Mechanism dossiers

Long-form deep-dives on the major pathways the corpus covers — what the receptor system does, what each compound interfacing with it brings, and where the published evidence does and does not support the practitioner conventions built on top of it.

Mechanism dossiers: 30
Goal-oriented guides: /decide
Format: Long-form

01·acromegaly
Acromegaly and peptides — when the GH-axis pharmacology this site covers extensively becomes the disease, not the desired effect
Acromegaly is the inverted case in the peptide-pharmacology corpus. The growth-hormone axis that drives the editorial center of Tesamorelin, Ipamorelin, CJC-1295, MK-677, Sermorelin, and Hexarelin — and the broader GH ax…
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02·neurodegeneration
Alzheimer's disease and peptides — what the trial record actually supports
Alzheimer's disease is the most-studied neurodegenerative dementia and the indication where the peptide field's clinical-trial record is most uniformly disappointing on prespecified primary endpoints. The 2024-to-2026 st…
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03·HPG-axis-modulation
Andropause — late-onset hypogonadism, traditional TRT, and the HPG-axis-preserving peptide alternatives
"Andropause" is the colloquial frame for an endocrinological reality that the medical literature now calls late-onset hypogonadism. The distinction matters editorially. Menopause is a discrete event — cessation of ovulat…
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04·cardiovascular-outcome
Chronic kidney disease and peptides — the FLOW trial, the SGLT2-inhibitor backbone, and the peptide signals that sit on top of them
Chronic kidney disease is the indication in which the GLP-1 receptor agonist class produced the most consequential positive peptide-class clinical-trial readout of the 2020s, and where the standard of care simultaneously…
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05·chronic-pain
Chronic pain and peptides — a heterogeneous syndrome category where the peptide-pharmacology layer is mostly underused relative to its mechanistic potential
Chronic pain is the syndrome category where the peptide-pharmacology layer is most clearly underused relative to its mechanistic potential, and where the gap between mechanism and validated therapeutic is widest in this…
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06·GI-inflammation
Crohn's disease and peptides — what the literature actually supports for the transmural, skip-lesion, fistulizing subtype
Crohn's disease is the inflammatory bowel disease subtype defined by transmural inflammation that may involve any segment of the gastrointestinal tract, with discontinuous "skip lesions," a strong predilection for the te…
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07·neuropathy
Diabetic neuropathy and peptides — disease-modifying ambition versus what the trial record shows
Diabetic neuropathy is the most common chronic complication of diabetes and, in 2026, still the indication with the longest graveyard of failed disease-modifying trials in peptide pharmacology. The 2017 American Diabetes…
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08·female-sexual-function
Female sexual dysfunction — what the literature supports beyond Vyleesi, across desire, arousal, orgasm, and pain
Female sexual dysfunction (FSD) resists single-drug framing more than almost any other domain in adult medicine. The DSM-5 collapses what previous editions treated as separate disorders — hypoactive sexual desire disorde…
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09·GLP-1-receptor
GLP-1 receptor pharmacology
GLP-1 receptor pharmacology is the area of metabolic peptide biology where the rate of evidence accumulation has outrun the field's ability to absorb it. In the span of five years (2021–2026), three molecules have either…
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10·angiogenesis
Healing and angiogenesis
The healing-and-angiogenesis class is the area of peptide pharmacology where mechanistic plausibility runs furthest ahead of human clinical evidence — and where the practitioner-protocol layer has built the most elaborat…
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11·cardiovascular-outcome
Heart failure and peptides — what the literature actually supports for HFrEF and HFpEF
Heart failure is the condition where peptide pharmacology has produced its biggest positive clinical-trial signal of the 2020s — and also where it has produced one of its cleanest Phase 2 failures. The two readings sit o…
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12·hereditary-angioedema
Hereditary angioedema and peptides — the rare-disease indication where the entire modern therapeutic class engages a peptide pathway
Hereditary angioedema is the rare-disease indication where every clinically meaningful therapeutic developed over the past two decades engages the kallikrein-kinin pathway — and where the peptide pharmacology of that pat…
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13·blood-pressure-modulation
Hypertension and peptides — the bidirectional pharmacology, the natriuretic-peptide cautionary tale, and the modest GLP-1 signal
Hypertension is the indication where peptide pharmacology runs in two directions at once. The same molecular family containing the body's most potent endogenous blood-pressure-lowering hormones — atrial, B-type, and C-ty…
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14·GI-inflammation
Inflammatory bowel disease and peptides — what the literature actually supports
Inflammatory bowel disease — Crohn's disease and ulcerative colitis taken together — is a chronic, immune-mediated inflammatory condition of the gastrointestinal tract affecting an estimated 2.39 million adults in the Un…
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15·irritable-bowel-syndrome
Irritable bowel syndrome and functional GI motility — the only peptide-pharmacology territory with two FDA-approved class members
Functional gastrointestinal disorders — the umbrella the Rome Foundation now formalises as disorders of gut-brain interaction (DGBI) — are the territory where peptide pharmacology has produced two FDA-approved class memb…
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16·post-viral-recovery
Long COVID and peptides — what the literature actually supports
Long COVID — post-acute sequelae of SARS-CoV-2 infection (PASC), ICD-10 code U09.9 — is the condition where the gap between biohacker peptide protocols and published human evidence is wider than anywhere else in this cor…
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17·retinal-degeneration
Macular degeneration and peptides — what the literature actually supports for dry AMD, geographic atrophy, and adjacent retinal pathology
Age-related macular degeneration is the leading cause of irreversible vision loss in adults over 50 in high-income countries, and it is the indication where the standard-of-care landscape moved more in 2023 than in any p…
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18·mood-modulation
Major depressive disorder and peptides — what the trial record actually supports
Major depressive disorder is the indication where the gap between popular peptide claims and the controlled-trial record is most asymmetric in either direction — most marketed peptide pharmacology has not been tested in…
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19·migraine-prevention
Migraine and peptides — the indication that put a peptide-pathway class on the global formulary
Migraine is the indication where the peptide-pathway story produced the most consequential drug-class success of the last decade, and the only indication in this corpus where targeting a peptide signalling axis has resha…
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20·mitochondrial-signaling
Mitochondrial peptides
The mitochondrial-peptide field is the most recently-emerging area of peptide therapeutics. Three classes of molecules occupy this category: MOTS-c and the broader family of mitochondrial-derived peptides (MDPs) discover…
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21·multiple-myeloma
Multiple myeloma and peptides — the proteasome-inhibitor peptide-pharmacophore class, the bone-disease comorbidity, and the modern triplet-quadruplet sequencing
Multiple myeloma is the malignancy where peptide pharmacology became the therapeutic backbone of the modern treatment paradigm — not through endogenous-peptide replacement or growth-axis modulation, but through three pep…
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22·bone-formation
Osteoporosis and peptides — what the literature actually supports for low bone density and fragility fracture
Osteoporosis is the condition where peptide and protein pharmacology arrives at fracture prevention through a different door than the rest of the drug class — and where three of the most clinically consequential agents i…
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23·PCOS-metabolic-syndrome
PCOS and peptides — what the literature actually supports for polycystic ovary syndrome across the GLP-1, amylin, and HPG-axis classes
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-age women — the World Health Organization estimates a prevalence of 8–13% globally, with Global Burden of Disease 2021 reporting a ~2…
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24·neurodegeneration
Parkinson's disease and peptides — what the trial record actually supports
Parkinson's disease is the second-most-common neurodegenerative disorder and the indication where the peptide field's clinical-trial record has produced the most informative contrast in any neurology indication: two full…
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25·prostate-cancer
Prostate cancer hormonal therapy and peptides — the GnRH-axis pharmacology that anchors modern androgen deprivation
Prostate cancer hormonal therapy is the indication where peptide pharmacology built the foundation of an entire treatment paradigm and then handed half of the modern intensification package to small-molecule chemistry. T…
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26·aging-musculoskeletal
Sarcopenia and peptides — what the evidence actually supports for age-related muscle loss
Sarcopenia is the progressive, age-associated loss of skeletal muscle mass, strength, and physical function. The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recast the diagnostic logic in 2019 around…
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27·sleep-apnea
Sleep apnea and peptides — the first FDA-approved peptide-class drug for obstructive sleep apnea
On December 20, 2024, the U.S. Food and Drug Administration approved tirzepatide — marketed as Zepbound — for moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity. It is the first pharmacotherapy of an…
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28·GH-secretion
The growth-hormone axis
The growth-hormone axis is the endocrine spine that connects pituitary somatotroph cells, hepatic IGF-1 production, and downstream tissue effects on muscle, bone, fat distribution, and metabolic substrate handling. Four…
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29·type-1-diabetes
Type 1 diabetes and peptides — the indispensable hormone, the one approved adjunct, and the slow arrival of disease-modifying therapy
Type 1 diabetes is the indication in which peptide pharmacology has always mattered the most and the indication in which the gap between the indispensable peptide therapy and every candidate adjunct on top of it is the w…
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30·visceral-adiposity-reduction
Visceral adiposity and peptides — what the literature actually supports for the deep-fat depot
The single most important framing in metabolic medicine that BMI obscures is the distinction between subcutaneous fat — the storage compartment under the skin, on the hips, thighs, and abdominal wall — and visceral adipo…
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Mechanism dossiers

Acromegaly and peptides — when the GH-axis pharmacology this site covers extensively becomes the disease, not the desired effect

Alzheimer's disease and peptides — what the trial record actually supports

Andropause — late-onset hypogonadism, traditional TRT, and the HPG-axis-preserving peptide alternatives

Chronic kidney disease and peptides — the FLOW trial, the SGLT2-inhibitor backbone, and the peptide signals that sit on top of them

Chronic pain and peptides — a heterogeneous syndrome category where the peptide-pharmacology layer is mostly underused relative to its mechanistic potential

Crohn's disease and peptides — what the literature actually supports for the transmural, skip-lesion, fistulizing subtype

Diabetic neuropathy and peptides — disease-modifying ambition versus what the trial record shows

Female sexual dysfunction — what the literature supports beyond Vyleesi, across desire, arousal, orgasm, and pain

GLP-1 receptor pharmacology

Healing and angiogenesis

Heart failure and peptides — what the literature actually supports for HFrEF and HFpEF

Hereditary angioedema and peptides — the rare-disease indication where the entire modern therapeutic class engages a peptide pathway

Hypertension and peptides — the bidirectional pharmacology, the natriuretic-peptide cautionary tale, and the modest GLP-1 signal

Inflammatory bowel disease and peptides — what the literature actually supports

Irritable bowel syndrome and functional GI motility — the only peptide-pharmacology territory with two FDA-approved class members

Long COVID and peptides — what the literature actually supports

Macular degeneration and peptides — what the literature actually supports for dry AMD, geographic atrophy, and adjacent retinal pathology

Major depressive disorder and peptides — what the trial record actually supports

Migraine and peptides — the indication that put a peptide-pathway class on the global formulary

Mitochondrial peptides

Multiple myeloma and peptides — the proteasome-inhibitor peptide-pharmacophore class, the bone-disease comorbidity, and the modern triplet-quadruplet sequencing

Osteoporosis and peptides — what the literature actually supports for low bone density and fragility fracture

PCOS and peptides — what the literature actually supports for polycystic ovary syndrome across the GLP-1, amylin, and HPG-axis classes

Parkinson's disease and peptides — what the trial record actually supports

Prostate cancer hormonal therapy and peptides — the GnRH-axis pharmacology that anchors modern androgen deprivation

Sarcopenia and peptides — what the evidence actually supports for age-related muscle loss

Sleep apnea and peptides — the first FDA-approved peptide-class drug for obstructive sleep apnea

The growth-hormone axis

Type 1 diabetes and peptides — the indispensable hormone, the one approved adjunct, and the slow arrival of disease-modifying therapy

Visceral adiposity and peptides — what the literature actually supports for the deep-fat depot