Safety and Efficacy of Approved and Unapproved Peptide Therapies for Musculoskeletal Injuries and Athletic Performance
Mendias CL, Awan TM
Sports Medicine (2026)
A 2026 Sports Medicine narrative review by the Performance Medicine Institute mapping the pharmacology, safety, and regulatory status of twelve sports-marketed peptides — AOD-9604, BPC-157, CJC-1295, FS-344, GHK-Cu, ipamorelin, MOTS-C, sermorelin, SS-31, tesamorelin, Tβ4, and TB-500 — and the first credible journal-tier framework for clinicians discussing the gray-market peptide channel with patients.
This narrative review in Sports Medicine (the official journal of the American College of Sports Medicine) by Mendias and Awan at the Performance Medicine Institute (Phoenix, AZ) provides the first journal-tier synthesis specifically scoped to the sports-medicine and athletic-performance use case of peptide therapies. The review is explicitly written as a framework for clinicians fielding patient questions about the gray-market peptide channel.
The authors cover twelve compounds spanning the approved-to-unapproved spectrum: AOD-9604 (anti-obesity drug 9604), BPC-157 (body protection compound 157), CJC-1295, FS-344 (follistatin-344), GHK-Cu (glycyl-L-histidyl-L-lysine copper), ipamorelin, MOTS-C, sermorelin, SS-31 (elamipretide), tesamorelin (Egrifta), thymosin β4 (Tβ4), and TB-500 (the synthetic Tβ4 fragment). For each compound the review summarises the pharmacological mechanism, available animal and human evidence, the safety profile, and the regulatory and approval status.
The headline framing: numerous unapproved peptides demonstrate favourable tissue-repair and metabolic outcomes in animal models, but rigorous human safety data are scarce, and the gray-market channel — operating largely outside regulatory oversight — creates real potential for serious patient harm. The authors also explicitly discuss the placebo effect as a mediator of perceived peptide efficacy, and the role of social media in amplifying that effect.
The review proposes a framework for evidence-based patient discussions and points to alternative musculoskeletal-healing therapies where peptide evidence is weakest.
This is a narrative review, not a systematic review or meta-analysis — there is no prespecified search protocol, no quality-of-evidence grading, and no quantitative synthesis. The authors are explicit that this is a framework piece for clinician-patient conversations, not a definitive evidence appraisal. For each individual compound, the corpus already contains more detailed primary-literature entries that should be the load-bearing citations for any specific clinical claim.
Conflict-of-interest disclosure: Tariq M. Awan receives consulting fees from Arthrex for activities the authors describe as unrelated to the content of this article; Christopher L. Mendias declares no direct conflicts. Arthrex is a major orthopaedic-implant and biologics company, and the perception of independence is non-trivial in this space — caveat readers should be alert to whether the review's "alternative treatments" framing structurally favours device-based or biologic-based therapies over peptide therapies.
Abstract-only extraction; the per-compound assessments and the proposed clinical framework cannot be reproduced from the abstract alone. The compound list omits several peptides the corpus does cover separately (PT-141, Selank, Semax, KPV, dihexa) and the sports-medicine framing means non-orthopaedic indications are out of scope.
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