Review
. 2026 Aug;56(8):1921-1935.
doi: 10.1007/s40279-026-02437-0. Epub 2026 Apr 12.
Affiliations
PMID: 41966639 DOI: 10.1007/s40279-026-02437-0
Review
Safety and Efficacy of Approved and Unapproved Peptide Therapies for Musculoskeletal Injuries and Athletic Performance
Christopher L Mendias et al. Sports Med. 2026 Aug.
Abstract
Peptides are short chains of amino acids with a unique pharmacological niche between small-molecule drugs and large proteins. Their use in sports medicine is rapidly expanding, driven by patient demand for accelerated injury recovery and performance enhancement. While numerous peptide drugs have undergone a rigorous approval process that evaluates both safety and efficacy, a parallel "gray market" of unapproved compounds has emerged, operating largely outside of regulatory oversight. Our objective is to present the pharmacological mechanisms, safety profiles, and regulatory status of prominent approved and unapproved peptides marketed direct to patients, including 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 (mitochondrial ORF of the 12S rRNA type-c), sermorelin, SS-31 (elamipretide), tesamorelin (Egrifta), Tβ4 (thymosin beta-4), and TB-500 (thymosin beta-4 fragment). Many unapproved peptides demonstrate favorable tissue repair and metabolic outcomes in animal models, but rigorous human safety data are scarce, and there is potential for serious harm to patients. This narrative review focuses on the utilization of peptides in sports medicine, and alternative treatments that may be considered. We provide a framework to navigate patient discussions about peptides to better facilitate evidence-based practices for musculoskeletal healing and athletic performance. We also discuss the placebo effect as a mediator of peptide efficacy, and how social media amplifies this effect.
© 2026. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
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Conflict of interest statement
Declarations. Conflicts of interest/competing interests: Tariq M. Awan receives consulting fees from Arthrex for activities unrelated to topics discussed in this article. Christopher L. Mendias has no conflicts of interest that are directly relevant to the content of this article. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Availability of data and material: Not applicable. Code availability: Not applicable. Authors’ contributions: CLM and TMA conceived the study; CLM drafted the manuscript; CLM and TMA edited the manuscript, and read and approved the final version of the manuscript and agree with the order of presentation of the authors.
References
Otvos L, Wade JD. Big peptide drugs in a small molecule world. Front Chem. 2023;11:1302169. https://doi.org/10.3389/fchem.2023.1302169 . - DOI - PubMed - PMC
Wang L, Wang N, Zhang W, Cheng X, Yan Z, Shao G, et al. Therapeutic peptides: current applications and future directions. Signal Transduct Target Ther. 2022;7:48. https://doi.org/10.1038/s41392-022-00904-4 . - DOI - PubMed - PMC
Bonnet A-L, Aboishava L, Mannstadt M. Advances in parathyroid hormone-based medicines. J Bone Miner Res. 2025;40:1195–206. https://doi.org/10.1093/jbmr/zjaf118 . - DOI - PubMed - PMC
Turnock DL, Gibbs DN. Click, click, buy: the market for novel synthetic peptide hormones on mainstream e-commerce platforms in the UK. Perform Enhanc Health. 2023;11:100251. https://doi.org/10.1016/j.peh.2023.100251 . - DOI
Józwiak M, Bauer M, Kamysz W, Kleczkowska P. Multifunctionality and possible medical application of the BPC 157 peptide: literature and patent review. Pharmaceuticals Basel. 2025;18:185. https://doi.org/10.3390/ph18020185 . - DOI - PubMed - PMC