What We Don’t Prescribe — and Why

Most clinic websites list everything they offer and stay quiet about what they choose not to. We think the opposite framing is more useful for patients trying to find the right care. The peptides we choose not to prescribe say as much about our practice as the ones we do prescribe — maybe more.

This article walks through several categories of peptides that have generated patient interest but that we do not offer at The Tide, and the reasoning behind each decision. The categories include compounds with significant safety concerns, compounds without legitimate clinical pathways, compounds outside our scope of practice, and compounds where existing alternatives are clearly better.

Melanotan II: the safety concerns are real

Melanotan II is a synthetic melanocortin receptor agonist with broad activity at MC1R, MC3R, MC4R, and MC5R subtypes. It has been promoted in consumer markets for skin pigmentation enhancement and sexual desire effects. We do not prescribe it, despite the patient interest, for specific safety reasons.

Case reports document new melanocytic lesions, atypical mole formation, and changes in existing nevi following Melanotan II use. Some cases have progressed to malignant melanoma. The MC1R activity that produces skin darkening is the same activity that affects melanocyte biology more broadly, and the documented cases of malignant transformation are not theoretical concerns — they are reported clinical events.

Safer alternatives exist. Bremelanotide (PT-141, Vyleesi) is FDA-approved with a more focused MC3R/MC4R activity profile that captures the sexual response benefits without the broad melanocortin activation. For pigmentation concerns, sun protection and dermatologic care are the appropriate pathways — not peptides that may increase melanoma risk.

The Melanotan II marketed in consumer channels has additional problems beyond the inherent pharmacological concerns. Independent testing of products sold as Melanotan II has documented variable purity, mislabeled content, and contamination. Patients who have used these products before seeing us are advised to discontinue them and to maintain ongoing dermatologic surveillance for any pigmented lesion changes.

The HCG diet: it does not work

HCG (human chorionic gonadotropin) has legitimate clinical uses, primarily for fertility indications and for maintaining testicular function during testosterone replacement therapy. It does not have a legitimate use as a weight loss intervention.

The “HCG diet” pairs low-dose HCG injections with extreme caloric restriction (typically 500 calories daily). Proponents claim that HCG produces specific fat loss patterns and protects lean mass during the caloric restriction. Multiple controlled studies have evaluated this claim and found that HCG does not produce weight loss beyond what the caloric restriction alone produces, does not preferentially target abdominal fat, does not protect lean mass, and does not reduce hunger during severe caloric restriction.

The FDA has issued formal warnings about over-the-counter “homeopathic HCG” products marketed for weight loss. The use of prescription HCG for weight loss is not supported by evidence and we do not offer it. Patients seeking weight management are appropriately served by GLP-1 therapies, structured nutrition and activity, and addressing underlying contributors to weight gain.

We do prescribe HCG for legitimate indications — primarily testicular function support during TRT and selected fertility-adjacent uses for men. The “HCG diet” is a different application that we decline to participate in.

Insulin and most diabetes medications: outside our scope

Insulin therapy is appropriately the domain of endocrinology and primary care providers with diabetes management expertise. Insulin requires careful titration based on glucose monitoring, attention to hypoglycemia prevention, integration with diet and activity patterns, and coordination of multiple insulin formulations. Patients with type 1 diabetes or insulin-treated type 2 diabetes need comprehensive diabetes care rather than peptide-focused outpatient care.

Pramlintide (Symlin), which is used in insulin-treated diabetes, falls in the same category for the same reasons. Setmelanotide (Imcivree) for rare genetic obesity is appropriately managed by genetics or specialized obesity programs experienced in monogenic disorders.

Some peptide-class medications that look superficially similar to what we do — semaglutide and tirzepatide — are within our scope when prescribed for weight management or metabolic support in appropriate candidates. The boundary is whether the patient needs comprehensive diabetes care (in which case primary care or endocrinology is appropriate) or whether they need metabolic support that fits the GLP-1-class indication (in which case our practice fits).

Oncology peptides: not our role

Several peptides are FDA-approved for oncologic indications: leuprolide, triptorelin, goserelin, histrelin, and degarelix for prostate cancer; lutetium Lu 177 dotatate for neuroendocrine tumors; bortezomib for multiple myeloma. These are appropriately prescribed by oncology specialists with experience in the underlying conditions, coordinated with chemotherapy regimens and supportive care that fall entirely outside our practice scope.

Patients with active cancer who are interested in peptide therapy as adjunctive support to their oncologic treatment should have those conversations primarily with their oncology team. Some peptide approaches may be appropriate as adjuncts; others may interact with cancer treatment in ways that require specialist evaluation. The Tide is not the right place to make those decisions independently.

Cosmetic peptides: a different industry

Topical cosmetic peptides — Matrixyl, Argireline, palmitoyl peptides, copper peptides in cosmetic formulations — are appropriately addressed through dermatology, aesthetic medicine, or skincare retail channels. The Tide is a peptide-focused medical clinic, not a skincare retailer. We do not formulate, sell, or recommend specific cosmetic skincare products.

The clinical use of GHK-Cu (which we do prescribe) is distinct from the cosmetic use of GHK-Cu in skincare products. We use GHK-Cu for medical skin remodeling, post-procedure recovery, and selected systemic applications. We do not compete with the cosmetic industry for general anti-aging skincare.

Hospital and ICU peptides: not appropriate for outpatient use

Several peptide medications are appropriately used only in hospital settings: angiotensin II (Giapreza) and vasopressin as ICU vasopressors, nesiritide for acute decompensated heart failure, daptomycin and vancomycin and other IV antibiotics for serious infections, ziconotide for severe chronic pain through implanted intrathecal pumps. These require monitoring infrastructure that simply does not exist in outpatient care.

Patients with these clinical situations are appropriately under the care of hospital-based specialists. The Tide does not provide acute or hospital-level care.

Specialty endocrinology applications

Acromegaly treatment with octreotide, lanreotide, or pasireotide; severe osteoporosis treatment with teriparatide or abaloparatide; corticotropin (Acthar Gel) for infantile spasms or MS exacerbations; somatostatin analogs for various neuroendocrine conditions — these require specialist expertise in the underlying conditions and ongoing coordination with the relevant specialty (endocrinology, rheumatology, neurology).

The Tide does not provide care for severe osteoporosis, pituitary disorders, or other complex endocrine conditions. Patients with these diagnoses are referred to or managed in coordination with the appropriate specialty.

Research-only compounds

Many peptides that get attention in online discussions are research compounds that are not legally available for human use in the US: most of the peptides marketed as longevity or experimental compounds without established clinical pathways. These include FOXO4-DRI, certain SS-family mitochondrial peptides, Dihexa, some experimental neuropeptides, and others that exist primarily in research literature without legitimate clinical infrastructure.

We work exclusively with FDA-approved pharmaceuticals and licensed compounding pharmacies that meet specific quality standards. Research-only compounds purchased from research peptide vendors do not meet pharmaceutical quality standards and we cannot incorporate them into clinical care responsibly.

Compounds where alternatives are clearly better

Several peptides that we could prescribe, we choose not to, because better alternatives exist:

GHRP-2 and GHRP-6: we use ipamorelin, which provides equivalent GH release without the cortisol elevation, prolactin elevation, and (for GHRP-6) appetite stimulation that limit the older GHRPs.

Hexarelin: the tachyphylaxis with continued use, the more pronounced cortisol effects, and the older-generation pharmacology compared to ipamorelin make this an unfavorable choice.

CJC-1295 with DAC: the long albumin-binding modification produces sustained GH/IGF-1 elevation that loses the pulsatile pattern. We use CJC-1295 without DAC, which preserves the physiologic release pattern.

MK-677 (ibutamoren): not technically a peptide, with sustained continuous GH/IGF-1 elevation and significant appetite stimulation that often counteracts the metabolic goals patients have. Pulsatile peptide protocols are typically preferred.

Why this matters

What a clinic chooses not to do is informative. A peptide clinic that prescribes everything that has been theoretically discussed in the peptide literature is not exercising clinical judgment. A peptide clinic that prescribes only what is appropriate, evidence-supported, within their scope of practice, and clearly better than alternatives is exercising the kind of judgment patients should look for.

The list above is not comprehensive — there are other peptides we choose not to prescribe for various reasons. The principles are consistent: we work with peptides that have appropriate evidence bases, that are available through legitimate regulatory channels, that fit our scope of practice, that have favorable risk-benefit profiles, and that represent the best available option for the indication. Peptides that fail any of these tests we decline to prescribe, regardless of patient interest or marketing momentum.

If you are evaluating peptide-focused practices, ask not just what they prescribe but what they choose not to prescribe and why. Practices that have thought carefully about the second question are typically the ones to trust with the first.