What are the guidelines for using peptides, such as growth hormone-releasing peptide (GHRP) or ipamorelin, for therapeutic purposes?

Growth Hormone-Releasing Peptides (GHRP) and Ipamorelin: Not Recommended for Therapeutic Use

Growth hormone-releasing peptides such as GHRP and ipamorelin are not approved for therapeutic use and should not be prescribed outside of research settings. These compounds lack established clinical guidelines, FDA approval for therapeutic indications, and evidence demonstrating benefits on mortality, morbidity, or quality of life.

Why These Peptides Are Not Recommended

Lack of Regulatory Approval

• No growth hormone secretagogues (GHS) like ipamorelin or GHRP-6 have FDA approval for clinical therapeutic use 1
• These peptides are listed on the World Anti-Doping Agency (WADA) Prohibited List, indicating concerns about their safety and appropriate use 2
• The ghrelin analogue anamorelin, despite showing some efficacy in phase III trials for cancer cachexia, remains unapproved for clinical use 1

Evidence of Potential Harm Without Clear Benefit

• Ipamorelin increases body fat through GH-independent mechanisms, including increased food intake and serum leptin, which contradicts the intended metabolic benefits 3
• While animal studies show ipamorelin increases bone mineral content, this occurs through increased bone dimensions rather than improved bone density, and the clinical significance for fracture prevention remains unknown 4
• The detection window and metabolism of these peptides varies significantly between individuals, making dosing unpredictable 2

Approved Alternatives for Legitimate Growth Hormone Deficiency

When Growth Hormone Therapy Is Indicated

If you suspect true growth hormone deficiency, use FDA-approved recombinant human growth hormone (rhGH), not secretagogues:

• Diagnosis must be confirmed through appropriate GH-stimulation tests using validated cut-points specific to each test 5
• In children with chronic kidney disease stages 3-5, GH therapy is indicated when height is below the 3rd percentile AND height velocity is below the 25th percentile for ≥3 months in infants or ≥6 months in older children 1, 5
• Dosing for approved rhGH: 0.045-0.05 mg/kg body weight per day via nightly subcutaneous injections 6

Absolute Contraindications to Any GH-Related Therapy

• Closed epiphyses 1, 6
• Active malignancy 1, 6
• Acute critical illness 1, 6
• Severe secondary hyperparathyroidism (PTH >500 pg/ml) 1, 6
• Known hypersensitivity to the active substance 1, 6

Critical Pitfalls to Avoid

Do Not Use GHS for Off-Label "Anti-Aging" or "Wellness"

• Peptide therapeutics show promise in pharmaceutical research for specific validated indications, but GHS compounds remain investigational 7
• Poor oral bioavailability and rapid plasma clearance make these peptides challenging to deliver effectively, requiring injectable formulations that increase risk without proven benefit 8

Recognize Inappropriate Marketing Claims

• Claims about muscle building, fat loss, or anti-aging benefits from GHS peptides lack supporting evidence from high-quality trials demonstrating improvements in mortality, morbidity, or quality of life
• The increase in body fat observed with ipamorelin contradicts marketing claims about metabolic benefits 3

Monitor for Adverse Effects If Patients Self-Administer

If patients disclose they are using these compounds despite your recommendations against them:

• Screen for intracranial hypertension (persistent headache, vomiting) 6
• Monitor glucose metabolism, as GHS can affect glucose homeostasis 6
• Check for fluid retention 6
• Assess for orthopedic complications including scoliosis and femoral head epiphysiolysis 6