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Compound guide

Every compound the journal covers: what kind of compound it is, how it is taken, where it stands with the FDA, and how much research in people there is.

The journal is published by Rovere, a telehealth service that sells some of the treatments discussed here. Articles are general information, not medical advice. Only a licensed clinician can say whether a treatment is right for you.

How to read the ratings

The rating shows how much research in people exists, not whether it worked. Some compounds failed their large trials. The note after the rating says what the trials found and which use they tested. Trials of FDA-approved products did not test compounded versions. FDA status is as of the date shown.

Large trials in people
At least two randomized trials of 200 or more people each, or one of 1,000 or more. FDA approvals usually rest on trials like these, but large trials can also find no benefit.
Small trials in people
Randomized trials in people, but fewer or smaller than that.
Early studies in people
Only studies without a comparison group, case reports, or short studies that measured how the body handles it.
Lab and animal studies only
No published studies of it in people.

GLP-1 medications

Read the article: What are GLP-1 medications like semaglutide and tirzepatide?

  • Semaglutide

    What it is
    GLP-1 receptor agonist (peptide)
    How it is taken
    Injection under the skin, or a tablet taken by mouth
    FDA status
    Specific semaglutide products are FDA-approved; compounded versions are not FDA-approved, and the FDA does not review them for safety, effectiveness or quality before they are sold. Checked (source).
    Research in people
    Large trials in people. In randomized trials, FDA-approved semaglutide led to more weight loss than placebo (STEP 1, 1,961 adults) and fewer combined heart attacks, strokes and cardiovascular deaths (SELECT, 17,604 adults with cardiovascular disease); none tested a compounded version.

  • Tirzepatide

    What it is
    GIP and GLP-1 receptor agonist (peptide)
    How it is taken
    Injection under the skin
    FDA status
    Specific tirzepatide products are FDA-approved; compounded versions are not FDA-approved, and the FDA does not review them for safety, effectiveness or quality before they are sold. Checked (source).
    Research in people
    Large trials in people. In randomized trials, FDA-approved tirzepatide led to more weight loss than placebo (SURMOUNT-1, 2,539 adults) and was no worse than dulaglutide, an older GLP-1 drug, on heart attacks, strokes and cardiovascular deaths (SURPASS-CVOT, 13,299 adults with type 2 diabetes); none tested a compounded version.

  • Liraglutide

    What it is
    GLP-1 receptor agonist (peptide)
    How it is taken
    Injection under the skin
    FDA status
    Specific liraglutide products, from the original maker and, since December 2024, other companies, are FDA-approved; compounded versions are not FDA-approved. Checked (source).
    Research in people
    Large trials in people. In randomized trials, FDA-approved liraglutide led to more weight loss than placebo (SCALE Obesity and Prediabetes, 3,731 adults without diabetes) and fewer combined heart attacks, strokes and cardiovascular deaths (LEADER, 9,340 adults with type 2 diabetes); none tested a compounded version.

  • Retatrutide

    Also called LY3437943

    What it is
    GIP, GLP-1 and glucagon receptor agonist (peptide)
    How it is taken
    Injection under the skin (in trials)
    FDA status
    Not FDA-approved for any use; the FDA says it is not a component of any approved drug and cannot be used in compounding under federal law. Checked (source).
    Research in people
    Large trials in people. Phase 3 obesity trials, TRIUMPH-1 (2,339 adults) and TRIUMPH-2 (1,152 adults with type 2 diabetes), found more weight loss than placebo over 80 weeks, with more digestive side effects; effects on heart and kidney events and long-term safety are unknown.

  • Cagrilintide

    Also called AM833

    What it is
    Amylin analog (peptide)
    How it is taken
    Injection under the skin (in trials)
    FDA status
    Not FDA-approved for any use; the FDA says it is not a component of any FDA-approved drug and cannot be used in compounding under federal law. Checked (source).
    Research in people
    Large trials in people. Combined with semaglutide, it led to more weight loss than placebo in phase 3 trials REDEFINE 1 (3,417 adults, 68 weeks) and REDEFINE 2 (1,206 adults with type 2 diabetes); phase 3 trials designed to test it alone are due to finish in 2027.

  • Orforglipron

    What it is
    GLP-1 receptor agonist (small molecule, not a peptide)
    How it is taken
    Tablet taken by mouth
    FDA status
    FDA-approved on April 1, 2026, for chronic weight management in adults with obesity, or with overweight and a weight-related condition; not approved for any other use. Checked (source).
    Research in people
    Large trials in people. In ATTAIN-1, a randomized trial of 3,127 adults with obesity but not diabetes, orforglipron led to more weight loss than placebo over 72 weeks, and more people stopped it because of side effects; it did not test a compounded version.

Growth hormone peptides

Read the article: What are growth hormone peptides like sermorelin and ipamorelin?

  • Sermorelin

    Also called sermorelin acetate, GHRH(1-29), GRF(1-29)

    What it is
    Growth hormone-releasing hormone analog (peptide)
    How it is taken
    Injection under the skin (into a vein for the former diagnostic test)
    FDA status
    Not FDA-approved today; it was approved in 1990 as a diagnostic test and in 1997 for children with growth hormone deficiency, and both approvals were withdrawn at the maker’s request in 2009, not for safety or effectiveness reasons. Checked (source).
    Research in people
    Small trials in people. A randomized trial of 60 children with growth hormone deficiency, the use it was once approved for, found growth hormone itself worked better; a 110-child study without a comparison group found faster growth.

  • Tesamorelin

    Also called tesamorelin acetate, TH9507

    What it is
    Growth hormone-releasing hormone analog (44 amino acids; regulated by the FDA as a protein, a biologic)
    How it is taken
    Injection under the skin
    FDA status
    FDA-approved since 2010 only to reduce excess abdominal fat in adults with HIV who have lipodystrophy, and not for weight loss or any other use. Checked (source).
    Research in people
    Large trials in people. Two 26-week randomized, placebo-controlled phase 3 trials, of 412 and 404 adults with HIV and excess abdominal fat, found less deep belly fat with tesamorelin than with placebo, an effect that faded after stopping; none tested a compounded version.

  • CJC-1295

    Also called CJC-1295 with DAC, DAC:GRF, CJC-1295 without DAC, tetrasubstituted GRF(1-29)

    What it is
    Growth hormone-releasing hormone analog (peptide); its DAC form is long-acting
    How it is taken
    Injection under the skin
    FDA status
    Not FDA-approved for any use; in December 2024, FDA staff and advisers opposed adding any form of it to the 503A bulks list of extra compounding ingredients. Checked (source).
    Research in people
    Early studies in people. Two short randomized, placebo-controlled dosing studies in healthy adults found it raised growth hormone and IGF-1 but measured no health outcome; 63 people received the DAC version across three published studies, and the FDA found no human study of the version without DAC.

  • Ipamorelin

    Also called ipamorelin acetate

    What it is
    Ghrelin receptor agonist (peptide)
    How it is taken
    Injection into a vein (in trials); injection under the skin (proposed for compounding)
    FDA status
    Not FDA-approved for any use; the FDA lists it as raising safety risks when outsourcing facilities compound it, and its nomination for 503A pharmacy compounding was withdrawn. Checked (source).
    Research in people
    Small trials in people. Its only published trial in patients gave ipamorelin or a placebo by vein to 114 adults having bowel surgery and found no clear benefit in how soon they could eat; the FDA found no study of it injected under the skin.

  • Ibutamoren

    Also called ibutamoren mesylate, MK-677, MK-0677, LUM-201

    What it is
    Ghrelin receptor agonist (small molecule, not a peptide)
    How it is taken
    By mouth
    FDA status
    Not FDA-approved for any use; the FDA lists it among compounding ingredients that raise safety risks, citing heart failure in a hip fracture trial. Checked (source).
    Research in people
    Large trials in people. Randomized trials found no slowing of Alzheimer’s disease in 563 people and, added to an osteoporosis drug, more bone density at one hip site only in 292 women. None tested it for bodybuilding; in 65 healthy older adults, lean tissue rose but strength did not.

  • AOD-9604

    Also called AOD9604, AOD-9604 acetate

    What it is
    Modified fragment of growth hormone (peptide)
    How it is taken
    By mouth or injection into a vein (in trials); injection under the skin (proposed for compounding)
    FDA status
    Not FDA-approved for any use; in December 2024, FDA staff recommended against adding it to the 503A bulks list of extra compounding ingredients, and advisers voted 12 to 0 against. Checked (source).
    Research in people
    Large trials in people. In its largest trial, 502 adults with obesity taking it by mouth for 24 weeks did not lose clearly more weight than those on placebo; all six trials were company-funded, most were never fully published, and none gave it as an injection under the skin.

BPC-157 and TB-500

Read the article: What are BPC-157 and TB-500?

  • BPC-157

    Also called Body protection compound 157, PL-14736, Pentadecapeptide BPC 157

    What it is
    Lab-made peptide of 15 amino acids
    How it is taken
    Injection under the skin, capsule or tablet by mouth, or mouth or nasal spray (as sold); enema (in trials)
    FDA status
    Not FDA-approved; FDA staff opposed adding it to the 503A bulks list; in a nonbinding 2026 draft, HHS says it does not intend to take enforcement action against 503A compounding of BPC-157 acetate for under-the-skin or muscle injection, oral or skin use, under its conditions. Checked (source).
    Research in people
    Small trials in people. Its only reported randomized trial in patients, of enemas for ulcerative colitis in 53 people, found no clear difference from placebo; it appeared only as a 2005 conference abstract and did not test the injury healing BPC-157 is mostly promoted for.

  • TB-500

    Also called Thymosin beta-4 fragment 17-23, Ac-LKKTETQ, N-acetyl-LKKTETQ

    What it is
    Lab-made seven-amino-acid fragment of thymosin beta-4
    How it is taken
    Injection or nasal spray (as sold)
    FDA status
    Not FDA-approved; FDA staff opposed adding it to the 503A bulks list; in a nonbinding 2026 draft, HHS says it does not intend to take enforcement action against 503A compounding of TB-500 acetate for under-the-skin or muscle injection under its conditions. Checked (source).
    Research in people
    Early studies in people. No trial of TB-500 in people has reported results; the only published report, three dental nerve-injury cases given injections of it alongside other drugs, cannot show what TB-500 itself did. A first placebo-controlled safety trial, in people with cardiovascular disease, began in 2026.

  • Thymosin beta-4

    Also called Tβ4, TB4, Timbetasin, RGN-259 (eye-drop form in trials), NL005 (injectable form in heart attack trials)

    What it is
    Small protein of 43 amino acids (often called a peptide), made by the body
    How it is taken
    Eye drops, skin gel or injection into a vein (in trials)
    FDA status
    Not approved or licensed by the FDA for any use; no thymosin beta-4 product appears in the FDA’s database of licensed biological products. Checked (source).
    Research in people
    Large trials in people. Its two largest trials, of eye drops for dry eye in 601 and 700 people, found no clear difference from placebo on their main measures; no trial has tested it for muscle, tendon or joint injuries, the use it is mostly promoted for.

GHK-Cu

Read the article: What is GHK-Cu, the copper peptide?

  • GHK-Cu

    Also called Copper tripeptide-1, Prezatide copper, Glycyl-L-histidyl-L-lysine copper complex, GHK copper

    What it is
    Copper-bound peptide of three amino acids, found in human blood
    How it is taken
    On the skin (cream, serum or gel); injection (as sold)
    FDA status
    No GHK-Cu drug is FDA-approved; GHK-Cu except for injection is under evaluation for pharmacy compounding (Category 1), injected GHK-Cu is excluded, and an advisory committee review is planned before the end of February 2027. Checked (source).
    Research in people
    Small trials in people. The strongest trials tested chronic wounds, not appearance: a copper peptide cream did no better than placebo on leg ulcers (1992, 93 people), while GHK-Cu gel did better on diabetic foot-sole ulcers (1994). Small cosmetic trials disagree; no controlled human trial tested injected GHK-Cu alone.

Epitalon, MOTS-c, thymosin alpha-1 and SS-31

Read the article: What are epitalon, MOTS-c, thymosin alpha-1 and SS-31?

  • Epitalon

    Also called Epithalon, Epithalone, AEDG peptide, Ala-Glu-Asp-Gly

    What it is
    Lab-made peptide of four amino acids, modeled on a cattle pineal extract
    How it is taken
    Under the tongue, or injection next to the eye (in studies); injection, capsule or mouth spray (as sold)
    FDA status
    Not FDA-approved; FDA staff opposed adding it to the 503A bulks list; in a nonbinding 2026 draft, HHS says it does not intend to take enforcement action against 503A compounding of epitalon acetate for under-the-skin or muscle injection, dispensed in intermittent courses, under its conditions. Checked (source).
    Research in people
    Small trials in people. A 2021 randomized, placebo-controlled study of 40 women, mostly night-shift workers, found a melatonin by-product rose with an under-the-tongue spray but not with placebo; it did not measure sleep. No randomized trial has tested whether epitalon slows aging, the use clinics market it for.

  • MOTS-c

    Also called Mitochondrial open reading frame of the 12S rRNA-c, MOTs-C

    What it is
    Peptide of 16 amino acids encoded in mitochondrial DNA
    How it is taken
    Injection, including into a vein (as sold; no published study in people)
    FDA status
    Not FDA-approved; FDA staff opposed adding it to the 503A bulks list; in a nonbinding 2026 draft, HHS says it does not intend to take enforcement action against 503A compounding of MOTS-c acetate for under-the-skin or muscle injection under its conditions. Checked (source).
    Research in people
    Lab and animal studies only. No published study has given MOTS-c to people; studies in people have only measured the MOTS-c the body makes. An 88-person safety trial of a modified version, CB4211, ended in 2021 with no results in its registry entry or PubMed.

  • Thymosin alpha-1

    Also called Thymalfasin, Ta1

    What it is
    Immune-acting peptide of 28 amino acids, made by the body (approved in some countries outside the US)
    How it is taken
    Injection under the skin (in trials); injection or nasal spray (as sold)
    FDA status
    Not FDA-approved for any use; in December 2024 FDA advisers voted 17 to 4 against adding each form to the 503A bulks list of extra compounding ingredients, and the FDA had not decided by November 13, 2026. Checked (source).
    Research in people
    Large trials in people. Two large double-blind trials, in 1,106 adults with sepsis (2025) and 508 with predicted severe acute necrotizing pancreatitis (2022), found no benefit on their main outcomes. Both enrolled critically ill hospital patients, not the people it is marketed to online for immune support.

  • Elamipretide

    Also called SS-31, MTP-131, Elamipretide hydrochloride

    What it is
    Peptide of four amino acids that targets mitochondria (FDA-approved prescription drug)
    How it is taken
    Injection under the skin
    FDA status
    FDA-approved on September 19, 2025, under accelerated approval, to improve muscle strength in Barth syndrome in patients weighing at least 30 kilograms (66 pounds); the FDA requires a trial to confirm the benefit. Checked (source).
    Research in people
    Large trials in people. The largest published randomized trials, in 300 adults treated for heart attack (2016) and 218 with mitochondrial muscle disease (2023), found no clear benefit. Its Barth approval rests on a 12-patient trial; no trial has tested whether it slows aging or tested a compounded version.

Semax, selank, KPV and DSIP

Read the article: What are semax, selank, KPV and DSIP?

  • Semax

    Also called Met-Glu-His-Phe-Pro-Gly-Pro, ACTH(4-7)-Pro-Gly-Pro, Semax acetate

    What it is
    Lab-made peptide of seven amino acids based on a fragment of the hormone ACTH (registered as a drug in Russia)
    How it is taken
    In the nose (in the studies the FDA assessed); nasal spray or injection under the skin (as sold)
    FDA status
    Not FDA-approved; FDA staff opposed adding it to the 503A bulks list; in a nonbinding 2026 draft, HHS says it does not intend to take enforcement action against 503A compounding of semax free base for nasal use under its conditions. Checked (source).
    Research in people
    Small trials in people. A 2018 Russian trial in 110 stroke patients, assigned at random without a placebo, reported faster recovery with semax; FDA staff set it aside as untranslated and judged the evidence insufficient. It is also sold for focus and anxiety, which that trial did not test.

  • Selank

    Also called Selank acetate, TP-7, Thr-Lys-Pro-Arg-Pro-Gly-Pro

    What it is
    Lab-made peptide of seven amino acids based on tuftsin, an immune peptide (registered as a drug in Russia)
    How it is taken
    Not stated in trial summaries; nasal spray or injection (as sold)
    FDA status
    Not FDA-approved; the FDA lists selank acetate among withdrawn nominations it once placed in Category 2 over possible immune reactions, and says it lacks important safety information in people. Checked (source).
    Research in people
    Small trials in people. In three small Russian anxiety trials, selank matched one benzodiazepine sedative, eased anxiety less than another during treatment and sped that drug’s effect when added, with fewer side effects. None used a placebo, two were open-label, and all share a co-author from selank’s institute.

  • KPV

    Also called Lys-Pro-Val, Lysine-proline-valine, Alpha-MSH(11-13), KPV acetate

    What it is
    Three-amino-acid fragment of the hormone alpha-MSH
    How it is taken
    Injection, by mouth, on the skin or nasal spray (as sold); no studies in people
    FDA status
    Not FDA-approved; FDA staff opposed adding it to the 503A bulks list; in a nonbinding 2026 draft, HHS says it does not intend to take enforcement action against 503A compounding of KPV acetate for oral or skin use under its conditions. Checked (source).
    Research in people
    Lab and animal studies only. The FDA found no published study of KPV in people; the strongest evidence is from mice, in which KPV in drinking water reduced chemically induced colitis (2008).

  • Emideltide

    Also called DSIP, Delta sleep-inducing peptide, Trp-Ala-Gly-Gly-Asp-Ala-Ser-Gly-Glu

    What it is
    Peptide of nine amino acids first isolated from rabbits
    How it is taken
    Into a vein (most studies) or in the nose (a 2014 study); injection under the skin or nasal spray (as sold)
    FDA status
    Not FDA-approved; FDA staff advised in May 2026 against adding it, in either form, to the 503A bulks list. Checked (source).
    Research in people
    Small trials in people. Two double-blind insomnia trials by independent teams (1987, 1992), of 6 and 16 people, found little or no benefit from DSIP given into a vein; other small studies, most led by one researcher, reported benefits. None tested injection under the skin.

PT-141 and melanotan II

Read the article: What are PT-141 (bremelanotide) and melanotan II?

  • Bremelanotide

    Also called PT-141

    What it is
    Lab-made peptide of seven amino acids that activates melanocortin receptors (active ingredient of one FDA-approved injection)
    How it is taken
    Injection under the skin
    FDA status
    FDA-approved in 2019 only for premenopausal women with acquired, generalized hypoactive sexual desire disorder; not approved for men, for women after menopause or to enhance sexual performance; compounded bremelanotide is not FDA-approved. Checked (source).
    Research in people
    Large trials in people. Two 24-week trials in 1,267 premenopausal women found more desire and less distress about it than placebo, gains the FDA called modest, but no more satisfying sexual events. Neither tested men, women after menopause or a compounded version.

  • Melanotan II

    Also called MT-II

    What it is
    Lab-made peptide of seven amino acids that activates melanocortin receptors (unapproved)
    How it is taken
    Injection under the skin (in studies); injection or nasal spray (as sold)
    FDA status
    Not FDA-approved for any use and not on the 503A bulks list; it was in the FDA’s Category 2 of compounding ingredients flagged for safety risks until its nominators withdrew it, and the FDA’s page still cites case reports of melanoma. Checked (source).
    Research in people
    Small trials in people. Two crossover trials in 1998 and 2000 each gave 10 men with erectile dysfunction melanotan II and a placebo in turn, and found more erections on melanotan II; neither tested tanning. A 1996 pilot study in three men reported darker skin.

NAD+, NMN and NR

Read the article: What is NAD+, and what are NMN and NR?

  • NAD+ (nicotinamide adenine dinucleotide)

    Also called NAD, nadide, coenzyme I, beta-NAD

    What it is
    Coenzyme built from two nucleotides (not a peptide)
    How it is taken
    Infusion into a vein; injection under the skin or into a muscle; nasal spray
    FDA status
    Not FDA-approved; in 2019 the FDA proposed not to add NAD to the 503A bulks list of extra compounding ingredients, but while NAD stays under evaluation (Category 1), the FDA does not intend to act against state-licensed pharmacies compounding it under set conditions. Checked (source).
    Research in people
    Small trials in people. Two randomized trials by one hospital team in China gave 180 and 120 heart patients low-dose NAD+ by vein for 7 days; heart pumping was better than with placebo at one month, major events did not clearly differ, and neither tested aging or wellness.

  • NMN (nicotinamide mononucleotide)

    Also called beta-nicotinamide mononucleotide, MIB-626

    What it is
    NAD+ precursor, itself a nucleotide (not a peptide)
    How it is taken
    Taken by mouth
    FDA status
    Not FDA-approved as a drug; in September 2025 the FDA reversed its 2022 position and said NMN is not excluded from the definition of a dietary supplement, though it remains a new dietary ingredient. Checked (source).
    Research in people
    Small trials in people. A 2026 meta-analysis of 15 randomized trials, lasting 14 days to 24 weeks, found no effect on weight, blood sugar or cholesterol and no rise in side effects. Trials do show NMN raises blood NAD+.

  • NR (nicotinamide riboside)

    Also called nicotinamide riboside chloride

    What it is
    NAD+ precursor and a source of vitamin B3 (not a peptide)
    How it is taken
    Taken by mouth; also given by infusion into a vein
    FDA status
    Not FDA-approved as a drug but sold as a dietary supplement; it is neither on the 503A bulks list of extra compounding ingredients nor being evaluated for that list, though for outsourcing facilities NR chloride is under evaluation (Category 1). Checked (source).
    Research in people
    Small trials in people. A 2026 randomized trial of 410 people with early Parkinson disease, lasting 52 weeks, found no benefit and worse symptom scores than placebo; smaller trials show NR raises blood NAD+ with few health changes.

Glutathione

Read the article: What is glutathione?

  • Glutathione

    Also called GSH, reduced glutathione, L-glutathione, gamma-L-glutamyl-L-cysteinylglycine

    What it is
    Antioxidant the body makes; a chain of three amino acids (peptide)
    How it is taken
    Infusion or injection into a vein; injection into a muscle or under the skin; by mouth; inhaled; nasal spray; on the skin; rectal suppository
    FDA status
    Not FDA-approved for any use; listed as under evaluation (Category 1) on the FDA’s list of substances nominated for pharmacy compounding, updated May 14, 2026. Checked (source).
    Research in people
    Large trials in people. The largest randomized trials, of 396 to 825 heart patients in China, found IV glutathione did not prevent kidney injury from X-ray dye, a different use from skin lightening. Skin-lightening trials were small and mixed.

Testosterone

Read the article: What is testosterone therapy for men?

  • Testosterone

    Also called testosterone cypionate, testosterone enanthate, testosterone undecanoate, 17β-hydroxyandrost-4-en-3-one

    What it is
    Steroid hormone (androgen)
    How it is taken
    Injection into a muscle or under the skin, gel or solution on the skin, nasal gel, capsule by mouth, or pellet implanted under the skin
    FDA status
    In men, approved only for low testosterone with an associated medical condition, such as failed testicles or a pituitary problem, and not for age-related low testosterone; compounded testosterone is not FDA-approved. Checked (source).
    Research in people
    Large trials in people. In men with low testosterone, TRAVERSE (5,246 at high heart risk) found heart attacks and strokes similar to placebo but more irregular heartbeat, lung clots and fractures; the Testosterone Trials (790 aged 65 or older) found better sexual function, not energy. None tested compounded testosterone.

Drugs used with or instead of testosterone

Read the article: What are hCG, enclomiphene and the other drugs used with or instead of testosterone?

  • Human chorionic gonadotropin (hCG)

    Also called hCG, chorionic gonadotropin, choriogonadotropin alfa (lab-made)

    What it is
    Glycoprotein hormone that acts like LH (a protein, regulated as a biologic)
    How it is taken
    Injection into a muscle; a lab-made version approved only for women’s fertility treatment is injected under the skin
    FDA status
    FDA-approved, as a licensed biologic, for undescended testicles in boys, some men with low testosterone from a pituitary deficiency, and inducing ovulation in some women; not eligible for compounding under sections 503A or 503B. Checked (source).
    Research in people
    Large trials in people. Randomized trials of 205 to 297 women in fertility treatment, a different use, found lab-made and urine-derived hCG worked about equally; in healthy men given testosterone, the randomized studies were small and short and measured testicular hormones or sperm-forming cells, not fertility.

  • Enclomiphene

    Also called enclomiphene citrate, enclomifene, trans-clomiphene

    What it is
    Selective estrogen receptor modulator (small molecule)
    How it is taken
    By mouth
    FDA status
    Not FDA-approved; the FDA’s May 14, 2026 list of substances nominated for 503A compounding keeps it in Category 1, under evaluation. Checked (source).
    Research in people
    Small trials in people. Two randomized 16-week phase 3 trials in 256 overweight men with low testosterone from weak pituitary signals did not show that symptoms improved and used no validated symptom measures; they found it raised testosterone and kept sperm counts normal. None tested a compounded version.

  • Clomiphene

    Also called clomiphene citrate, clomifene

    What it is
    Selective estrogen receptor modulator (small molecule)
    How it is taken
    Tablet by mouth
    FDA status
    Approved only to treat ovulation problems in women who want to become pregnant; prescribing it to men is off-label, and its label says there are no adequate or well-controlled studies demonstrating that it works for male infertility. Checked (source).
    Research in people
    Large trials in people. Large trials in women with polycystic ovary syndrome (a different use) found more live births than with metformin (2007, 626 women) but fewer than with letrozole (2014, 750 women). Trials in men were small or short, with mixed results; no trial tested a compounded version.

  • Gonadorelin

    Also called gonadorelin acetate, gonadorelin hydrochloride, gonadotropin-releasing hormone (GnRH)

    What it is
    Lab-made gonadotropin-releasing hormone (peptide)
    How it is taken
    Injection; studied in men as pulses under the skin from a pump
    FDA status
    No FDA-approved gonadorelin product for people is marketed: both human injections, approved in 1982 and 1989, are discontinued. Checked (source).
    Research in people
    Small trials in people. In randomized trials in boys with undescended testicles, a different use, it brought testicles down more often than placebo, but in a minority of cases; the largest, of 252 boys, found little difference. No study has tested whether it preserves sperm production on testosterone.

  • Anastrozole

    What it is
    Aromatase inhibitor, which blocks estrogen production (small molecule)
    How it is taken
    Tablet by mouth
    FDA status
    Approved only to treat breast cancer in women after menopause; prescribing it to men is off-label, and its label says it was not shown to work for breast enlargement in adolescent boys. Checked (source).
    Research in people
    Large trials in people. Its large breast cancer trials in women after menopause, a different use, found longer survival without recurrence than with tamoxifen. In older men, a year-long placebo-controlled trial found no gain in body composition or strength, and spine bone density fell. None tested a compounded version.

Menopause hormone therapy

Read the article: What is menopause hormone therapy (HRT)?

  • Estradiol

    Also called 17β-estradiol, E2, oestradiol

    What it is
    Estrogen (steroid hormone)
    How it is taken
    By mouth, on the skin (patch, gel or spray), in the vagina (cream, tablet, insert or ring), or by injection into muscle (as estradiol valerate or estradiol cypionate)
    FDA status
    FDA-approved for moderate to severe hot flashes and night sweats, vaginal and vulvar symptoms of menopause, low estrogen from underactive, failed or removed ovaries, preventing bone loss after menopause, and palliative treatment of some advanced breast and prostate cancers; compounded estradiol is not FDA-approved. Checked (source).
    Research in people
    Large trials in people. In REPLENISH (1,845 women), estradiol with progesterone eased hot flashes more than placebo; KEEPS (727) and ELITE (643) tested a different use, slowing artery disease, and found slower artery thickening only among ELITE women within six years of menopause. None tested a compounded version.

  • Progesterone

    Also called micronized progesterone, P4

    What it is
    Progestogen (steroid hormone)
    How it is taken
    Capsule by mouth; vaginal gel or insert, or injection into a muscle (approved for other uses); cream or troche (as sold)
    FDA status
    FDA-approved as an oral capsule for absent periods (secondary amenorrhea) and, in women with a uterus, to prevent uterine-lining overgrowth while taking conjugated estrogens tablets or, combined with estradiol in one capsule, to treat moderate to severe hot flashes; compounded progesterone is not FDA-approved. Checked (source).
    Research in people
    Large trials in people. In PEPI (596 women, three years), adding progesterone to estrogen kept uterine-lining overgrowth near placebo rates, and REPLENISH (1,845 women, one year) found almost none with the estradiol and progesterone capsule. Neither tested a compounded version.

  • Estriol

    Also called E3, oestriol

    What it is
    Estrogen (steroid hormone)
    How it is taken
    Vaginal insert (in trials); capsule by mouth, or cream, gel or ointment on the skin or in the vagina (as sold)
    FDA status
    No FDA-approved drug for people contains estriol; the FDA says marketed estriol products are compounded and not FDA-approved, and that it lacks evidence of their safety and effectiveness. Checked (source).
    Research in people
    Large trials in people. Estriol vaginal inserts improved measures of vaginal atrophy more than placebo in a 12-week trial of 436 women, and eased urinary symptoms about as well as an estradiol ring in a 24-week trial of 251. Neither tested whole-body use or a compounded version.