A peptide is a size designation, nothing else. Insulin is a peptide, and the contents of the vial someone ordered at two in the morning from an online store is also a peptide. Treating those two things as one story is how the public ended up this confused.
U.S. News asked me about peptides earlier this month. That is where I started, and it is where anyone honest has to start.
Take the Word Apart First
A peptide is defined as a chain of amino acids normally composed of anywhere from two to about fifty in number. It is a size range, not a drug class nor a benefit.
Insulin is a peptide, just like the peptide in an antiaging serum, just like the compounded vial someone ordered from an overseas website. They have all been thrown into the same box together, making people think they are identical, hence the rampant, widespread confusion on the issue.
Most marketing makes these products out to be better than they are, and the vagueness of the word is exactly what makes that possible.
The Serum on Your Counter
In short, the science is good, not great.
Copper peptides and signal peptides used in some consumer skincare have lab studies that show they can stimulate collagen synthesis, and a small selection have proven in trials to smooth fine wrinkles modestly over several months of regular use.
Then physics gets a vote. Delivery limits how much of this can penetrate the outer layer of the skin, which consists of dead skin cells built up as a shield designed to keep outside contaminants like large molecules, especially water-loving ones, from entering the body.
So here is the rule I give patients. A peptide is a reasonable addition to a product where a sunscreen and a retinoid are doing the real work. It is not a replacement for either one.
When a client tells me their plan for anti-aging is a peptide serum, that is when I feel a little uneasy. It is a quiet harm that we miss discussing within the safety debate.
Nobody gets hurt by the serum. They get hurt by the decade they spent on it instead.
The Vial in the Refrigerator
My real issues began with the injectable and compounded peptides.
It is about impossible to go a month without seeing at least one patient who is self-injecting peptides obtained without a prescription from who knows where, for an injury, for joint pain, or for what they are calling recovery. BPC-157 comes up all the time, and growth hormone secretagogues are about the most frequent second thing asked about, usually phrased as anti-aging.
Very few of them know how little human research is available on these compounds, know that most dosage regimens have been picked up from bodybuilding forums, or know that the vial is coming from an overseas research-chemical company, with no guarantee as to contents, purity or whether it is a sterile preparation.
I have seen and operated on patients with abscesses as well as infected lesions at injection sites that stem from these supplies.
That is not a warning I am passing along. That is an operation I performed.
What I Now Ask Before I Operate
Before operating, I routinely ask my patients if they have been injecting peptides, much like asking about their supplements, mainly because I have no idea what is in the vial my patient received and neither do they.
The Part Everyone Is About to Get Wrong
If some peptides could now go through licensed compounding pharmacies with an actual prescription, that would be safer than the massive, unregulated market people are already buying from on the internet. I am in favor of that.
The big risk is that people read the news and think a scientist gave their blessing simply because it became more available.
Expanding legal options answers the question, who is allowed to make these? It does not address the question of how effective these peptides actually are. One of those questions deals with legal access and the other asks about scientifically verified results, yet they will both get treated the same.
Allowing a pharmacy to compound it means a pharmacy can make it. Allowing them to make it does not mean it will work.
Where I Land
Peptides are not peptides, and one answer is not the answer.
Topical peptides applied to the skin are mostly not toxic and, in most circumstances, they have been exaggerated. Peptides that are compounded or injected are promising enough to merit genuine study, and they are already used a great deal, far ahead of the studies and with almost no supervision.
Both of those sentences are true at once. Any coverage that picks one and runs with it is going to mislead somebody.
Why I Get Asked
I am board certified in plastic surgery. I practice in El Paso, Texas, and I am a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. I also sit on the editorial boards of Aesthetic Plastic Surgery and Plastic and Reconstructive Surgery Global Open.
I am not against peptides. I am against a word doing the work that evidence is supposed to do.
Ready to Talk?
If you are injecting something and cannot say what is in it, bring the bottle. Call (915) 590-7900, text 1-866-814-0038, or book online. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Companion reads: the plain guide to what is in the bottle at swplasticsurgery.com, and the surgical safety piece on agulloplasticsurgery.com.