Peptides for Longevity and Anti-Aging: What Is Actually Prescribed and What the Evidence Says

The working framework for aging biology is the "hallmarks of aging" scheme published in Cell in 2013 and expanded in 2023: among them telomere attrition, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, loss of proteostasis and chronic inflammation. Every product below maps onto one or two of these and none onto all of them. A longevity protocol is a choice of which process to act on.

Skin, tendon and vessel walls are built from collagen, elastin and proteoglycans, and with age the balance between synthesis and breakdown shifts toward breakdown. The tripeptide GHK is present in human plasma and is reported to fall substantially between young adulthood and later life; it was isolated in a 1973 Nature New Biology paper and later characterized as a copper-binding peptide involved in tissue remodelling. That decline is the rationale for GHK-Cu.

Nicotinamide adenine dinucleotide carries electrons in the reactions that turn nutrients into ATP and is consumed by sirtuins and PARP enzymes involved in DNA repair. A 2012 PLOS ONE study measured NAD+ in human tissue across ages and reported an age-associated decline alongside rising oxidative-stress markers; reviews in Science in 2015 and Trends in Molecular Medicine in 2017 set out why that is thought to matter. Whether replacing NAD+ changes anything downstream in humans is a separate question, taken up below.

The inner mitochondrial membrane is organized around cardiolipin, the phospholipid that holds the electron-transport complexes in the folded cristae where they work. Oxidized or depleted cardiolipin is a described feature of aged and ischemic tissue, and it is the target of SS-31; papers in the Journal of the American Society of Nephrology in 2013 and the British Journal of Pharmacology in 2014 describe the compound binding cardiolipin and restoring bioenergetics in stressed mitochondria.

Growth hormone secretion falls steadily from early adulthood, mostly through loss of the large night-time pulses, and IGF-1 falls with it; a 2000 JAMA study in healthy men tied the decline in slow-wave sleep across adult life to the decline in GH. Clinically that looks like less deep sleep, slower recovery, more fat and less lean mass. The tension a candid page has to state: in animals, lower growth signalling is associated with longer life; in humans a 2011 Science Translational Medicine study of Ecuadorian adults with growth hormone receptor deficiency reported a near-absence of cancer and diabetes, and a 2014 Aging Cell study of people over 95 reported that lower IGF-1 predicted longer survival. Raising GH in mid-life is a body-composition and quality-of-life decision, not a longevity decision, and a physician should say so.

GHK-Cu is glycyl-L-histidyl-L-lysine bound to a copper ion, and it is the best-evidenced compound in this category. A 1988 FEBS Letters paper reported it stimulating collagen synthesis in cultured fibroblasts; a 1993 Journal of Clinical Investigation paper reported connective-tissue accumulation in rat wounds; papers in the Journal of Investigative Dermatology in 1999 and Life Sciences in 2000 describe it modulating the enzymes that break tissue down. The 2015 BioMed Research International and 2018 International Journal of Molecular Sciences reviews summarize gene-expression work in which GHK is reported to shift many human genes toward repair and away from inflammation.

The human data is real but topical: a 1994 Wound Repair and Regeneration trial in diabetic ulcers and a 2006 Archives of Facial Plastic Surgery study on laser-resurfaced skin. There are no randomized human trials of injectable GHK-Cu. It suits the patient whose primary complaint is skin, connective tissue and recovery.

Epithalon (also written epitalon) is a synthetic tetrapeptide, Ala-Glu-Asp-Gly, designed after epithalamin, a pineal-gland extract studied for decades in Russia. The cell work is the interesting part: a 2003 Bulletin of Experimental Biology and Medicine paper reported telomerase activation and telomere elongation in human somatic cells, and an independent 2025 Biogerontology paper from a UK group reported telomere lengthening in human cell lines through telomerase or ALT activity. Mouse work in Biogerontology in 2003 reported effects on biomarkers of aging and tumor incidence, and a 2001 study in old monkeys reported effects on melatonin and cortisol rhythms.

The human data is the weak point, and epithalon is the peptide here where claims most exceed data. The human studies are of epithalamin, the parent extract, not the synthetic peptide: a 2006 study in elderly subjects with accelerated aging and a 2011 fifteen-year follow-up, both from the Khavinson group, reported lower mortality and slower decline in small, single-group, unblinded reports. Epithalon suits the patient who understands they are buying a coherent cell-culture mechanism, whose circadian and sleep complaints are prominent, and who is not expecting a telomere measurement to move.

The NAD+ injection supplies the coenzyme directly, and most of the human trial evidence is for oral precursors. A 2018 Nature Communications trial reported that nicotinamide riboside was well tolerated and raised blood NAD+ in healthy middle-aged and older adults; a 2018 American Journal of Clinical Nutrition trial in obese men reported safety but no change in insulin sensitivity; a 2021 Science trial reported that nicotinamide mononucleotide increased muscle insulin sensitivity in prediabetic women; a 2023 GeroScience dose-ranging trial in healthy middle-aged adults reported raised NAD+ and some functional measures; the NADPARK trial (Cell Metabolism, 2022) reported brain NAD+ changes in Parkinson's disease; and the NICE trial (Nature Communications, 2024) reported a walking-distance effect in adherent participants with peripheral artery disease. For the injected form, a 2019 Frontiers in Aging Neuroscience pilot measured the NAD+ metabolome during a six-hour intravenous infusion in a handful of healthy participants.

Precursors reliably raise NAD+ in humans and there are clinical signals in specific populations. No trial has shown NAD+, by any route, extending human lifespan or slowing a measured aging clock. NAD+ suits the patient whose complaint is energy and recovery and who wants the compound with the largest human safety literature here.

SS-31 is elamipretide, the only compound on this page whose molecule has been through a full clinical development program. The human trials are in mitochondrial disease: a 2018 Neurology dose-escalation trial and a 2020 Journal of Cachexia, Sarcopenia and Muscle crossover trial in primary mitochondrial myopathy reported functional signals, while the larger MMPOWER-3 randomized trial in Neurology in 2023 did not meet its primary endpoints. The TAZPOWER program in Barth syndrome, a genetic cardiolipin disorder, reported open-label improvements over 168 weeks in Genetics in Medicine in 2024, the data behind the 2025 approval described below. Trials in heart failure (PROGRESS-HF, 2020) and geographic atrophy (ReCLAIM-2, 2024) are also published.

The mechanism is real and the compound has a substantial human safety record, but every trial is in people with a diagnosed disease; there are no randomized trials of SS-31 in healthy aging adults. SS-31 suits the patient whose complaint is exercise tolerance and fatigue, particularly where a physician suspects a mitochondrial component.

The pair acts on two receptors to raise the body's own GH output. CJC-1295 is a long-acting GHRH analogue; a 2006 Journal of Clinical Endocrinology and Metabolism trial in healthy adults reported prolonged GH and IGF-1 elevation after single doses, and a companion paper reported that pulsatile GH secretion persisted. Ipamorelin acts on the ghrelin receptor; the 1998 European Journal of Endocrinology paper that introduced it described the first GH secretagogue that did not also raise cortisol or prolactin at GH-releasing doses, and a 2014 randomized trial in the International Journal of Colorectal Disease for post-operative ileus is its largest human safety dataset.

Neither has been studied in a randomized trial for aging, sleep or body composition in healthy adults. Prescribers describe sleep depth first, then recovery, then body composition over months. CJC-1295 / Ipamorelin suits the patient whose complaints track the GH decline above and who has been told plainly about the growth-signalling tension.

Sermorelin is the first 29 amino acids of GHRH and has the most human trial data in older adults of any GH secretagogue, because it was studied as a drug in the 1990s. A 1992 Journal of Clinical Endocrinology and Metabolism study reported that twice-daily GHRH(1-29) restored GH and IGF-1 in older men; 1997 studies in the same journal and in Metabolism reported endocrine, body-composition and immune effects of nightly injections in healthy older adults; a 2006 Neurobiology of Aging trial and a 2012 Archives of Neurology controlled trial reported cognitive effects in healthy older adults and in mild cognitive impairment. Sermorelin suits the patient who wants the longest human record. Ipamorelin + Sermorelin and CJC-1295 / Ipamorelin / Sermorelin combine it with the ghrelin-receptor agonist.

Tesamorelin is a stabilized GHRH analogue with the strongest randomized evidence of any GH-axis compound here, in a specific population. The 2007 New England Journal of Medicine trial and two phase 3 trials pooled in the Journal of Clinical Endocrinology and Metabolism in 2010 reported reductions in visceral fat in HIV-infected adults with abdominal fat accumulation; a 2014 JAMA trial and a 2019 Lancet HIV trial reported effects on liver fat in the same population; a 2012 randomized trial in obese adults with reduced GH secretion, without HIV, reported visceral-fat and lipid changes. Tesamorelin suits the patient whose complaint is central fat. RADIANCE pairs it with GHK-Cu; Tesamorelin + Ipamorelin pairs it with the ghrelin-receptor agonist.

ETERNAL combines GHK-Cu, epithalon, BPC-157 and TB-500; RADIANCE is GHK-Cu with tesamorelin; REVIVE puts GHK-Cu and TB-500 alongside CJC-1295 / Ipamorelin. A blend is not more evidence than its parts; it is a convenience for a patient a physician has decided needs more than one mechanism.

Tesamorelin (visceral fat in HIV lipodystrophy and in obese adults with low GH), sermorelin as GHRH(1-29) (older adults), elamipretide (mitochondrial myopathy, Barth syndrome, heart failure, geographic atrophy), NAD+ precursors (several populations) and ipamorelin (post-operative ileus). Those trials establish safety and specific endpoints in the populations studied, and nothing about aging in healthy adults; a page that borrows a Barth-syndrome result to sell a mitochondrial "reset" is misusing it.

Injectable GHK-Cu, epithalon, and CJC-1295 with ipamorelin. For each, the mechanism is coherent and there is prescribing experience, but no randomized human trial of the product as prescribed for the purpose it is prescribed for.

That any peptide extends human lifespan or slows a biological age clock in a controlled trial; that raising GH or IGF-1 in mid-life is neutral for long-term health, where the human genetic and centenarian data point the other way; or an effect size or timeline for any of these in healthy adults, because those trials have not been run.

Injectable GHK-Cu had been in Category 2. In April 2026 FDA removed it, with eleven other peptides, after the nominations were withdrawn; the Category 2 page now lists "GHK-Cu (for injectable routes of administration)" among substances "nominated but withdrawn." The May 14, 2026 category list restored "GHK-Cu (except for injectable routes of administration)" to Category 1 after a nominator clarified it had meant to withdraw only the injectable route, and FDA intends to consult the Pharmacy Compounding Advisory Committee on GHK-Cu before the end of February 2027. So: no longer flagged for significant safety risk, with a committee review scheduled.

Epitalon was likewise removed from Category 2 in April 2026 and sits on the "nominated but withdrawn" list. It was one of seven peptides on the agenda of the Pharmacy Compounding Advisory Committee's July 23–24, 2026 meeting, discussed on July 24 for the proposed use "insomnia." The committee voted 7 to 4, with one abstention, to recommend adding epitalon to the 503A bulks list. The votes are not binding, and FDA's determination through rulemaking is pending.

Nicotinamide adenine dinucleotide (NAD) and its reduced form NADH are both in 503A Category 1 on the May 14, 2026 list, the category for substances under evaluation with no identified significant safety risk; glutathione, which some protocols pair with it, is in Category 1 as well. NAD+ is not an FDA-approved drug in any form.

Elamipretide, the molecule sold as SS-31, is the one compound here with an FDA-approved product: Forzinity was approved on September 19, 2025 to improve muscle strength in patients with Barth syndrome weighing at least 30 kg. The label states the indication is approved under accelerated approval based on an improvement in knee extensor muscle strength, an intermediate clinical endpoint. Compounded SS-31 is not that product; the approval is for a rare genetic disease, not for aging.

CJC-1295 appears on the Category 2 page under "nominated but withdrawn," where FDA's note records serious adverse events including increased heart rate and a systemic vasodilatory reaction in the limited clinical data it reviewed. Ipamorelin acetate is split: its 503A nomination is listed as withdrawn, while it remains in Category 2 under the 503B outsourcing-facility policy, added September 29, 2023, on immunogenicity grounds. The 503A Category 2 list itself now holds six substances; the only GH secretagogue on it is ibutamoren, and kisspeptin-10 remains.

Both are components of drugs FDA has approved, a separate route to eligibility from the bulks list. Sermorelin acetate was Geref, approved on December 28, 1990 and, as the treatment vial, on September 26, 1997, for idiopathic growth hormone deficiency in children; in a March 4, 2013 Federal Register notice FDA determined that Geref was not withdrawn from sale for reasons of safety or effectiveness. Tesamorelin acetate is Egrifta, approved on November 10, 2010 under NDA 022505, deemed a biologics license application on March 23, 2020, with its most recent supplement approved March 25, 2025. Compounded sermorelin and tesamorelin borrow the molecule, not the approval, and are prescribed off-label.

MOTS-c was removed from Category 2 in April 2026, and on July 23, 2026 the advisory committee voted 7 to 5, with two abstentions, to recommend it for the bulks list for obesity and osteoporosis. FOXO4-DRI and thymalin appear on none of the three category lists as of May 14, 2026.

The 2026 WADA Prohibited List, in force from January 1, 2026, prohibits at all times under S2.2.4 "growth hormone-releasing hormone (GHRH) and its analogues (e.g. CJC-1293, CJC-1295, sermorelin and tesamorelin)" and "growth hormone secretagogues (GHS) and their mimetics" including ipamorelin, and under S2.3 thymosin-beta-4 and its derivatives such as TB-500. MOTS-c is listed under S4.4.1 as an AMPK activator, and BPC-157 is named under S0, the non-approved-substances class. Epithalon, GHK-Cu, NAD+ and elamipretide are not named, though S0 covers any pharmacological substance with no current approval by a governmental health authority. If you compete in tested sport, tell your physician before starting.

Fatigue, poor sleep, central weight gain, thinning skin and slow recovery each have ordinary causes a peptide would only paper over: hypothyroidism, iron or B12 deficiency, sleep apnea, depression, untreated hypogonadism, perimenopause and menopause, and type 2 diabetes. The intake and baseline bloodwork exist to find them.

Anything that raises GH and IGF-1 is a growth signal, and GHK-Cu is described as supporting new blood-vessel growth. A 2004 Lancet meta-analysis reported higher circulating IGF-1 associated with higher risk of several common cancers. A personal history of cancer is the standing reason a physician declines the GH-axis products.

GH reduces insulin sensitivity, so fasting glucose and HbA1c are checked before any GH-axis prescription and again after. GHK-Cu delivers copper, so Wilson's disease, other copper-handling disorders and high-dose zinc are reasons to discuss GHK-Cu, ETERNAL and RADIANCE first. None of these is used in pregnancy or while breastfeeding; safety data are absent.

For CJC-1295 / Ipamorelin, sermorelin, tesamorelin and blends containing them: IGF-1, fasting glucose and HbA1c, lipids, thyroid (TSH and free T4) and, where symptoms suggest it, sex hormones. For GHK-Cu, NAD+, SS-31 and epithalon, bloodwork is not routinely required; the physician decides from history.

IGF-1 is repeated after the first months on a GH-axis product and is the number the physician doses to: into the upper part of the age-adjusted normal range and not above it. Glucose and HbA1c are repeated because GH reduces insulin sensitivity; lipids and thyroid at the physician's interval. Joint swelling, tingling in the hands, persistent water retention or a change in glucose readings are reasons to contact your physician before the next panel.

GH-axis products: injection-site redness, water retention, joint aches, tingling in the hands, increased appetite with ipamorelin, and headache or flushing after a dose. NAD+ injections: injection-site discomfort and, with larger volumes given quickly, transient flushing or nausea. GHK-Cu, epithalon and SS-31: injection-site reactions predominantly. Stop and contact your physician for any reaction that is severe, spreading, or involves difficulty breathing.