Is Fishtown Medicine a "peptide clinic"?

No. Fishtown Medicine is a Direct Primary Care practice. We prescribe FDA-approved medications, including a small number of FDA-approved peptide medications when clinically indicated, and we do not market or operate as a peptide clinic or prescribe research-grade peptides.

Are GLP-1 medications considered peptides?

Yes. GLP-1 receptor agonists like semaglutide, tirzepatide, and liraglutide are peptide medications. They are FDA-approved, manufactured under FDA oversight, and dispensed through licensed pharmacies. They are the most clinically useful peptide medications available to most patients today, and they are what most people mean when they ask whether we prescribe peptides for weight.

Why don't you prescribe BPC-157 or similar?

State medical boards have made clear that physicians cannot prescribe, recommend, administer, or supply non-FDA-approved or research-grade peptides. This includes BPC-157 and similar compounds, regardless of how they are sourced or labeled.

Why do other clinics still advertise BPC-157 or similar?

We cannot speak to other clinics' practices or the legal exposure they may be taking on. State medical boards have been clear that the prohibition applies regardless of how a clinic frames the offering, what consent forms a patient signs, or which staff member writes the prescription.

Can I get any peptide prescribed if I want to pay cash?

No. The regulatory standard does not bend based on payment method. A physician's prescribing authority is defined by the FDA and state licensure, not by whether the patient pays through insurance or cash.

Does this restriction apply to FDA-approved peptides too?

No. FDA-approved peptide medications (GLP-1s, Sermorelin, Tesamorelin, insulin, and others) are prescription medications and are prescribed through the normal process when clinically indicated. The prohibition applies specifically to research-grade and non-FDA-approved peptides.

What if a peptide is sold legally as a "supplement"?

A small number of peptides are sold over the counter as dietary supplements. These sit outside the prescription system. We do not endorse, evaluate, or take clinical responsibility for over-the-counter peptide supplements. If you are using one, that is a decision you have made independently.

Are GLP-1 medications safe long term?

GLP-1 medications have multi-year safety data, particularly from cardiovascular and diabetes studies. Common side effects are gastrointestinal and typically improve with slow dose titration. We monitor for thyroid, gallbladder, and pancreatic issues, and we say plainly that very-long-term data continues to accumulate.

Sermorelin is an FDA-approved peptide medication that stimulates the pituitary to release growth hormone in natural overnight pulses. It is used in adult patients with documented growth hormone deficiency after appropriate workup, not as a routine longevity tool.

Tesamorelin is an FDA-approved peptide medication labeled for HIV-associated lipodystrophy. Off-label use in other clinical contexts requires careful patient selection, explicit consent, and ongoing monitoring.

Can peptides replace strength training and sleep?

No. Sleep, training, protein intake, and stress management drive the majority of clinical outcomes. Peptide medications can amplify those foundations or fill specific clinical gaps. They do not replace the basics.

What if I am already using a research-grade peptide?

We do not provide clinical guidance on research-grade or non-FDA-approved peptides. If you are using one independently, that decision and its associated risk are yours. We can discuss FDA-approved alternatives, order labs relevant to your broader health, and coordinate with other physicians, and we will not interpret or optimize a research-grade peptide protocol.

How do I know if a compounding pharmacy is legitimate?

Legitimate compounding pharmacies are registered as 503A or 503B facilities, hold state board licensure, and operate inside the FDA's compoundable substances list. We work only with vetted, licensed pharmacies.

Can I use peptide medications while on hormone therapy?

FDA-approved peptide medications can often be used alongside hormone therapy, but the combination requires careful planning and lab monitoring. We coordinate dosing, watch for overlap, and communicate with any other prescribers involved.

Why has the FDA tightened the compounded peptide landscape?

The FDA reclassified several peptides because of inconsistent purity, limited human safety data, and a flood of off-label prescribing through telehealth platforms. The Category 2 list places these substances outside what 503A compounding pharmacies can produce. State medical boards have reinforced these limits with explicit guidance to licensees.

How do GLP-1 medications affect the brain?

GLP-1 medications cross into brain regions that regulate appetite, reward, and inflammation. Early evidence suggests reduced neuroinflammation and possible cognitive benefit. The Alzheimer's prevention data is early and actively being studied. We follow the evidence and prescribe within FDA-approved indications and well-supported off-label uses.

What about subcutaneous versus intramuscular injection?

Most FDA-approved peptide medications are dosed subcutaneously because steady absorption is the goal. Intramuscular delivery is used in specific contexts. We discuss the route, schedule, and technique when prescribing.

Can peptide medications help with autoimmune conditions?

The FDA-approved peptide medications we prescribe are not autoimmune therapies. Autoimmune care lives in coordination with rheumatology and may include standard immunomodulators. We will discuss what is and is not supported by the evidence rather than offer compounds outside the regulatory perimeter.

What about low-dose naltrexone (LDN)?

Low-dose naltrexone is not a peptide; it is a small molecule. At 1.5 to 4.5 mg nightly it appears to modulate the immune system and reduce inflammation in select clinical contexts. We use it where the evidence supports. Our low-dose naltrexone clinical guide walks through the dosing, the conditions where it helps, and the limits of the evidence.

Can FDA-approved peptide medications cause cancer?

Most peptide medications do not directly cause cancer, but any compound that stimulates growth signals (such as IGF-1 in growth-hormone pathways) carries a theoretical risk. We screen for active or recent cancer before starting any growth-supporting medication and discuss family history carefully.

What labs do you monitor?

Typical monitoring includes CBC, CMP, fasting insulin, A1c, lipid panel, ApoB, IGF-1 where relevant, and hsCRP. We baseline before starting, recheck at 3 months, and then every 6 months once stable. Specific medications add specific labs.

How does peptide therapy fit into longevity care?

FDA-approved peptide medications can support specific clinical goals when the evidence applies (metabolic health, growth hormone deficiency, etc.). They are one tool inside a broader plan. We pair them with strength training, ApoB management, sleep optimization, and a strong nutrition foundation. See Peptide Therapy in Philadelphia for how we structure this in practice.

Are athletes affected by anti-doping rules?

Yes. Certain peptide medications and growth-hormone-related substances are restricted by WADA and other governing bodies. Competitive athletes should disclose any treatment to their governing body and verify that the prescribed medication is permitted under their sport's rules.

Is Fishtown Medicine a "peptide clinic"?

No. Fishtown Medicine is a Direct Primary Care practice. We prescribe FDA-approved medications, including a small number of FDA-approved peptide medications when clinically indicated, and we do not market or operate as a peptide clinic or prescribe research-grade peptides.

Are GLP-1 medications considered peptides?

Yes. GLP-1 receptor agonists like semaglutide, tirzepatide, and liraglutide are peptide medications. They are FDA-approved, manufactured under FDA oversight, and dispensed through licensed pharmacies. They are the most clinically useful peptide medications available to most patients today, and they are what most people mean when they ask whether we prescribe peptides for weight.

Why don't you prescribe BPC-157 or similar?

State medical boards have made clear that physicians cannot prescribe, recommend, administer, or supply non-FDA-approved or research-grade peptides. This includes BPC-157 and similar compounds, regardless of how they are sourced or labeled.

Why do other clinics still advertise BPC-157 or similar?

We cannot speak to other clinics' practices or the legal exposure they may be taking on. State medical boards have been clear that the prohibition applies regardless of how a clinic frames the offering, what consent forms a patient signs, or which staff member writes the prescription.

Can I get any peptide prescribed if I want to pay cash?

No. The regulatory standard does not bend based on payment method. A physician's prescribing authority is defined by the FDA and state licensure, not by whether the patient pays through insurance or cash.

Does this restriction apply to FDA-approved peptides too?

No. FDA-approved peptide medications (GLP-1s, Sermorelin, Tesamorelin, insulin, and others) are prescription medications and are prescribed through the normal process when clinically indicated. The prohibition applies specifically to research-grade and non-FDA-approved peptides.

What if a peptide is sold legally as a "supplement"?

A small number of peptides are sold over the counter as dietary supplements. These sit outside the prescription system. We do not endorse, evaluate, or take clinical responsibility for over-the-counter peptide supplements. If you are using one, that is a decision you have made independently.

Are GLP-1 medications safe long term?

GLP-1 medications have multi-year safety data, particularly from cardiovascular and diabetes studies. Common side effects are gastrointestinal and typically improve with slow dose titration. We monitor for thyroid, gallbladder, and pancreatic issues, and we say plainly that very-long-term data continues to accumulate.

Sermorelin is an FDA-approved peptide medication that stimulates the pituitary to release growth hormone in natural overnight pulses. It is used in adult patients with documented growth hormone deficiency after appropriate workup, not as a routine longevity tool.

Tesamorelin is an FDA-approved peptide medication labeled for HIV-associated lipodystrophy. Off-label use in other clinical contexts requires careful patient selection, explicit consent, and ongoing monitoring.

Can peptides replace strength training and sleep?

No. Sleep, training, protein intake, and stress management drive the majority of clinical outcomes. Peptide medications can amplify those foundations or fill specific clinical gaps. They do not replace the basics.

What if I am already using a research-grade peptide?

We do not provide clinical guidance on research-grade or non-FDA-approved peptides. If you are using one independently, that decision and its associated risk are yours. We can discuss FDA-approved alternatives, order labs relevant to your broader health, and coordinate with other physicians, and we will not interpret or optimize a research-grade peptide protocol.

How do I know if a compounding pharmacy is legitimate?

Legitimate compounding pharmacies are registered as 503A or 503B facilities, hold state board licensure, and operate inside the FDA's compoundable substances list. We work only with vetted, licensed pharmacies.

Can I use peptide medications while on hormone therapy?

FDA-approved peptide medications can often be used alongside hormone therapy, but the combination requires careful planning and lab monitoring. We coordinate dosing, watch for overlap, and communicate with any other prescribers involved.

Why has the FDA tightened the compounded peptide landscape?

The FDA reclassified several peptides because of inconsistent purity, limited human safety data, and a flood of off-label prescribing through telehealth platforms. The Category 2 list places these substances outside what 503A compounding pharmacies can produce. State medical boards have reinforced these limits with explicit guidance to licensees.

How do GLP-1 medications affect the brain?

GLP-1 medications cross into brain regions that regulate appetite, reward, and inflammation. Early evidence suggests reduced neuroinflammation and possible cognitive benefit. The Alzheimer's prevention data is early and actively being studied. We follow the evidence and prescribe within FDA-approved indications and well-supported off-label uses.

What about subcutaneous versus intramuscular injection?

Most FDA-approved peptide medications are dosed subcutaneously because steady absorption is the goal. Intramuscular delivery is used in specific contexts. We discuss the route, schedule, and technique when prescribing.

Can peptide medications help with autoimmune conditions?

The FDA-approved peptide medications we prescribe are not autoimmune therapies. Autoimmune care lives in coordination with rheumatology and may include standard immunomodulators. We will discuss what is and is not supported by the evidence rather than offer compounds outside the regulatory perimeter.

What about low-dose naltrexone (LDN)?

Low-dose naltrexone is not a peptide; it is a small molecule. At 1.5 to 4.5 mg nightly it appears to modulate the immune system and reduce inflammation in select clinical contexts. We use it where the evidence supports. Our low-dose naltrexone clinical guide walks through the dosing, the conditions where it helps, and the limits of the evidence.

Can FDA-approved peptide medications cause cancer?

Most peptide medications do not directly cause cancer, but any compound that stimulates growth signals (such as IGF-1 in growth-hormone pathways) carries a theoretical risk. We screen for active or recent cancer before starting any growth-supporting medication and discuss family history carefully.

What labs do you monitor?

Typical monitoring includes CBC, CMP, fasting insulin, A1c, lipid panel, ApoB, IGF-1 where relevant, and hsCRP. We baseline before starting, recheck at 3 months, and then every 6 months once stable. Specific medications add specific labs.

How does peptide therapy fit into longevity care?

FDA-approved peptide medications can support specific clinical goals when the evidence applies (metabolic health, growth hormone deficiency, etc.). They are one tool inside a broader plan. We pair them with strength training, ApoB management, sleep optimization, and a strong nutrition foundation. See Peptide Therapy in Philadelphia for how we structure this in practice.

Are athletes affected by anti-doping rules?

Yes. Certain peptide medications and growth-hormone-related substances are restricted by WADA and other governing bodies. Competitive athletes should disclose any treatment to their governing body and verify that the prescribed medication is permitted under their sport's rules.

FDA-Approved Peptide Medications: What We Prescribe and Why

TL;DR30-second take

Fishtown Medicine prescribes only FDA-approved peptide medications obtained through licensed US pharmacies. These include GLP-1 receptor agonists (semaglutide, tirzepatide), Sermorelin, and Tesamorelin where clinically indicated. We do not prescribe, recommend, administer, or supply research-grade or non-FDA-approved peptides. State medical boards have made clear that physician involvement with non-FDA-approved peptides is prohibited.

Important: Fishtown Medicine does not prescribe, recommend, administer, or supply research-grade or non-FDA-approved peptides. This article is provided for general educational purposes only and is not medical advice or an offer of treatment. We prescribe only FDA-approved peptide medications obtained through licensed US pharmacies. State medical boards across the country have clarified that any recommendation, prescription, or administration of non-FDA-approved peptides by a medical professional constitutes the unauthorized practice of medicine.

What Peptides Are

Peptides are short chains of amino acids, the same building blocks proteins are made from. In the body, peptides act as signaling molecules: instructions that tell cells when to repair tissue, release a hormone, or modulate inflammation. Insulin is a peptide. Many of the hormones your body produces every day are peptides.

A subset of peptide medications are FDA-approved and sit firmly inside the prescription landscape. These are manufactured under FDA oversight, tested for safety and efficacy, and dispensed through licensed pharmacies. They are what physicians can legally prescribe.

A much larger group of compounds marketed online as "peptides" are not FDA-approved. They are sold as research chemicals or compounded products outside of FDA oversight. The compounds in this category, frequently discussed in podcasts and longevity-adjacent forums, have not been tested or approved for human use by the FDA, and their manufacturing standards, purity, and dosing accuracy cannot be verified.

The Regulatory Landscape

The peptide landscape has shifted significantly. The FDA's compounding categories (503A and 503B) have been clarified, and many compounds that were available a few years ago through compounding pharmacies are no longer compoundable. State medical boards have followed with explicit guidance that prohibits physicians from prescribing, recommending, administering, or supplying non-FDA-approved peptides.

The boards have stated that:

Physicians may only purchase prescription products from entities permitted by the relevant State Board of Pharmacy.
All drugs administered or dispensed to a patient must be prescription-quality.
Compounding, administering, or dispensing a non-FDA-approved or research-grade peptide is prohibited.
This prohibition includes advising, recommending, supplying, prescribing, or administering.
Patient consent forms purporting to identify a product as "research-grade" are ineffective and do not eliminate professional or legal liability.
A medical professional cannot delegate this work to a nurse practitioner or physician assistant.

What this means in practice:

FDA-approved peptide medications are prescribed through the normal process when clinically indicated, sourced from licensed pharmacies, and integrated into a broader care plan.
Research-grade and non-FDA-approved peptides are outside the scope of what any licensed physician can ethically and legally provide. We do not prescribe, recommend, or coordinate their use.

When a patient independently acquires and self-administers such substances, the associated risk rests solely with the patient. Fishtown Medicine takes no part in that decision and provides no clinical guidance on those substances.

What We Do Prescribe

The FDA-approved peptide medications we use, when the clinical picture warrants them:

GLP-1 Receptor Agonists

The most clinically useful peptide medications for the majority of patients.

Examples. Semaglutide, tirzepatide, liraglutide, dulaglutide.
FDA-approved indications. Type 2 diabetes, obesity treatment, cardiovascular risk reduction in selected populations. Several have indications beyond weight.
Why we use them. Strong human safety data over multiple years, clear prescribing framework, and meaningful effect on metabolic disease. We prescribe brand-name FDA-approved products dispensed by licensed pharmacies.
Emerging data. Neuroprotective effects and possible cognitive benefits are being actively studied, and we cover where that stands in GLP-1s and your brain. We follow the evidence rather than the marketing.

Sermorelin

A growth-hormone-releasing-hormone analog that stimulates the pituitary to release growth hormone in natural overnight pulses.

Status. FDA-approved.
Where it fits. Adult patients with documented growth hormone deficiency, after appropriate workup. Not a first-line longevity tool.
What to watch for. Headache and vision changes can show up on any growth hormone peptide, and they are a reason to call us rather than wait it out.

Tesamorelin

A growth-hormone-releasing-hormone analog approved for specific FDA-labeled indications.

Status. FDA-approved.
Where it fits. FDA-labeled use for HIV-associated lipodystrophy. Off-label use in carefully selected patients requires explicit consent, monitoring, and clinical justification.

What We Do Not Prescribe

Fishtown Medicine

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We do not prescribe, recommend, administer, or supply any of the following:

BPC-157 (injectable or otherwise marketed for clinical use)
TB-500 / Thymosin Beta-4
CJC-1295
Ipamorelin
GHK-Cu (for clinical injection)
Melanotan I or II
PT-141
Selank, Semax, DSIP
Any compound marketed as "research-grade" or "for research use only"

This list is illustrative, not exhaustive. If a compound is not FDA-approved or has been removed from the compoundable substances list, we do not provide it and we do not provide clinical guidance on its use.

Why We Don't Prescribe Research-Grade Peptides

3 reasons, in order of importance:

Patient safety. When manufacturing oversight does not exist, neither the physician nor the patient can verify the contents of a vial, the purity of the compound, or the consistency of the dose. The "peptide" sold online may not contain what the label claims.
Legal and licensing exposure. State medical boards have made the rule explicit. A physician who recommends, prescribes, or administers a non-FDA-approved peptide is practicing outside the scope authorized by their license.
Long-term evidence. Even the most-studied research-grade peptides have limited long-term human safety data. The evidence base does not support the confidence that wellness marketing implies.

How We Think About This With Patients

When a patient asks about peptides, the conversation usually starts with the clinical goal: weight loss, recovery, sleep, performance, longevity. We work backward from the goal to the evidence-based, FDA-approved tools that exist for that goal. Sometimes a peptide medication is part of the answer. More often, the foundational work (sleep, training, nutrition, stress, and standard medications) covers most of the ground.

Patients who arrive already using a research-grade peptide are not judged, and that is a personal choice. We do not provide clinical advice on substances we cannot legally prescribe, so we will not interpret, optimize, or troubleshoot a research-grade protocol, and we will not write replacement prescriptions for compounds outside the FDA-approved formulary. What we can do:

Discuss the broader clinical picture you are trying to address.
Order labs that may be relevant to your overall health, independent of any peptide.
Help you weigh FDA-approved alternatives that may serve the same goal.
Coordinate care with your other physicians.

Guidance from the Clinic

"The boring answer to 'should I be on peptides?' is that for most patients, the FDA-approved options cover the clinical ground. The rest is wellness marketing dressed up in laboratory language."

Actionable Steps in Philly

Thinking about peptide therapy?

Define the goal. Weight, metabolic health, sleep, recovery - the goal determines the tool.
Get the workup. Fasting insulin, A1c, ApoB, full thyroid, vitamin D, ferritin, and sex hormones. Most decisions get easier with the data in front of you.
Fix the foundation. Sleep, training, protein, and stress carry most of the result. No peptide replaces them.
Ask about FDA-approved options. If a peptide medication fits your situation, we will say so and walk through what it does and does not do.

Book Your Warm Invitation Call Here

Scientific References

Wilding JPH, et al. "Once-weekly semaglutide in adults with overweight or obesity." NEJM. 2021.
Jastreboff AM, et al. "Tirzepatide once weekly for the treatment of obesity." NEJM. 2022.
Walker RF. "Sermorelin: a better approach to management of adult-onset growth hormone insufficiency?" Clin Interv Aging. 2006.
Falutz J, et al. "Effects of tesamorelin (TH9507) on visceral adipose tissue in HIV-infected patients." NEJM. 2007.

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