNS stimulants or narcotics, and in some rare cases antibiotics.
This is legitimately a better system. Takes out the middleman.
In the US you can get any drug if you pay $120 and recite the magic words to a telemedicine "doctor."
Funny you mention this... I bumped into a VP of Merck at a conference and that's the exact example he gave: in the US, you can't adjust your own coumadin dosage without a M.D. consult, but here, have 200 doses of insulin to take home with you.
In much of the world -- including almost all of Asia, Africa, and much of Eastern Europe
Doctors in the US get a nice $200 to $500 per doctors visit, required to extend the prescription drug. I only notice because I pay cash. This is why they will argue against anything I am saying until they are code-blue in the face. I will leave them with my code brown.
In the US you can get any drug if you pay $120 and recite the magic words to a telemedicine "doctor."
That's how a number of us in a particular circle stock up on anti-biotics. That said anti-biotics are a last resort for me whereas I find doctors are quick to prescribe them.
I take a small issue with the claim that we don't test peptides. Some of us test them extensively before injecting. Granted, probably the same people who also understand how little science there is backing up most of the popular peptides today. I enjoy being able to buy my own GLP1s, however, at least those which have made it through phase III trials succesfully. As tempting as the claims are about things like BPC-157 and such ... no thanks, that is past my comfort level a good bit.
> My patient is refusing a drug studied in 170,000 people because of side effects that a 124,000-person analysis just confirmed do not exist — while injecting a compound studied in 14 humans, from unregulated sources, based on the recommendation of someone who profits from selling it. She’s probably not the only one. And those using it believe they are “doing their own research.”
Ok, and? At worst you waste a couple hundred dollars and deem the alternative therapy not worth it and go back to your doctor but I know dozens of people at my gym that used BPC 157 and TB 500 that fixed their chronic tendon/joint issues within weeks of starting the therapy that physios couldn't fix for years.
I don't doubt it. You make casual friends sometimes at certain gyms, especially if any sort of sports are involved like tennis or even group classes.
I am a super introvert and know at least half a dozen folks with such issues, more if you include my close friend group.
Any place that has a lot of physically active people stressing their limits a bit is going to have a lot of injured folks over a decent period of time. And of course it gets talked about quite a lot, since it limits performance and ability.
My trainer knows I have a chronic shoulder issue, and an adductor issue at the moment I'm working through that we need to avoid stressing too much. The few other folks who tend to work out around my schedule know of this, and I know of theirs.
My partner's grandfather died of cancer because when he was having pains they believed their homeopathic medicine would work. When he finally when in to see a real doctor it was too late. If he had gone in earlier, he would been able to have a chance. This is not a rare occurrence for these types.
Why would you stop going to a real doctor though? It's not one or the other.
I'm very on the fence over BPC-157/TB500, I really want to see some actual clinical trials ran on it. I have a feeling the effects are overstated, but I also have had a number of "insider" conversations where I know these and other compounds are very much being utilized in pro athlete injury recovery programs. Those athletes certainly are getting state of the art medical care via traditional sources, plus elite level physio therapy - so it's hard to say if the illicit injury recovery drugs are doing much or not.
I don’t think either of those are patentable so I doubt you’ll see studies or trials any time soon. A lot of strength athletes at all levels, not just elite, are absolutely convinced of their efficacy and their usage sometimes seems as common as ibuprofen.
According to our new AI overlords, a short synopsis of potential risks of BPC 157 based on mechanistic and animal work to date (don't know human risks because there haven't been sufficient clinical studies):
* Possible pathologic angiogenesis (abnormal blood‑vessel growth), which theoretically could support tumor growth or inflammatory and autoimmune processes.
* Modulation of nitric‑oxide pathways that, at high levels, might contribute to anemia, altered drug metabolism (CYP enzyme activity), and possibly neurodegenerative processes in theory.
* Concerns that its pro‑healing, pro‑growth signalling (e.g., FAK–paxillin) could encourage cancer spread if malignant cells are already present; this remains theoretical, with no proof in humans.
* Possible liver and kidney toxicity suggested in some commentary and extrapolated from preclinical work, but not well characterized in people.
* Immune reactions or allergic responses, including fevers, rash, hives, muscle aches, or systemic inflammatory responses
These do not appear to be results that would appear overnight. It would be "nice" if the folks injecting random shit into their bodies also disclaimed any subsequent medical intervention as a result of said shit, but that I suspect that's unlikely.
You mean the ones that are the result of experience through controlled clinical trials with statistical analyses and error bars, yep, sure. I guess I have a bit more faith in those leaflets and the testing regimes that generates them than the word of some gymbro or influencer who injected themselves and didn't immediately fall over dead.
I think if you're a cloudflare customer they set a cookie in your browser that let's you bypass the waiting period. Just wait until next year when they show ads during the wait.
With India getting generic GLP-1s, the tech to "print" peptides will probably see costs fall off a cliff, so we're probably only looking at the tip of the iceberg with the amount of damages the reddit biohacker bros will accomplish. Men especially are feeling a lot more lonely and image-conscious and there are peptides people claim make them taller[1] or muscular[2].
Yeah I'm always amazed at what they can get people to pay for individual vials. I buy kits of 24mg reta for ~280. And that's not the cheapest, for certain.
Lowe has a point, but the FDA has painted itself into a corner by (a) forcing up the costs and the various bureaucratic demands associated with clinical trials, (b) allowing drug advertising , but then forcing those comical "may cause death" disclaimers, both of which have become totally ubiquitous, and (c) inconsistently following its own rules, and in some cases flouting its own rules.
At this point, broscience is considered no less valid than actual clinical trials, and the FDA should blame itself for this. Not "human nature being what it is in this fallen world" in a sort of general or abstract sense.
Another point I could raise is that telemedicine has turned the entire prescription system into nothing more than a parasitic middleman/gatekeeper.
FDA reform is very badly necessary. That ought to come before harsher enforcement, and I think that much of the populace already intuitively understands this.
When medicine ignores nutrition entirely, and nutrient supplements are still complete unknowns, you have to wonder who the FDA is working for.
You don’t have to wonder. It’s public record that 45% of the FDA’s budget incomes from user fees that companies pay when they apply for approval of a medical device or drug.
In the drug division specifically, the number is about 75%.
Medicine doesn't ignore nutrition, you just don't like the answers.
And it shows on the research: e.g. does creatine help muscle building? No.[1] But cue some anecdote from someone where they also changed a dozen other things at the same time but are sure it was that.
[1] https://www.unsw.edu.au/newsroom/news/2025/03/sports-supplem...
But there's a core problem with this, in many states doctors are legally forbidden to give nutrition advice. The academy of nutrition and dietetics has worked very hard to make it so that only dietitians can provide nutrition advice. Take Ohio for example, a medical doctor in Ohio is legally forbidden and actually in jeopardy of losing their license and going to jail if they were to provide nutrition advice without a dietetics license. Dietitians are not doctors, but the academy of nutrition and dietetics wants you to think they are.
> Dietitians are not doctors
And doctors are not dietitians.
Doctors in the US receive an average of under 20 hours of training in nutrition over four years of medical school. What little they do receive is often focused on nutrient deficiencies rather than on meal planning for health and chronic disease prevention. Less than 15% of residency programs include anything on nutrition.
To become a registered dietician requires at least a Master's degree in dietetics or nutrition or a related field, and at least 1000 hours of supervised internships.
PS: before any Europeans hold this up as an example of the poor US health care system, doctors in Europe average 24 hours of nutrition training.
Aren't doctors actually exempted specifically from such regulations in almost all states? AFAIK they can actually give nutritional advice legally in nearly every jurisdiction in the US.
Mmmm, regulatory capture and rent seeking. Will it ever end?
> Another point I could raise is that telemedicine has turned the entire prescription system into nothing more than a parasitic middleman/gatekeeper.
I’m curious what you mean by this. I’m not sure what you mean by “prescription system” specifically.
I'll give you a case in point. This article was discussed the other day:
> https://www.nytimes.com/2026/04/02/technology/ai-billion-dol...
People want GLP-1 drugs. They can't get them without a prescription. They pay $$$ to a "telemedicine" "doctor", recite a list of well-known symptoms, and buy the prescription.
The system is that you can't buy these drugs without the piece of paper, and the piece of paper is basically something that anybody can buy regardless of whether or not they actually need the drug. Wanting it is usually enough.
I think access is a good thing. The issue isn't with telemedicine but the fact that there's a prescription wall for helpful meds like GLP-1 in a country where we've failed people by creating one of the worst food environments.
Also, most doctor's visits aren't any different from getting it if you want it except it's gated on the mood/attitude of the doctor, maybe your ability to sell some sob story. And then you book a different doctor until you get it. Telemedicine just makes the process easier an arbitrary system.
GLP-1 prescriptions are easy to get in the US. It's filling the prescription that is the problem, because insurance rarely covers it and it is beyond the disposable income of most Americans.
The prescription hurdle is absolutely necessary -- these are not drugs that anyone can safely take without guidance. It's the price that needs to be fixed.
I know a lot of people on GLP-1 meds and even took a dose myself out of curiosity.
You take a dose every two weeks. And if you accidentally double dose because you misread 1U to mean 1 dose, it just gives you some nausea.
Are we going to pretend it's hard to take this drug now too? Or that the doctor has some magical insight into your getting-on? Remember to eat. That's it. I guess a few people might need the doctor to go "you're eating, right?" but I don't believe in infantilizing everyone over that.
> You take a dose every two weeks
Weekly, if you are following guidelines correctly. The half-life of most GLP1 peptides is 5-6 days.
I otherwise agree with your point entirely. Though anecdotally, I may have given my brother-in-law a single small vial of tirzepatide at his request so that he could experience it, and the results were ... not good. Turns out he's an idiot, thought that 'more is better', 'drinking enough water is for weenies', and 'I am not an alcoholic even though I get plowed most evenings.' All against my very specific advice on how to give it a try. Whoops.
My fault, yes, I should have realized he was too stupid to do it without adult supervision. He made himself so sick he almost went to the ER. Nothing really dangerous, of course, tirzepatide is pretty safe stuff, but overdosing on it can make you feel very shitty for a few days until the blood concentration drops.
One dose is one thing -- but there are other risks that can lead to complication or death here if taken improperly for a long period of time. Musculoskeletal issues, cardiac issues, thyroid issues, etc.
Additionally, getting the correct dose is not straightforward for a layperson as it is for other OTC drugs with standard doses.
There are similar risks, and probably more likely, to all sorts of consumables that aren't regulated at all. It is reasonable to ask whether the prescription regime for GLP-1s makes sense. It isn't the only substance posing that conundrum! Ondansetron is OTC in a lot of countries, but not in the US, Canada, or UK. But ondansetron is arguably less dangerous and more helpful than pseudoephedrine.
Pseudoephedrine, of course, isn't BTC because it's dangerous to take or complicated to dose. It's there because of the war on drugs. But I do agree that not all drugs are regulated appropriately. Marijuana also comes to mind.
I do think GLP-1s are just about right. It is appropriate to take them under personalized professional guidance.
Right, and I actually see the logic of that (unlike virtually everyone else on HN, and let's not rekindle that debate; the search bar avails). The point is you don't need a prescription to get it. People might be better off if GLP1s were also BTC. Hard to say!
Certainly you can abuse a GLP1 and get yourself very sick, or not abuse it and still end up with pancreatitis. But smoking and alcohol presumably cause way more cases of pancreatitis, and you don't need a script for a handle of Popov.
There used to be prescriptions for alcohol products and cigarettes have been sold as medical products -- the reason we accept them in society today is not because we think they have relative less risk to other things, but that their acceptance as recreational vices outweighs the harm that we know they cause.
> smoking and alcohol presumably cause way more cases of pancreatitis
Indeed. In fact, I think just recently there were updated studies for at least one of the popular GLP1s that disclaimed entirely a link to pancreatitis.
> Or that the doctor has some magical insight into your getting-on beyond a couple questions they ask you in your visit? Remember to eat. That's it.
Apparently we have forgotten people who died from eating disorders (previously called anorexia nervosa)?
There is a VAST difference between someone who weighs 300lbs asking for GLP-1 to combat morbidity and someone who is barely 100lbs asking for a GLP-1 to take off weight for bikini season. That's what needing to ask a doctor for a prescription is for.
> The prescription hurdle is absolutely necessary
You're totally missing the point thought. The prescription hurdle effectively does not exist. It's just a paywall.
You pay your $100, get a 3 minute call with a NP/PA/whomever, and basically the robot writes you a prescription for whatever you want. The point is you pay and you get the prescription. Patient safety has nothing to do with anything.
It's cheaper for most people to get the prescription written at a PCP.
The advantage to a telehealth is not getting the prescription written -- it's that they'll fill it for cheap through a tiny compounding pharmacy that is making it, technically illegally, but are small enough to be off the FDAs enforcement radar for the moment.
I have used both my PCP and telehealth for prescription writing, never once have I used a compounding pharmacy.
It's slightly cheaper for me to use telehealth vs. billing through my insurance. The downside is it doesn't go towards my deductible of course.
The stuff you are describing are entire supply chains of a sort where you want a GLP-1 or perhaps a few other things like TRT. Those you are signing up for the drug itself, which happens to include the prescription part with it.
Telehealth can be used for any old medication you want. It removes the permission slip part of the process and replaces it with a payment gateway. If you have $75-150 you can just click some buttons and have a prescription for nearly anything you want at most a day later. This includes antibiotics, ADHD meds (getting harder on these), certain benzos, etc.
HIMS/HERS/etc. and their smaller ilk are super popular, but they are the tip of the iceberg.
Telehealth providers can certainly work with compounding pharmacies but not necessarily. If you are looking to get a prescription for Diazapam you are going to be getting that sent to your local Walgreens or whatnot.
Go to doctor, get prescription for restricted medicine, pick up prescription.
If you can call up a teledoc and they give you a prescription based on your description why could you not just go buy the meds yourself without a prescription. You have essentially diagnosed yourself and just asked the doctor for permission to buy the drug you want.
The "perscription system" used to be that you'd have to go see a doctor, the doctor knew who you were, and would make decisions on what prescriptions/medications you should be given.
Due to drug advertising rules, the prescription system has been turned on its head, and the patient now goes to their doctor asking for a specific prescription.
Telemedicine took advantage of this and has effectively removed the middleman (the doctor) in many cases and you just sign-up look at a person on a camera, and get your drugs sent to you.
I take certain medications--nothing interesting, nothing controlled, nothing abusable. I have to deal with a whole thing just to get refills, because my PCP forces me to come in every time--and even that is now just a telehealth call that is annoying.
In Mexico, for meds like mine, you can just buy them at the pharmacy. There's no reason for all this nonsense.
(Edit: same PCP refused to prescribe GLP-1s early, without any scientific or medical reason not to. Delayed my weightloss by months until I found a place that would.)
> I’m curious what you mean by this. I’m not sure what you mean by “prescription system” specifically.
They basically operate as a "pay for a prescription" service.
Figure out what drug you want, google the drug name and telehealth. You will be marketed in a wink wink sort of manner over how easy it is to get them, just hours away! Then if you are not a total idiot, you answer certain questions in the right manner on the intake form, the doctor (usually NP/PA or similar for most things) will quickly run through that and expect you to answer correctly - perhaps guide you a bit if you don't.
5 minutes later you have a prescription in the web portal and it's sent to your pharmacy of choice.
It really shows how the whole "permission slip" program is BS. I've used these services a couple times vs. my normal doctor just to save time and expense of an office visit. If I can click some buttons, have a call 30 minutes later, and be on my way to the pharmacy for $50 it's sometimes the path I take now vs. traditional route.
Someone used to the traditional doctor/patient relationship thing and prescriptions being "holy" would be shocked at how easy and gamed it all is.
To your first point, if you know where to look, you can get tens of vials of GLP-1s that have much higher dosing per vial for cheaper than you can get a third of the amount on the grey market. A lot of these sites even have purity testing to soothe consumers worries that they're getting garbage. For your third point, you have the FDA limiting HGH, yet you can buy the growth horomone releasing factor peptides (tesamorelin, sermorelin, ipamorelin) after doing a simple Google search.
As for broscience, moving into peptides was a logical next step after exhausting anabolic steroid "research". In fact, I'd say that biohackers are actually behind the bros when it comes to trying various peptides out and documenting experiences.
The author is missing a massive segment of that gray market: people who buy FDA-approved weight loss drugs (e.g., semaglutide or tirzepatide) at 2–5% of the brand-name price. This route carries some risk, but there are ways to mitigate it, such as performing third-party testing. I assume most people who do this couldn't realistically afford the brand-name drug anyway, making this their only viable treatment.
I bought Semaglutide at 50c/mg and had it tested, it's the real deal. What's the normal price, $100/mg?
My gf is in medicine so she had a friend test it through their work.
Won't be anywhere near that. I don't have prices handy, but Lilly sells tirzepatide (a bit better than sema, and usually a bit more expensive) at 500/mo (maybe a bit less now on the trump rx site, I don't recall). Depending on dose, that'll be about 10 bucks a mg give or take. At 50c/mg for sema you were paying a bit of a premium. These days even tirz is only about 30-35c/mg.
I used to buy from Peptide Sciences so I was certainly paying a premium for reputation at $20/mg. I think Semaglutide is now at a bit of a premium due to it falling out of favour and most people switching to Triz and Reta. I only take a low dose and am happy to stick with what's working.
There must be an irony that it was Trumps crackdown on peptides, I presume to prop up his prescription company, that forced me to switch to Chinese supply. By doing it all at once it created a critical mass for that market.
IIRC the biggest impetus for cracking down was Lilly throwing a fit about the gray market supplying reta well before it even becomes available via the normal channels (who knows when that will be). But as you say, it just pushes people to buy direct from Chinese vendors (and it is basically impossible to stop direct imports like that). Would be safer if more reputable US-based sellers could supply it semi-openly as before. Nexaph is still selling it, but I figure the clock is ticking on that.
[dead]
I imagine it's legally risky to buy a large quantity, test it, and then resell smaller quantities. That's a shame because the alternative is probably that some folks settle for products of dubious quality and end up getting hurt.
Yes, I believe most people buy directly from somewhat shady Chinese factories. I tried contacting a few and they all refuse to meet or send samples from within China, so I assume what they're doing is illegal in China. In the US, it's legal to sell them as a "research chemical" but the FDA is cracking down on companies that are clearly engaging in b2c.
There's this company that offers free testing: https://finnrick.com/
Another popular testing company is https://janoshik.com
Some other useful resources: https://graymarket.substack.com/ and https://glp1forum.com/
There are a few subreddits as well.
FWIW, I never ended up buying any myself.
Right, but I don't know the people at those companies. I have local chemists that I trust. I'm just lamenting the fact that developing that kind of trust network everywhere, so everybody can be similarly sure of what they're putting in their body, is likely to run afoul of local laws.
FWIW, finnrick's claim to fame is being free. Someone is paying for it. They have also failed blind tests in the past, Janoshik (IIRC) never has. There are several US-based labs but none of them have the same reputation as Janoshik.
Actually, you just described most of the tele-health and compounding pharmacies that carry GLP1s!
Where do you think Hims, Ro, Brello, or the rest get the APIs they sell to their customers? They get them from grey market suppliers in China. They don't go to Ely Lilly or NovoNordisk and say, "politely sir, may I skirt around your IP and sell your drugs for 10x what they cost instead of 10,000x what they cost?" Hopefully, they test them and filter them and use sterile/pharma processes for what they sell to their customers. Well, except for the Medspas, those are just wild west snake oil farms.
Things have changed a little, but during the time that compounding was explicitly allowed, the licensed pharmacies were buying from FDA approved manufacturers, sometimes in China, and sometimes the same manufacturers who also do contract manufacturing for Lilly.
Today ... who knows? It might just be the same gray market stuff us plebes can get.
It probably is, but that does not stop people from effectively doing it. There are a number of groups that specialize in conducting group buys, doing a bunch of testing on randomized samples, and then shipping out the product to individuals.
Also, if you plan to be on it a good long time, you can buy a bunch of kits yourself (a kit is 10 vials), run a bunch of tests, and then just have a nice stockpile that will last you years. The testing will likely cost as much or more than the product itself, but given how inexpensive the product is, you still come out way ahead financially.
>I imagine it's legally risky to buy a large quantity, test it, and then resell smaller quantities
It is illegal, but it doesn't stop people from doing it. In fact, if you don't have any sort of test results for your peptides people will absolutely avoid buying your wares until you have them. Purity and mg/ml are the 2 basic test results that any shop worth their stuff will have.
To be fair, most everyone I know who is buying on the gray market considers vendor tests to be minimally required, but still insufficient -- there is no assurance they tested the product they shipped to you. Plan on testing it yourself. I'm sure some people do trust nexaph enough, though, to not worry so much. Whether that trust is well placed, that is a separate discussion.
With most of these you can really tell if they work or not and there is a pretty predicable dose dependent reaction profile. With slow meds like semaglutide you'd maybe not notice it in the first week but you will by week 3. I had mine tested but if that wasn't available I probably would have considered the anecdotal evidence to be sufficient. It appears that most of the scamming is just people taking the money and not shipping anything.
The most dangerous failures I've seen have been sending the wrong peptide. 15 mg of tirzepatide and 15 mg of semaglutide is a very different experience.
After nearly getting hosed in a group buy (I did get refunded, but that is far from a guarantee) because of a product mismatch, I decided to just pay for nexaph. Love him or hate him, his popularity relies on his reputation and he has been more careful than most suppliers to cultivate it with more extensive testing and quality control.
That makes sense, I don't like that the bottles are unlabelled so the first thing I have to do is label them. The box is labelled and this seems to be standard practice. Semaglutide is falling out of favour so I guess they're substituting. I have 4 years supply now so I guess I'll check back then and see where the market is at.
> I have 4 years supply now
<Insert that "one of us, one of us..." GIF here>
I know a bunch of people with multi-year stockpiles. I've got ~5 years of reta and ~6 years of tirz. This is too much, of course, but I determined a while back that under no circumstances do I ever intend to find myself unable to source it. My life is immeasurably better after losing 110 pounds.
Peptides are a revolution and you don't need to know how they work to know that they work (for various people for various conditions). There is a tension between empiricism and fundamentalism with much of medical science focusing on fundamentalism. Now with the ability to collect and search large amounts of empirical data and communicate it peer-to-peer people are picking up on a lot of things that work without knowing why they work. I think people are just going to circumvent the fundamentalist and chase after whatever works.
I owe my health to early adoption of experimental peptides, I have life long ME/CFS and there is no known treatment for this nor is there any on the horizon. At least they finally have a diagnostic test and know it's not psychosomatic but I could have told them that from day 1. Most doctors are not researchers and have little understanding on statistics instead preferring to rely on discrete classifications and simple decision tress. As someone with hEDS from TNXB I am a walking bag of symptoms and yet not a single doctor could figure it out. I had to research it myself which involved post-doc level textbooks and research journals. I came across the work done by Prof. Khavinson (USSR) and it did appear to me that peptides were incredibly under-explored. Given the poor quality of life with ME/CFS I was willing to take serious risks so previous trials were helpful to give an idea on dosing and lethality, I went through most of the research peptides one by one. I actually waited on semaglutide a bit because I suspected there was a small minority who would have hyper sensitivity and I both expected that to appear in the data, which it did, and I expected to have hypersensitivity, which I did. Others who were less careful ended up with pretty bad gastroenteritis. Semaglutide has been the most effective and with it and a few others I am largely able to lead a normal life. I was getting gray market from the US but now I get it direct from China.
I tried retatrutide for 10 weeks, here are my results: Before: 5'7, ~182lb
Bench 1rm: 315
Squat: 5x10 225
Deadlift: 5x5 315
After: same height lol, 154lb
Bench 1rm: 285
Squat: 5x10 205
Deadlift: 5x5 275
Suffered some anhedonia towards the end but that went away ~1wk after stopping. Overall pretty good, not any side effects. Definitely fixed my food craving problem. I didn't have a high intake of protein during the 10 weeks, so I suspect thats why I lost muscle mass :/
I used a combo of low-dose retatrutide, tesamorelin, and ipamorelin and lost about 15lb over 45 days, including 60% of my visceral fat, and put on 4lb of muscle, per before-and-after DEXA scans. I lifted regularly, ate well, and prioritized protein, and while I definitely under-ate protein, I was very pleased to find that I was able to increase muscle mass while cutting the fat. My visceral fat was the primary target here, since I'd been unable to get it to budge despite consistent training and diet. Very pleased.
You lost muscle because you lost around 1.54% of body weight per week, which is way too aggressive. The maximum recommended amount for losing weight while retaining muscle is around 1%. You will also most likely experience a weight rebound.
Hasn't this mostly been debunked? You lose muscle mass because you lost mass overall, and whether you lost it too quickly or not is not the major factor. AFAIK maintaining muscle mass while losing fat is borderline impossible for anyone who isn't extremely fat and/or very disproportionate composition to begin with.
Did you work out during those 10 weeks any? TBH if you went from regular lifting to not for 10 weeks I'd expect a similar decrease in your lifting numbers (though not a .4lb/day weight loss of course)
Those are sizable drops for 10 weeks unless you stopped lifting as well
solid bench brother
I know a couple of people that should know better (phds in biosciences but now doing corporate management) taking expensive weird Chinese peptides that would probably be better off if they did some cardio a few days per week and ate better.
It seems we are treating Peptides like drugs here. It's my opinion that amino acids regardless of how they are chained do not belong under and stricter regulation than food given I eat peptides every day from my food. Then again I do not believe in the concept of prescription drugs. Everything with a NDC code should be at the grocery store and I should be able to stock up on it without permission especially given how fragile global shipping is these days. Drugs risks do not enter into the picture given the fact I can buy ammonia and bleach along with a myriad of other dangerous compounds. Worse, I could crush up apple seeds from the veggie isle. One can also make just about anything using fourth thieves vinegar. Maybe put expensive high demand things like cocaine behind locked glass along with the underwear and condoms.
As a side note more dangerous than any drug is stopping a prescription drug cold turkey. Watch what happens when global trade to/from China and India are cut off for a year. Attitudes will change.
> given I eat peptides every day from my food
This is briefly addressed in the article, but basically it's one thing to eat a peptide and quite another thing to inject it. Your digestive system is extremely adroit at taking peptides and proteins and breaking them down into individual amino acids, which are then absorbed via "transporters" in the gut. (e.g. SLC6A14 for glutamate and cysteine.)
If you eat insulin, absolutely nothing will happen. If you inject just a little bit too much, you're dead.
So, generally: Ingested proteins/peptides aren't drug-like, whereas they can be extremely potent drugs if administered via injection.
Granted, there are exceptions. If you accidentally get a drop of botox into your mouth, you'll be okay, but if you drink a vial, you'll be poisoned. And people have been trying to make orally-active peptides and proteins for decades, with some noteworthy successes, however few and far between in the general case.
I agree with some of this. There are most certainly orally active peptides such as BPC-157 and its replacement PDA penta deca arginate that can repair the gut and still circulate throughout the body especially in those with leaky gut. People with leaky gut should be able to buy a clean source of BPC-157 or PDA without a prescription and without visiting dark alleys. It is very safe and tolerable.
GLP's are all the rage these days. Doctors seem to be giving GLP peptides out like candy and those are injected. People are looking like zombies. That said if doctors are going to be so liberal with them I should be able to buy it in the grocery store and slap it down on the conveyor belt. Again I can buy things far more dangerous than any prescription drug. There are very dangerous supplements, some that are shilled heavily on youtube. For example, Glycine (for me specifically used without a specific process) is more dangerous than heroine and the vast majority of doctors would have no idea what I am talking about.
> It is very safe and tolerable.
Can you point to the clinical trials that demonstrate this?
> Doctors seem to be giving GLP peptides out like candy and those are injected.
There have been several _thousand_ clinical trials that have shown GLP-1s to be safe and effective.
Also LOL at the notion "peptides are safe because GLP-1 exists".
Pretty much all venoms are mixes of short (10-15 base) peptide chains.
It's the naturalistic fallacy in an utterly perverse form ( and also goes to show why a regulatory system is good: the average person has no idea that they're dealing with or even common sense about it).
Injected BPC-157 to a wound is a magic healing potion as far as I'm concerned. That it's not more broadly available is a crime, imo. If I had a billion dollars, I'd push so many things through the FDA.
> > given I eat peptides every day from my food
It’s also just a silly rhetorical technique. The ability to construct a grammatical sentence of that form does not constitute a valid argument.
“Restricting nuclear material is silly given that nearly all the stuff I interact with every day contains atomic nuclei.”
The regulation of drugs or most any consumer product is not due to the inherent danger of an item itself, but the danger presented to a consumer inside the context of societal mechanisms that influence behavior. You're right that many regulations don't make sense outside of a societal context -- but that's because they also don't exist outside of a societal context.
The reason we don't need tight regulations on bleach is because we don't have a societal issue causing people to drink it and hurt themselves... at least, not anymore: most of the locking lids on household cleaning chemicals are there by law.
I'm all for laxer regulation of substance control e.g. buying cocaine at the grocery store, but I think its also a bit misleading to describe arbitrary sequences of amino acids as if they're meaningfully comparable to food.
That's like saying that since neither one nor zero requires regulation, neither does software. Maybe software does or doesn't, but in either case its best based on the nature of the aggregate, not the nature of its components.
> It's my opinion that amino acids regardless of how they are chained do not belong under and stricter regulation than food given I eat peptides every day from my food.
I mean, why regulate anything? Everything is just different arrangements of hydrogen and time. It's so weird that certain arrangements of hydrogen and time try to claim to have things like "morals", and try to force other arrangements of hydrogen and time to not do arbitrary contrived concepts like "murder".
All is one. Just hydrogen and time. Therefore everything should be legal.
> It seems we are treating Peptides like drugs here
That’s exactly what some biological drugs are too - peptides!
And peptides are just short chains of amino acids. Almost all the other biological drugs are just longer chains of amino acids - antibodies, enzymes, antigens, some hormones, and others.
Derek is right that the safety risks are exponentially higher when you inject peptides - you basically skip a bunch of protective mechanisms like enzymes that quickly break them down if taken orally or routes.
As a former R&D scientist there is no way I’d inject any peptide that hasn’t at least gone through a phase 1 safety study in humans. Otherwise you have no idea what it could be doing to your body.
A good example was a drug that was quickly pulled from market for causing fatal anaphylactic reactions. It wasn’t even caught in the clinical trials!
At the same time, I think people have the right to take whatever substance they want. But I worry a lot of people aren’t aware of the risks.
>As a former R&D scientist there is no way I’d inject any peptide that hasn’t at least gone through a phase 1 safety study in humans. Otherwise you have no idea what it could be doing to your body.
A lot of people do not understand the trial system or the value of Phase 0/1 tests when it comes to the substances that they put into their body. And thanks to the influencer/grifter/biohacker ecosystem that exists, more people would put their trust in accidental evidence, from people who's incentive it is to make money off of them, while complaining about the pharmaceutical industry operates off of a profit motive.
> Drugs risks do not enter into the picture given the fact I can buy ammonia and bleach along with a myriad of other dangerous compounds.
This is a deeply weird take. You think anyone ought to be able to buy, for instance, warfarin and freely take it without a doctor’s involvement? We should let parents self-diagnose diabetes and administer insulin without a prescription or discussion? We should just hope that patients heard their doctor say hydralazine and not hydroxyzine?
> As a side note more dangerous than any drug is stopping a prescription drug cold turkey.
Abject nonsense. It was very easy to stop my prescribed amoxicillin. It’s clear you don’t have any actual idea what “prescription drugs” are, in aggregate, and that should maybe inform your decision to have Big Opinions about them.
You think anyone ought to be able to buy, for instance, warfarin and freely take it without a doctor’s involvement?
Yes.
Triple yes! Most of the people buying it have been buying it and using it for years.
Your argument is even worse lol. Obviously he's proposing that you can take your doctors note to the pharmacy and get what the doctor prescribed in addition to being allowed to self purchase behind the counter drugs.
> This is a deeply weird take. You think anyone ought to be able to buy, for instance, warfarin and freely take it without a doctor’s involvement? We should let parents self-diagnose diabetes and administer insulin without a prescription or discussion? We should just hope that patients heard their doctor say hydralazine and not hydroxyzine?
Weird examples. You can buy insulin without a prescription today in the USA.
In much of the world -- including almost all of Asia, Africa, and much of Eastern Europe -- you can buy almost any drug without a prescription. The only exceptions are potent CNS stimulants or narcotics, and in some rare cases antibiotics.
This is legitimately a better system. Takes out the middleman.
In the US you can get any drug if you pay $120 and recite the magic words to a telemedicine "doctor."
Funny you mention this... I bumped into a VP of Merck at a conference and that's the exact example he gave: in the US, you can't adjust your own coumadin dosage without a M.D. consult, but here, have 200 doses of insulin to take home with you.
In much of the world -- including almost all of Asia, Africa, and much of Eastern Europe
Doctors in the US get a nice $200 to $500 per doctors visit, required to extend the prescription drug. I only notice because I pay cash. This is why they will argue against anything I am saying until they are code-blue in the face. I will leave them with my code brown.
In the US you can get any drug if you pay $120 and recite the magic words to a telemedicine "doctor."
That's how a number of us in a particular circle stock up on anti-biotics. That said anti-biotics are a last resort for me whereas I find doctors are quick to prescribe them.
I take a small issue with the claim that we don't test peptides. Some of us test them extensively before injecting. Granted, probably the same people who also understand how little science there is backing up most of the popular peptides today. I enjoy being able to buy my own GLP1s, however, at least those which have made it through phase III trials succesfully. As tempting as the claims are about things like BPC-157 and such ... no thanks, that is past my comfort level a good bit.
> My patient is refusing a drug studied in 170,000 people because of side effects that a 124,000-person analysis just confirmed do not exist — while injecting a compound studied in 14 humans, from unregulated sources, based on the recommendation of someone who profits from selling it. She’s probably not the only one. And those using it believe they are “doing their own research.”
Ok, and? At worst you waste a couple hundred dollars and deem the alternative therapy not worth it and go back to your doctor but I know dozens of people at my gym that used BPC 157 and TB 500 that fixed their chronic tendon/joint issues within weeks of starting the therapy that physios couldn't fix for years.
> I know dozens of people at my gym
I don't think I even know dozens of people, full stop, let alone well enough to talk to them about their peptide use.
I go to a gym that has IFBB pros and people competing on elite powerlifting level, steroid and peptide use is an every day chit chat topic.
You know dozens of people from a single place that have chronic tendon/joint issues?
I don't doubt it. You make casual friends sometimes at certain gyms, especially if any sort of sports are involved like tennis or even group classes.
I am a super introvert and know at least half a dozen folks with such issues, more if you include my close friend group.
Any place that has a lot of physically active people stressing their limits a bit is going to have a lot of injured folks over a decent period of time. And of course it gets talked about quite a lot, since it limits performance and ability.
My trainer knows I have a chronic shoulder issue, and an adductor issue at the moment I'm working through that we need to avoid stressing too much. The few other folks who tend to work out around my schedule know of this, and I know of theirs.
Not very uncommon really.
Yes? These types of injuries are common among bodybuilders and powerlifters.
Pfft -- they're common among anyone over 30 who exercises!
Hang out at a BJJ or MMA gym for a bit, and you'll find plenty. Peptides are really popular in combat sports circles, with good reason.
It's often part of the life if you're lifting competitively.
You should hang out at a climbing gym sometime. There is nothing that unites climbers more than injury talk.
My partner's grandfather died of cancer because when he was having pains they believed their homeopathic medicine would work. When he finally when in to see a real doctor it was too late. If he had gone in earlier, he would been able to have a chance. This is not a rare occurrence for these types.
Why would you stop going to a real doctor though? It's not one or the other.
I'm very on the fence over BPC-157/TB500, I really want to see some actual clinical trials ran on it. I have a feeling the effects are overstated, but I also have had a number of "insider" conversations where I know these and other compounds are very much being utilized in pro athlete injury recovery programs. Those athletes certainly are getting state of the art medical care via traditional sources, plus elite level physio therapy - so it's hard to say if the illicit injury recovery drugs are doing much or not.
I don’t think either of those are patentable so I doubt you’ll see studies or trials any time soon. A lot of strength athletes at all levels, not just elite, are absolutely convinced of their efficacy and their usage sometimes seems as common as ibuprofen.
> Ok, and?
According to our new AI overlords, a short synopsis of potential risks of BPC 157 based on mechanistic and animal work to date (don't know human risks because there haven't been sufficient clinical studies):
* Possible pathologic angiogenesis (abnormal blood‑vessel growth), which theoretically could support tumor growth or inflammatory and autoimmune processes. * Modulation of nitric‑oxide pathways that, at high levels, might contribute to anemia, altered drug metabolism (CYP enzyme activity), and possibly neurodegenerative processes in theory. * Concerns that its pro‑healing, pro‑growth signalling (e.g., FAK–paxillin) could encourage cancer spread if malignant cells are already present; this remains theoretical, with no proof in humans. * Possible liver and kidney toxicity suggested in some commentary and extrapolated from preclinical work, but not well characterized in people. * Immune reactions or allergic responses, including fevers, rash, hives, muscle aches, or systemic inflammatory responses
These do not appear to be results that would appear overnight. It would be "nice" if the folks injecting random shit into their bodies also disclaimed any subsequent medical intervention as a result of said shit, but that I suspect that's unlikely.
My total layman view is that powerful drugs often have powerful side effects.
That's because you grew up in a society still deeply coded to puritan moral viewpoints.
People for so upset that GLP-1 has no long term side effects.
There's still the crowd completely sure everyone will get HyperCancer in 10 years or something (they won't).
Have you ever looked at leaflets attached to any medicine prescribed by doctors?
You mean the ones that are the result of experience through controlled clinical trials with statistical analyses and error bars, yep, sure. I guess I have a bit more faith in those leaflets and the testing regimes that generates them than the word of some gymbro or influencer who injected themselves and didn't immediately fall over dead.
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I really enjoyed having to wait 30 seconds for Cloudflare to let me into this website.
I think if you're a cloudflare customer they set a cookie in your browser that let's you bypass the waiting period. Just wait until next year when they show ads during the wait.
With India getting generic GLP-1s, the tech to "print" peptides will probably see costs fall off a cliff, so we're probably only looking at the tip of the iceberg with the amount of damages the reddit biohacker bros will accomplish. Men especially are feeling a lot more lonely and image-conscious and there are peptides people claim make them taller[1] or muscular[2].
1: https://www.reddit.com/r/endocrinology/comments/1jb2cce/grow...
2: https://r2medicalclinic.com/best-muscle-growth-peptides
These peptides are already relatively cheap, here's one US domestic source: https://imgur.com/a/OXOkSdR
$120 for 10mg of reta is highway robbery.
Yeah I'm always amazed at what they can get people to pay for individual vials. I buy kits of 24mg reta for ~280. And that's not the cheapest, for certain.
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