The 10 peptides people run in 2026: where each stands

Ten peptides people actually run, each with its human evidence and its US status after the July 23-24, 2026 FDA advisory votes on BPC-157, TB-500, MOTS-c.

A crowded lab bench covered in dozens of small hand-labelled vials and bottles, evoking research compounds whose labels are handwritten, not approved

For research and educational purposes only. Not medical advice.

Category: Peptides. 21 min read. By pepSmart Editorial. .

Key takeaways

  • On July 23, 2026 FDA's Pharmacy Compounding Advisory Committee voted to recommend BPC-157, TB-500, and KPV, each 8 to 6 with one abstention, and MOTS-c 7 to 5 with two abstentions, for the 503A list of bulk substances that compounding pharmacies are allowed to use. FDA's own review staff had argued against all of them .
  • Nothing is legal today because of that vote. The committee advises and does not decide , and FDA's interim 503A lists still read "Updated May 14, 2026" and contain none of those four substances . FDA's compounding file states it has identified no human exposure data for TB-500, and none for MOTS-c by any route of administration, and no or only limited safety data for BPC-157 .
  • The three GLP-1-family drugs carry trial numbers nothing else here approaches: semaglutide 2.4 mg averaged a 14.9 percent body-weight reduction at 68 weeks in STEP 1 , tirzepatide 15 mg 20.9 percent at 72 weeks in SURMOUNT-1 , and retatrutide 12 mg 28.3 percent at 80 weeks in phase 3 TRIUMPH-1 on the efficacy estimand, 25.0 percent on the estimand the other two led with .
  • FDA's reviewers found five published human studies of BPC-157. The only randomized efficacy trial among them, a 53-patient ulcerative-colitis enema study reported as a meeting abstract, did not separate from placebo: a between-group difference of 1.6 points, 95 percent confidence interval -4.84 to 1.62. The only other one with a placebo arm was a 32-subject phase 1 . The knee-pain series is 17 charts and 12 patients given BPC-157 alone into the joint .
  • Real-world staying power on the GLP-1s started low and has improved sharply since 2022. In a 125,474-adult cohort starting liraglutide, semaglutide, or tirzepatide between 2018 and 2023, 64.8 percent of people without type 2 diabetes stopped within a year . In a 33,607-adult cohort indexed 2021 to mid-2024, 1-year persistence rose from 33.2 percent among the 889 who started in 2021 to 60.9 percent among the 15,573 who started in the first half of 2024 .

Skip to:

  • The scorecard: ten rows, four columns
  • What the July 23-24 votes actually changed
  • The three with phase 3 obesity trials behind them
  • Tesamorelin's label, and FDA's safety paragraphs on the other six
  • What happens to people who actually take these
  • The registry now holds example records that read like real trials
  • Final read

The scorecard: ten rows, four columns

There is no census of peptide use, so nobody can hand you a verified ranking. This ten comes from two places: approval status and trial size for the three approved drugs, and FDA's own compounding files for the gray-market names, since FDA took these substances up on its own initiative, prioritising them for the level of public interest . That file lists seventeen withdrawn peptide nominations, so which six made this list is a judgment call about visible consumer demand and not a measurement. Retatrutide is the exception: unapproved, in neither set of files, and on the list because it is being bought ahead of approval.

Ten peptides, what they are used for, and where each stands

US status as of July 25, 2026. The evidence column names the strongest human study that exists, rather than the best result anyone has claimed. CJC-1295 and ipamorelin share a row because they are commonly sold together.

CompoundWhat people use it forStrongest human evidenceUS status, July 2026
Semaglutide (Ozempic, Wegovy)Weight loss, type 2 diabetesSTEP 1, 1,961 randomized 2:1, 14.9 percent mean weight reduction at 68 weeks FDA-approved. FDA has separately proposed not to add it to the 503B bulks list for lack of clinical need ; comments close July 30, 2026 . Not named on the 2026 WADA Prohibited List, and approved drugs fall outside the S0 catch-all
Tirzepatide (Mounjaro, Zepbound)Weight loss, type 2 diabetesSURMOUNT-1, 2,539 randomized 1:1:1:1, 20.9 percent at 72 weeks on 15 mg ; beat semaglutide head to head in the open-label SURMOUNT-5 FDA-approved. Also covered by that proposal not to add it to the 503B bulks list ; comments close July 30, 2026 . Not named on the 2026 WADA list, and approved drugs fall outside S0
RetatrutideWeight lossTRIUMPH-1, 2,339 randomized, 28.3 percent at 80 weeks on 12 mg on the efficacy estimand, 25.0 percent on the estimand STEP 1 and SURMOUNT-1 led with Investigational. Lilly states it is legally available only to trial participants , and said on July 23, 2026 that it plans to file for US approval in Q1 2027 . Unapproved, so WADA S0 reaches it
BPC-157Tendon, joint, and gut healingOne randomized efficacy trial, 53 patients, ulcerative-colitis enema, did not beat placebo ; the others small, including 12 knee-pain patients given BPC-157 alone into the joint PCAC voted 8-6-1 to recommend for 503A , but it is still on no 503A list . WADA S0, named, prohibited at all times
TB-500 (thymosin beta-4 17-23 fragment)Soft-tissue repairNone. FDA has identified no human exposure data for the fragment PCAC voted 8-6-1 to recommend , but it is still on no 503A list . WADA S2.3 as a thymosin-beta-4 derivative
CJC-1295 with ipamorelinGrowth hormone and IGF-1 supportThe albumin-binding form raised mean GH 2- to 10-fold and IGF-1 1.5- to 3-fold in healthy adults ; no human data exists for the DAC-free form Nominations withdrawn; ipamorelin also sits in FDA's 503B category 2 . Both WADA S2.2.4
Tesamorelin (Egrifta WR)Visceral abdominal fatTwo pivotal trials, visceral fat down 18 and 14 percent at week 26 versus plus 2 and minus 2 percent on placebo ; the first is a registered completed phase 3 FDA-approved only to reduce excess abdominal fat in HIV-associated lipodystrophy; label says it is not indicated for weight loss . WADA S2.2.4
GHK-CuSkin, hair, wound repairTopical only. Two randomized wound trials, opposite results: better than vehicle in diabetic neuropathic ulcers , no better than placebo in venous stasis ulcers . The regenerative claims trace to lab and animal work Injectable nomination withdrawn, FDA cites limited human data ; non-injectable goes back to category 1, and FDA says it intends to consult PCAC before the end of February 2027 . Not named by WADA; S0 still reaches unapproved substances it does not name
MOTS-cMetabolic health, insulin sensitivityNone. FDA has identified no human exposure data by any route PCAC voted 7-5-2 to recommend , but it is still on no 503A list . WADA S4.4.1 as an AMPK activator
Melanotan IITanning, libidoTwo ten-man crossover trials in erectile dysfunction, 1998 and 2000 , and a 1996 phase 1 in 3 volunteers that did show tanning ; nothing sinceNomination withdrawn; FDA cites melanoma, posterior reversible encephalopathy syndrome, sympathomimetic toxidrome, priapism . Not named by WADA; S0 still reaches unapproved substances it does not name

Compiled from the cited FDA, DailyMed, WADA, ClinicalTrials.gov, and peer-reviewed sources.

What the July 23-24 votes actually changed

FDA convened its Pharmacy Compounding Advisory Committee at White Oak on July 23 and 24 to review seven peptides for the 503A bulk drug substances list. All seven nominations had already been withdrawn by their nominators; FDA took the substances up on its own initiative . Day one covered BPC-157 for ulcerative colitis, KPV, which is not one of the ten here, for wound healing and inflammatory conditions, TB-500 for wound healing, and MOTS-c for obesity and osteoporosis. Day two covered emideltide (DSIP) for opioid withdrawal, chronic insomnia, and narcolepsy, semax for cerebral ischemia, migraine, and trigeminal neuralgia, and epitalon for insomnia .

Six of the seven got a favorable vote . BPC-157, KPV, and TB-500 each cleared 8 to 6 with one abstention, for both the free base and acetate forms. MOTS-c cleared 7 to 5 with two abstentions . On day two, semax passed 8 to 5 and epitalon also passed, while emideltide failed 6 to 7 . FDA has not posted summary minutes or a certified roll-call, so treat every tally here as press-reported. Epitalon's is reported differently by different outlets, 7 to 5 with an abstention by one and 7 to 4 by another, and FDA's own meeting page carries no vote record .

None of this changes what is legal today. FDA's own page states the plain rule: "Advisory committees make non-binding recommendations to the FDA, which generally follows the recommendations but is not legally bound to do so" . FDA's interim 503A lists still carry a May 14, 2026 update stamp and none of the four day-one peptides appear on them .

Practice can still move before any rule is final. FDA has said it will keep reviewing the docket and announce a final decision through notice-and-comment rulemaking, and the compounding bar reads its usual pattern after a PCAC review as moving substances onto the interim category 1 list and exercising enforcement discretion in the meantime . For the deeper regulatory background, see the FDA peptide compounding piece.

The three with phase 3 obesity trials behind them

Semaglutide, tirzepatide, and retatrutide are the only names here tested for weight loss in thousands of people against placebo. In STEP 1, 1,961 adults were randomized 2:1, and the semaglutide 2.4 mg arm averaged a 14.9 percent body-weight change at 68 weeks against 2.4 percent on placebo . In SURMOUNT-1, 2,539 adults were randomized 1:1:1:1, and the tirzepatide arms averaged 15.0, 19.5, and 20.9 percent at 72 weeks on 5, 10, and 15 mg, against 3.1 percent on placebo . Semaglutide is a GLP-1 receptor agonist , tirzepatide adds GIP , and retatrutide activates receptors for GIP, GLP-1, and glucagon .

Retatrutide is the newest of the three, and it is not approved and widely sold anyway. Lilly reported phase 3 TRIUMPH-1 topline on May 21, 2026: 2,339 adults randomized to 4, 9, or 12 mg or placebo, with mean weight reductions of 19.0, 25.9, and 28.3 percent at 80 weeks against 2.2 percent on placebo, and 45.3 percent of the 12 mg group losing at least 30 percent of body weight .

The side effects scale with the dose the same way the weight loss does. In TRIUMPH-1, nausea ran 28.6, 38.4, and 42.4 percent across the three retatrutide doses against 14.8 percent on placebo, and discontinuation for adverse events ran 4.1, 6.9, and 11.3 percent against 4.9 percent on placebo. Dysesthesia, an unpleasant altered sensation in the skin, ran 5.1, 12.3, and 12.5 percent against 0.9 percent on placebo, mostly mild to moderate and mostly resolving on drug .

If you are running retatrutide ahead of approval, the 4 mg arm is the one that bought most of the weight loss at an adverse-event discontinuation rate below placebo. That arm started at 2 mg once weekly and reached 4 mg with a single escalation step at four weeks . Whether that tolerability carries to a self-sourced vial is untested.

Retatrutide's initial TRIUMPH program is four global registrational trials, and Lilly states it is legally available only to participants in its clinical trials . Two more TRIUMPH trials read out on July 23, 2026: TRIUMPH-2 in type 2 diabetes with obesity or overweight at 20.8 percent on 12 mg, and TRIUMPH-3 in severe obesity with established cardiovascular disease at 22.6 percent on 12 mg, both at 80 weeks on the efficacy estimand . Lilly plans to file for US approval in the first quarter of 2027 .

Tesamorelin's label, and FDA's safety paragraphs on the other six

FDA's list of bulk substances whose compounding nominations were withdrawn is the most useful document on the gray-market side, because the agency wrote a plain-language safety paragraph for each one . FDA's wording on six of those entries is quoted and paraphrased below. It covers five of the six compounds; GHK-Cu's entry comes later, with the topical evidence.

  • TB-500: FDA "has not identified any human exposure data" for drug products containing the thymosin beta-4 LKKTETQ fragment, and flags immunogenicity risk from aggregation and peptide-related impurities. FDA also notes that websites use the names TB-500 and thymosin beta-4 interchangeably although the two are not the same substance, so your certificate of analysis decides which one you are holding .
  • MOTS-c: FDA "has not identified any human exposure data" by any route of administration, and says it "lacks important information regarding any safety issues raised by MOTs-C, including whether it would cause harm if administered to humans" .
  • BPC-157: no or only limited safety information for the proposed routes, plus immunogenicity risk and difficulty characterizing the active ingredient .
  • CJC-1295: FDA has identified serious adverse events including increased heart rate and systemic vasodilatory reaction, with limited clinical data. Ipamorelin carries its own entry noting serious adverse events including death when it was given intravenously for gastric motility .
  • Melanotan II: "published case reports discuss serious adverse events including melanoma, posterior reversible encephalopathy syndrome, sympathomimetic toxidrome and priapism" .

For the data-gap entries there is no label to fall back on. That puts most of the weight on vetting the provider and reading the certificate of analysis. For melanotan II and for ipamorelin the risk sits in the molecule, and a clean COA does not touch it.

CJC-1295, ipamorelin, and tesamorelin are the three with human trials on the growth-hormone axis. CJC-1295 has two published placebo-controlled dose-escalation trials in healthy adults, 28 and 49 days long. In the single-dose study, single injections produced dose-dependent increases in mean plasma GH of 2- to 10-fold for six days or more, and IGF-1 of 1.5- to 3-fold for nine to eleven days .

Ipamorelin has a published human pharmacokinetic study, terminal half-life about 2 hours after intravenous infusion in healthy men , and a 117-patient randomized placebo-controlled trial of intravenous dosing for postoperative ileus . That trial is the source of FDA's death report: two participants given ipamorelin died of postoperative complications after bowel resection, and FDA says it is unclear whether the deaths were related to the drug .

Tesamorelin is the third, and it is the one with a label. It is an approved drug whose approval rests on two pivotal trials, each with a 26-week placebo-controlled main phase and a 26-week blinded extension , the first of them registered as a completed phase 3 , indicated for reduction of excess abdominal fat in HIV-infected adults with lipodystrophy.

  • Study 1: visceral fat down 18 percent at week 26, against plus 2 percent on placebo .
  • Study 2: down 14 percent, against minus 2 percent on placebo .

The label also says, in the indications section, that it is not indicated for weight-loss management because it has a weight-neutral effect, and that its long-term cardiovascular safety has not been established .

GHK-Cu sells on mechanism: in laboratory work it promotes blood vessel and nerve outgrowth and raises synthesis of collagen, elastin, and glycosaminoglycans, with repair effects reported across skin, lung, bone, liver, and stomach lining. That comes from a review by GHK's discoverer, written from the copper-peptide skincare company he founded, and those particular claims rest on laboratory and animal work .

Topical GHK-Cu has been through randomized human wound trials and they disagree. In diabetic neuropathic ulcers it beat the vehicle, closing a median 98.5 percent of plantar-ulcer area against 60.8 percent . In venous stasis ulcers it did not, finishing level with placebo while a silver sulfadiazine arm beat both . The review's other human data is 8- to 12-week topical cosmetic trials , and FDA's entry for the injectable route says there are limited human data . The topical case is stronger than the injectable case; our GHK-Cu evidence map grades it by route, though the registered gel trial that map points to is one of the records in the cluster described below.

What happens to people who actually take these

For TB-500 and MOTS-c there is no published answer to that question at all, and for injectable GHK-Cu only what FDA calls limited human data. No registry cohort, no outcomes study, no surveillance, because there is no market FDA is watching. For melanotan II and for ipamorelin what exists is short trials plus case reports and adverse-event literature, never a cohort followed over time. The one post-market signal on BPC-157 is small: FDA's briefing materials describe three adverse-event reports after injection, including a 28-year-old man who developed shortness of breath after a subcutaneous dose and ended up in an emergency room. FDA says attribution is unclear . Three reports is not a rate.

No published number tells you what percentage of BPC-157 users get relief. The one published series is a retrospective chart review from a single Orlando clinic: 17 charts, 16 patients reachable by phone, 12 of those 16 having received BPC-157 alone, injected into the knee joint rather than subcutaneously, and 11 of those 12 reporting significant improvement . No control arm, no blinding, no randomization, and patients who had already chosen the treatment. Set beside the one randomized efficacy trial, which did not beat placebo , that is a lead, and the response rate is unknown.

Semaglutide and tirzepatide are the exception, and the real-world picture there has moved a lot since 2022. One cohort followed 125,474 US adults with overweight or obesity who started liraglutide, semaglutide, or tirzepatide between 2018 and 2023 .

  • 64.8 percent of those without type 2 diabetes stopped within a year, against 46.5 percent of those with it .
  • 81,919 stopped within two years. The 41,792 who had a weight recorded both at discontinuation and afterwards were the ones the restart analysis could follow .
  • 36.3 percent of those without diabetes restarted within a year .

That improvement tracks a period when supply stabilised and dose escalation and side-effect management improved, and it comes from a pharmacy benefit manager's own commercially insured book analysed by its own staff , so it does not describe someone paying cash or self-sourcing. What it does tell you is that dropping off in the first year is common enough to plan for, and that most of the drop happens early. Titrating slower and logging what you actually took beats guessing later, which is the argument for keeping a dose log.

The registry now holds example records that read like real trials

Anyone who checks this work will hit the same problem. Searching ClinicalTrials.gov by intervention for these compounds in July 2026 returns a cluster of recruiting phase 2 and phase 1/2 studies with polished protocol titles: BPC-157 for acute hamstring strain, TB-500 for cardiovascular biomarkers, MOTS-c for insulin sensitivity, melanotan II for vitiligo, topical GHK-Cu for wound healing. They share one sponsor, one site, and start dates within days of each other in February 2026. That sponsor has eight records in all, including clones of a retatrutide phase 2 and of SURMOUNT-1 itself, the tirzepatide trial this article's own table leans on.

Strip those out and the registry picture for the six is close to empty, which matches what FDA's file already says . The sourcing and dosing side of this deserves more of your attention than the mechanism side.

Final read

If you run any of the six, you are ahead of the evidence. Spend the effort where the risk sits: what is in the vial, whether the reconstitution math is right, and whether you kept a record you can read back in six months. Check the WADA status before you compete, because BPC-157 is named under S0, TB-500 sits in S2.3, the GH-axis peptides sit in S2.2.4, and S0's catch-all still reaches unapproved substances it never names .

For research and educational purposes only. Not medical advice.

pepSmart has not commissioned independent clinical review of this article.

More on how we write and source these pieces: Editorial process and contributor disclosure and Sourcing posture.

Spot an error? Email corrections via /about.

Sources: 44 entries, primary canon (FDA documents, the Federal Register, DailyMed labels, the WADA Prohibited List, ClinicalTrials.gov, and peer-reviewed human trials and cohort studies) plus one mechanistic review, two manufacturer toplines, and four press reports of the votes. FDA published no roll-call, so the tallies rest on those four. Last reviewed 2026-07-25.

Related tools

References

  1. [1] FDA Pharmacy Compounding Advisory Committee meeting, July 23-24, 2026 (FDA)
  2. [2] FDA, certain bulk drug substances for use in compounding that may present significant safety risks (FDA)
  3. [3] FDA 503A bulk drug substances interim categories 1, 2 and 3, updated May 14, 2026 (FDA)
  4. [4] RAPS, FDA advisory committee backs two controversial peptides (July 2026 PCAC day one) (Regulatory Affairs Professionals Society)
  5. [5] RAPS, FDA advisory committee backs two more peptides, rejects one for compounding list (Regulatory Affairs Professionals Society)
  6. [6] STAT (Lawrence and Todd), FDA advisory panel narrowly rejects compounding of one peptide, backs two others (July 24, 2026) (STAT News)
  7. [7] FDA Law Blog, PCAC approves four bulk drug substances for the 503A list (Hyman, Phelps & McNamara)
  8. [8] Wilding et al. 2021, once-weekly semaglutide in adults with overweight or obesity (STEP 1) (PubMed)
  9. [9] Jastreboff et al. 2022, tirzepatide once weekly for the treatment of obesity (SURMOUNT-1) (PubMed)
  10. [10] Aronne et al. 2025, tirzepatide as compared with semaglutide for the treatment of obesity (SURMOUNT-5) (PubMed)
  11. [11] Eli Lilly, TRIUMPH-1 phase 3 obesity trial topline (May 21, 2026); sponsor topline, not peer-reviewed (Eli Lilly and Company)
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  31. [31] Bishop et al. 1992, prospective randomized evaluator-blinded trial of two wound healing agents for venous stasis ulcers (three arms: silver sulfadiazine versus tripeptide copper complex versus placebo) (PubMed)
  32. [32] NCT00267527, terminated phase 2 study of CJC-1295 in HIV-infected patients with HIV-associated visceral obesity (ClinicalTrials.gov)
  33. [33] NCT07487363, TB-500 cardiovascular biomarkers record whose brief summary states it is a fictional example of a ClinicalTrials.gov-style record (ClinicalTrials.gov)
  34. [34] NCT07437560, melanotan II vitiligo record whose brief summary states it is an example interventional study record (ClinicalTrials.gov)
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  37. [37] Mulder et al. 1994, enhanced healing of ulcers in patients with diabetes by topical treatment with glycyl-L-histidyl-L-lysine copper (randomized, evaluator-blinded, placebo-controlled) (PubMed)
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  42. [42] NCT07505745, MOTS-c insulin-sensitivity record in the same sponsor cluster, carrying no example or mock disclosure (ClinicalTrials.gov)
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  44. [44] WADA Prohibited List, effective January 1, 2026 (WADA)

For research and educational purposes only. Not medical advice.