Peptide therapy FAQ

What are peptides?

Peptides are short chains of amino acids — the same building blocks that make up proteins in the body. Many peptides that occur naturally act as signaling molecules, helping cells communicate with one another. Depending on the specific peptide, this signaling can influence appetite, inflammation, collagen activity, tissue repair, skin quality, and metabolic regulation.

“Peptide therapy” is not one single treatment, and it’s a mistake to treat all peptides as equally proven — or equally experimental. Some peptide-based medications, such as insulin, semaglutide, and tirzepatide, are FDA-approved and have been studied in large clinical trials. Others used in wellness, recovery, or aesthetic medicine have encouraging laboratory or animal data, but far less human outcome data. A 2025 review in Pharmaceuticals on injectable peptide therapy for orthopedic and sports medicine use put it plainly: several popular recovery peptides show biological promise in preclinical models, but the supporting human clinical evidence remains limited.^[4]

At West Annapolis Medical Spa, the peptide-related treatments we offer include a BPC-157 + TB-500 recovery program, GHK-Cu topical skin renewal (available with or without added low-dose estradiol), and GLP-1/GIP-based weight-management injections (semaglutide and tirzepatide). We also offer an NAD+ + B12 program, which is often grouped with peptide wellness treatments, though NAD+ is technically a coenzyme and B12 is a vitamin — not a peptide.

How do these treatments work?

BPC-157 + TB-500 Recovery Program

This is a physician-directed, subcutaneous program used as a supportive recovery option — not a guaranteed healing treatment. BPC-157 is a peptide originally isolated from human gastric juice and is widely studied in animal models for tissue-repair signaling, inflammation modulation, and tendon, ligament, and muscle recovery.^[1] TB-500 is related to thymosin beta-4 biology and is commonly discussed for cell migration, tissue remodeling, and broader soft-tissue recovery.

The rationale is biologically plausible, but it’s important to be candid about the evidence base: a 2025 clinical review noted that the large majority of published BPC-157 research comes from animal studies produced by one research group, and that independent, controlled human trials are still scarce.^[1] A recent peer-reviewed primer for orthopedic and sports medicine physicians similarly concluded that BPC-157’s benefits for tendon and muscle repair are “largely unvalidated in human trials,” based on a single small human case series without a control group.^[4] A 2025 pilot study did find that a short course of intravenous BPC-157 was well tolerated in two healthy adults, which is reassuring but far from proof of effectiveness.^[5] We present this program as a supportive adjunct to a broader recovery plan (rest, physical therapy, nutrition), not as a stand-alone cure.

NAD+ + B12 Energy Kit

NAD+ is involved in cellular energy metabolism, mitochondrial function, and DNA repair signaling. B12 supports normal neurologic function and red blood cell production, and can be especially helpful for patients who are deficient. Our program is positioned as a supportive wellness treatment for energy and recovery, with individualized dosing — not as a proven anti-aging or disease-modifying therapy. Persistent or worsening fatigue should always be evaluated by a physician rather than assumed to be an NAD+/B12 issue.

GHK-Cu Skin Renewal (Topical) — With or Without Estradiol

GHK-Cu is a copper-binding tripeptide studied for its role in collagen support, skin remodeling, and post-procedure skin recovery. We offer GHK-Cu as a topical treatment or procedure-adjunct — not as a systemic injection. The FDA has specifically identified compounded injectable GHK-Cu as a substance of concern because of limited human safety data and the potential for immune reactions, and injectable GHK-Cu remains outside the FDA’s approved compounding pathway.^[9] Topical use has a more established safety track record, which is why it’s our recommended route.

Patients can choose our GHK-Cu topical cream with or without added low-dose estradiol, compounded per individual prescription. GHK-Cu is included primarily for its collagen-support and skin-remodeling properties, while the estradiol is included because topical estrogen has its own separate, more established research base in dermatology — small clinical studies and a 2025 systematic review in the Journal of the American Academy of Dermatology have evaluated topical estrogen formulations for improving skin thickness, hydration, and elasticity, particularly in postmenopausal patients, though the review’s authors noted that evidence is still limited by small sample sizes, short trial durations, and the fact many studies used compounded, non-FDA-approved formulations.^[12] Combining the two ingredients in one cream is a compounding choice, not an FDA-approved combination product, and we’re transparent about that distinction with every patient.

Adding estradiol is not appropriate for every patient. Because even small amounts of topical estradiol are absorbed into the bloodstream, patients using the estradiol version need the same screening we’d use for any estrogen-containing product — see estradiol-specific safety considerations below. Patients who prefer to avoid systemic hormone exposure altogether can select the GHK-Cu-only formulation, which does not carry these same considerations.

Our GHK-Cu skin renewal cream is available in two formulations, compounded to your provider’s prescription:

Adding estradiol changes the risk profile, so the combination formula is reserved for patients who complete additional screening. Topical estrogen can be absorbed systemically depending on the dose, application site, and skin barrier condition, and unopposed estrogen exposure carries a known risk of endometrial hyperplasia in patients who still have a uterus. For that reason, the GHK-Cu + estradiol cream is not appropriate for patients who are pregnant or breastfeeding, have a personal history of estrogen-sensitive cancer (including certain breast cancers), have an unexplained history of vaginal bleeding, or have a personal or strong family history of blood clots, stroke, or heart attack. Your provider will review your hormonal and cancer history, and may recommend periodic monitoring, before prescribing the estradiol-containing version. Patients who prefer to avoid systemic hormone exposure altogether can use the GHK-Cu-only formulation and still receive the peptide’s collagen-support benefits.

Semaglutide / Tirzepatide Weight-Management Program

Semaglutide and tirzepatide are peptide-based metabolic medications that work through appetite and satiety signaling. Semaglutide acts on the GLP-1 receptor; tirzepatide acts on both the GIP and GLP-1 receptors. Combined with nutrition, exercise, and medical follow-up, both can reduce appetite and support meaningful weight loss. FDA-approved branded versions (Wegovy, Ozempic, Zepbound, Mounjaro) have substantial clinical-trial evidence behind them. Compounded versions are not FDA-approved and are not equivalent to the branded products — a distinction we’ll always be transparent about.

Are peptides effective and backed by evidence?

The honest answer depends entirely on which treatment we’re discussing.

Strongest evidence: GLP-1/GIP weight-management medications. The first head-to-head trial comparing the two, SURMOUNT-5, was published in the New England Journal of Medicine in May 2025. Over 72 weeks, patients on tirzepatide lost an average of 20.2% of body weight, compared with 13.7% on semaglutide.^[6] Individual response and tolerability still vary from patient to patient.

Reasonable evidence for topical use: GHK-Cu (with or without estradiol). The rationale is more supportive for topical, skin-care, and post-procedure use than for systemic injection, which is why our patient-facing recommendations focus on skin-quality support through topical application rather than any claim of systemic anti-aging effects. Adding estradiol draws on a separate, better-established body of dermatology research on topical estrogen and skin quality, but that research is still limited by small studies and inconsistent formulations, and it should not be described as a proven anti-aging treatment.^[12]

Promising but preliminary: BPC-157 + TB-500. The current literature is strongest in laboratory and animal models. As described above, independent reviewers have flagged the concentration of BPC-157 research in a single lab, the small size of human studies, and the absence of controlled trials as reasons for caution, even as the underlying biology remains an active and legitimate area of research.^[1][4]

Strong biology, limited outcomes data: NAD+. NAD+ is clearly important in cell biology, but that doesn’t automatically prove that injected or infused NAD+ improves fatigue, cognition, or recovery outcomes for every patient. We describe it as a treatment that may support wellness goals in some patients, with results that vary.

Are peptides safe?

Safety depends on the specific medication, route, dose, pharmacy source, and your individual medical history. “Peptide” does not automatically mean “safe,” “natural,” or “risk-free,” and we screen every patient accordingly.

Common injection-related side effects can include site redness, bruising, swelling, itching, headache, nausea, flushing, or lightheadedness. Topical GHK-Cu may cause dryness, redness, burning, or irritation in some patients. Weight-management injections carry their own specific risks, including nausea, vomiting, diarrhea, constipation, and — rarely — pancreatitis or gallbladder problems; they are not appropriate for patients with a personal or family history of medullary thyroid cancer or MEN2, and require careful review for patients with a history of pancreatitis, gastroparesis, or eating disorders.

Product quality is a major, separate safety issue. In late 2024, the FDA reminded compounding pharmacies that food-grade NAD+ is not appropriate for making sterile injectable or IV products, because of contamination risk with microbes and endotoxins.^[10] That warning proved prescient: in 2025 the FDA classified a Class I recall — its most serious category — for NAD+ injections from a specific manufacturer after testing found elevated endotoxin levels, which can trigger fever, shock, or sepsis if injected.^[11] This is exactly why we only source from licensed, accredited compounding pharmacies that can document sterility testing and certificates of analysis for every batch.

Are peptides the same as hormones or steroids?

No. Peptides are not anabolic steroids. Anabolic steroids are synthetic derivatives of testosterone with a different mechanism, risk profile, and regulatory status entirely. Peptides are also not automatically the same as hormone replacement therapy, though some — like GLP-1 and GIP — are themselves metabolic signaling hormones. Our peptide and wellness programs are not presented as systemic hormone replacement therapy, but patients still require screening because these medications can affect metabolism, digestion, inflammation, and appetite.

Are these treatments FDA-approved?

Some are. Semaglutide and tirzepatide have FDA-approved branded products for specific indications (weight management and/or type 2 diabetes). Compounded versions of these medications are not FDA-approved and should never be described as equivalent to the branded products.

BPC-157 and TB-500 are not FDA-approved for any use — recovery, tendon healing, or otherwise. Their regulatory status has been shifting through 2026: in April 2026, the FDA removed BPC-157 and TB-500 (along with several other peptides) from its “Category 2” list of bulk substances presenting significant safety risk for compounding.^[7] That is a meaningful step, but it is not the same as FDA approval, and it does not by itself authorize compounding — the FDA’s Pharmacy Compounding Advisory Committee is scheduled to formally evaluate whether BPC-157 and TB-500 should be added to the approved 503A compounding list at a public meeting on July 23–24, 2026.^[8] We track this docket closely and will only source these peptides through pathways that are compliant with current FDA guidance at the time of your treatment.

Injectable GHK-Cu remains a substance the FDA has flagged for safety concerns in the compounded-injectable setting; topical GHK-Cu formulations fall under a separate, less restrictive review category.^[9]

Compounded medications, generally, are not FDA-approved. The FDA does not independently verify compounded products for safety or effectiveness before they reach a patient. That doesn’t mean compounding is inappropriate — it means patients deserve to understand the difference between an FDA-approved commercial drug and a compounded medication prepared for an individual prescription, and we make that distinction clearly in every consultation.

Why does sourcing matter so much?

This is one of the most important safety points we can make. Online “research peptide” products are frequently sold with disclaimers like “not for human consumption.” Patients ordering from these sites have no reliable way to know the true identity, concentration, sterility, or contamination risk of what they’re injecting, and there is no medical screening, informed consent, or follow-up.

Our approach is physician-directed and source-controlled. When we use a compounded medication, it comes from a licensed compounding pharmacy that can provide documentation of the prescription, concentration, beyond-use date, and sterility testing. That is a meaningfully different risk profile than unsupervised online purchasing — though, again, it does not make a compounded product equivalent to an FDA-approved drug.

How long do these treatments take to work?

Who needs additional review before starting?

You’ll need additional review before treatment if you are pregnant, breastfeeding, or trying to conceive; preparing for surgery or anesthesia; already using a GLP-1 medication, insulin, or a sulfonylurea; using blood thinners; actively infected; undergoing cancer treatment or immunosuppressed; subject to competitive drug testing; or have a history of pancreatitis, gallbladder disease, gastroparesis, bowel obstruction, kidney or liver disease, serious allergic reactions, an eating disorder, a clotting disorder, stroke, heart attack, estrogen-sensitive cancer, or medullary thyroid cancer/MEN2. A “yes” to any of these doesn’t automatically rule out treatment — it means we review it with you before prescribing. If you’re interested specifically in the estradiol-containing GHK-Cu cream, see the additional considerations above, which apply on top of this list.

When should I call the office or seek urgent care?

Call our office for worsening side effects, persistent nausea or vomiting, dizziness, rash, spreading redness, drainage, fever, or if you have an upcoming surgery, sedation, or endoscopy.

Seek urgent medical care for severe abdominal pain, persistent vomiting, dehydration, fainting, chest pain, shortness of breath, a severe allergic reaction, rapidly spreading redness, or any symptom that feels severe.

The bottom line

Peptides are medically legitimate molecules, and some peptide-based medications are well studied and FDA-approved for specific conditions. At the same time, many wellness and recovery peptide protocols are still emerging, and the quality of evidence varies substantially by treatment. Our approach at West Annapolis Medical Spa is to avoid hype, avoid unsupervised online sourcing, screen patients carefully, use licensed prescription-based sourcing, and set realistic expectations. These treatments may support recovery, skin quality, energy, or weight-management goals in the right patients — but results vary, and no specific outcome is guaranteed.

Medically directed by Sandel Duggal Center for Plastic Surgery
104 Ridgely Ave, Annapolis, MD 21401
Phone: (410) 266-7120
Website: sandelduggal.com

Schedule a peptide consultation or call us at (410) 266-7120 to discuss which program — including the BPC-157 + TB-500 recovery program, NAD+ + B12, GHK-Cu (with or without estradiol), or semaglutide/tirzepatide weight management — is right for you.

[1] GlobalRPH. “BPC-157 and TB-500: Background, Indications, Efficacy, and Safety.” November 2025. globalrph.com

[4] Injectable Peptide Therapy: A Primer for Orthopaedic and Sports Medicine Physicians. PubMed, 2025. pubmed.ncbi.nlm.nih.gov

[5] Safety of Intravenous Infusion of BPC-157 in Humans: A Pilot Study. PubMed, 2025. pubmed.ncbi.nlm.nih.gov

[6] Aronne LJ, et al. “Tirzepatide as Compared with Semaglutide for the Treatment of Obesity” (SURMOUNT-5). New England Journal of Medicine, May 2025; reported in Weill Cornell Medicine Newsroom. news.weill.cornell.edu

[7] U.S. FDA. “Certain Bulk Drug Substances for Use in Compounding that May Present Significant Safety Risks.” Updated April 2026. fda.gov

[8] U.S. FDA. “Meeting of the Pharmacy Compounding Advisory Committee,” July 23–24, 2026. fda.gov

[9] U.S. FDA. “Bulk Drug Substances Used in Compounding Under Section 503A of the FD&C Act.” fda.gov

[10] U.S. FDA. “FDA Reminds Compounders to Use Ingredients Suitable for Sterile Compounding.” fda.gov

[11] FDA Class I Recall, NAD+ Injection (GenoGenix, LLC), October 2025 — reported via HMP Global Learning Network. hmpgloballearningnetwork.com

[12] Marmon S, et al. Systematic review of topical estrogen formulations for skin aging, Journal of the American Academy of Dermatology — reported via Healio, November 2025. healio.com

[13] U.S. FDA. “Evamist (estradiol transdermal spray) prescribing information” — boxed warning on unintentional secondary exposure, and the estradiol transfer study, revised 8/2023. accessdata.fda.gov

[14] MedlinePlus. “Estradiol Topical: Drug Information.” National Library of Medicine, updated 2026. medlineplus.gov