When we hear “peptides” as clinicians, we think of GLP-1 drugs as compounds (Ozempic, Wegovy, Mounjaro, and Zepbound) that help with diabetes and weight management. These are FDA-approved medications with large human trials behind them. But peptides seem to mean something else to the general public, as I have observed in the bodybuilding world. Most are unapproved compounds sold primarily through a gray market. In fact, I did an experiment and went looking for a common combo of peptides known as the “Wolverine stack.” It only took me 20 minutes to find a website that sold the stack in injectable form. The site got around such legal tape by requiring buyers to click a box to verify they were 21 or older and purchasing for research purposes only. I needed no medical background to dose myself.
While there is a lack of scientific evidence behind these types of recovery peptides in humans, people are still using them. Peptide use can have a variety of side effects, but given my background in the OR, my concern centers on how they can impact surgical recovery and how to think about screening for them preoperatively.
Why Peptide Use Matters In and Outside of the OR
GLP-1 drugs delay gastric emptying. The American Society of Anesthesiologists (ASA) recommends stopping weekly GLP-1 medications one week prior to elective surgery, to minimize the risk of pulmonary aspiration and other increased postoperative complications.
Unlike GLP-1 receptor agonists, recovery peptides lack the human clinical data needed to evaluate these surgical risks and side effects. A surgical team cannot plan around a risk that has never been measured. While there are many peptides out there, there are two common recovery “stacks” I have heard about in the weightlifting world that have me concerned in the OR.
BPC-157 and TB-500 (the “Wolverine stack”). These two are usually taken together for healing — and so named and marketed because of the healing powers of Wolverine, a Marvel Comics character. BPC-157, a synthetic 15-amino-acid chain, is promoted for its ability to stimulate angiogenesis (the growth of new blood vessels) along with broad anti-inflammatory and tissue-repair effects. TB-500 is a short, synthetic fragment of thymosin beta-4. Researchers study it for cell movement, blood vessel formation, and tissue remodeling. In a surgical patient, a compound actively promoting blood vessel growth and suppressing inflammation at a fresh wound raises unanswered questions about bleeding, clot formation, and whether early signs of infection get masked.
Growth hormone secretagogues (CJC-1295 and ipamorelin). Often stacked, these push the pituitary to release growth hormone, which in turn raises IGF-1. The pharmacology is real; the recovery benefits are unproven. Surgical risks include vasodilation, hypotension, edema, and insulin resistance.
The Screening Gap
There are no catchall lab tests for this wide array of recovery peptides. Unbiased data regarding recovery peptides is sparse, but not nonexistent. Almost half (48%) of physicians reported patients disclosed using non-FDA-approved peptides in the past 12 months (via medspas, compounding pharmacies, and online “research” products). Patients are seeking peptides for a variety of reasons: 69% sought them for weight loss, 57% for anti-aging, 55% for muscle gain, and 41% for longevity. Peptide use is happening outside the gym. And peptides are everywhere online: 84% of physicians said patients cite social media, influencers, podcasts, or forums — not clinicians — as their source of peptide information.
How do we begin to talk to patients about peptides? Before surgery, we already go through a comprehensive medical assessment: interviews, medications, allergies, and a slew of other questions. We should be able to integrate a screening question for peptides, too. Something like “Are you using any peptides, injectables, or recovery and performance compounds, ordered either online or through a wellness clinic?” If yes, we would need to know the exact compound and the source (was it a compounding pharmacy or an online or gray market?) as well as dosage, frequency, etc. Using this information, a surgical team could flag based on the peptide: for example, glucose and hypo- or hyperglycemia should be watched for after GH secretagogues or IGF-1.
There are many real-world examples of recovery peptides gone awry, even outside the OR. At the 2025 Revolution Against Aging and Death Festival (RAADfest) in Las Vegas, Nevada, two women received peptide injections at a wellness clinic operating inside the event. Shortly afterward, both developed elevated heart rates, swollen tongues, and shortness of breath. By the time they reached the hospital, one had lost control of her neck muscles and the other had been intubated. Both were ultimately placed on ventilators. This is not a hypothetical — this is happening now, and we need to be asking patients about it.
How are you asking your patients about peptides? Share your conversation starters in the comments.
