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. We prescribe only FDA-approved peptide medications obtained through licensed US pharmacies. State medical boards have clarified that any recommendation, prescription, or administration of non-FDA-approved peptides by a medical professional constitutes the unauthorized practice of medicine.
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.
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.
Patient consent forms that purport to label a product as "research-grade" do not change this. The medical boards have been explicit on that point.
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. 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.
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
We do not prescribe, recommend, administer, or supply any of the following:
Fishtown Medicine
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- 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.
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 - that is a personal choice. But we do not continue, manage, or troubleshoot those protocols, and we do not write replacement prescriptions for compounds outside the FDA-approved formulary.
Guidance from the Clinic
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.
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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.
Frequently Asked Questions
Common Questions
Deep-Dive Questions
Ready when you are
Dr. Ash reads every intake himself, and answers questions personally - usually within a few hours.
