Latest / Clearly Hormonal / Peptides: Evidence-Based Medicine vs. Social Media Hype

Transcript

Peptides: Evidence-Based Medicine vs. Social Media Hype · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to Clearly Hormonal, the podcast where we stop googling our symptoms at midnight and actually start understanding what's going on in our bodies.
• 0:10
  Dr. Komal Patil-Sisodia: I'm Dr.
• 0:10
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, an endocrinologist, internist, obesity medicine specialist, and a Menopause Society certified practitioner, which is really just a whole lot of words to say hormones are kind of my jam.
• 0:22
  Dr. Komal Patil-Sisodia: I've spent 17 years watching women try to navigate their hormonal health without ever having been taught the language for what's happening in their own bodies, and then meeting clinicians who want nothing more than to help them figure it out, but are up against 10-minute appointments and a system that just wasn't built for it.
• 0:38
  Dr. Komal Patil-Sisodia: This podcast is my answer to that gap.
• 0:40
  Dr. Komal Patil-Sisodia: We'll cover menopause, metabolism, hormones, and everything in between with real evidence, not trends, and without the overwhelm.
• 0:48
  Dr. Komal Patil-Sisodia: A quick disclaimer.
• 0:49
  Dr. Komal Patil-Sisodia: I'm a physician, but this is education, not personalized medical advice.
• 0:53
  Dr. Komal Patil-Sisodia: Take what resonates and discuss it with your own healthcare team.
• 0:57
  Dr. Komal Patil-Sisodia: Now, let's get into it and talk about what's clearly hormonal and what's not.
• 1:04
  Dr. Komal Patil-Sisodia: Everyone is talking about peptides right now.
• 1:06
  Dr. Komal Patil-Sisodia: Instagram, TikTok, wellness clinics on every corner.
• 1:10
  Dr. Komal Patil-Sisodia: There's a peptide for weight loss, a peptide for sleep, a peptide for wrinkles, a peptide for muscle recovery.
• 1:16
  Dr. Komal Patil-Sisodia: Honestly, at this point, a peptide for almost everything.
• 1:20
  Dr. Komal Patil-Sisodia: As a board-certified endocrinologist, I use peptides every single day in my practice.
• 1:25
  Dr. Komal Patil-Sisodia: Real ones, FDA-approved ones, peptides that were tested in thousands of patients before they ever reached my prescription pad.
• 1:34
  Dr. Komal Patil-Sisodia: But here's the thing, the peptides I prescribe are probably not the ones showing up on your feed.
• 1:39
  Dr. Komal Patil-Sisodia: So today we're gonna talk about what a peptide actually is, which ones I use and why, and how to think clearly about the peptide trend without getting swept up in the hype or the fear.
• 1:50
  Dr. Komal Patil-Sisodia: Let's get into it.
• 1:51
  Dr. Komal Patil-Sisodia: I wanted to start with the basics because peptide has become one of those words that sounds impressive, but doesn't really tell you all that much on its own.
• 2:00
  Dr. Komal Patil-Sisodia: A peptide is simply a short chain of amino acids.
• 2:04
  Dr. Komal Patil-Sisodia: Amino acids are the building blocks of protein.
• 2:06
  Dr. Komal Patil-Sisodia: String a few of them together and you get a peptide.
• 2:09
  Dr. Komal Patil-Sisodia: String a lot of them together and you get a protein.
• 2:13
  Dr. Komal Patil-Sisodia: Your body makes peptides constantly.
• 2:15
  Dr. Komal Patil-Sisodia: Insulin is a peptide.
• 2:16
  Dr. Komal Patil-Sisodia: Many of your hormones are peptides.
• 2:19
  Dr. Komal Patil-Sisodia: So when someone says a product, quote,"contains peptides", that's not automatically meaningful.
• 2:25
  Dr. Komal Patil-Sisodia: It's like saying a product contains molecules.
• 2:28
  Dr. Komal Patil-Sisodia: The real question isn't whether something is a peptide, it's which peptide, how has it been tested, and what has it been proven to do?
• 2:36
  Dr. Komal Patil-Sisodia: Keep that in mind for the rest of the episode.
• 2:39
  Dr. Komal Patil-Sisodia: Let's talk about the peptides I reach for as an endocrinologist.
• 2:42
  Dr. Komal Patil-Sisodia: I'll group them by what they treat, because that's how I think about them in my clinic.
• 2:47
  Dr. Komal Patil-Sisodia: Before I get into my list, I want to explain how a medication actually earns FDA approval.
• 2:52
  Dr. Komal Patil-Sisodia: This is the exact standard I'm holding every peptide to in this episode, including the ones that are flooding your feed.
• 2:59
  Dr. Komal Patil-Sisodia: Research usually starts in a lab with cells and animals.
• 3:02
  Dr. Komal Patil-Sisodia: Researchers test whether a compound does what they think it does and whether it looks safe enough to try in people.
• 3:09
  Dr. Komal Patil-Sisodia: This is called the preclinical research.
• 3:11
  Dr. Komal Patil-Sisodia: It's a real and necessary step, but it doesn't mean a treatment works in humans yet.
• 3:16
  Dr. Komal Patil-Sisodia: If preclinical results look promising, a compound can move into phase one trials.
• 3:23
  Dr. Komal Patil-Sisodia: Phase one is small, usually a few dozen healthy volunteers.
• 3:26
  Dr. Komal Patil-Sisodia: The goal isn't to prove the treatment works.
• 3:28
  Dr. Komal Patil-Sisodia: The goal is to find out if it's safe, what dose humans can tolerate, and how the body processes it.
• 3:35
  Dr. Komal Patil-Sisodia: If phase one goes well, the compound moves to phase two.
• 3:39
  Dr. Komal Patil-Sisodia: This is where researchers start testing whether it actually works for the condition it's meant to treat, usually in a few hundred patients, while also fine-tuning the dose.
• 3:49
  Dr. Komal Patil-Sisodia: Phase three is the big one.
• 3:51
  Dr. Komal Patil-Sisodia: It involves hundreds to thousands of patients, often at multiple research centers, and it compares the new treatment against placebo or against the current standard treatment.
• 4:03
  Dr. Komal Patil-Sisodia: This is where we find out if a treatment actually outperforms what we already have and where rarer side effects tend to show up because you finally have enough people to catch them.
• 4:13
  Dr. Komal Patil-Sisodia: If phase three succeeds, the company submits everything to the FDA for review.
• 4:19
  Dr. Komal Patil-Sisodia: Reviewers go through all of it, safety data, effectiveness data, manufacturing data, before deciding whether to approve it.
• 4:27
  Dr. Komal Patil-Sisodia: That entire process usually takes years, sometimes over a decade, and most compounds that enter it don't make it all the way through.
• 4:36
  Dr. Komal Patil-Sisodia: That's not a system that's broken or slow for no reason.
• 4:39
  Dr. Komal Patil-Sisodia: It's a system built to catch problems before they reach you.
• 4:42
  Dr. Komal Patil-Sisodia: So when I say there's no published human data for a lot of trending wellness peptides, this is specifically what I mean.
• 4:49
  Dr. Komal Patil-Sisodia: Most of them are sitting at that preclinical stage or maybe just entering phase one if they've entered human testing at all.
• 4:57
  Dr. Komal Patil-Sisodia: They haven't been shown to work in people.
• 5:00
  Dr. Komal Patil-Sisodia: They haven't been shown to be safe at scale.
• 5:03
  Dr. Komal Patil-Sisodia: They're not close to that finish line, whatever the marketing might employ.
• 5:06
  Dr. Komal Patil-Sisodia: That's it.
• 5:07
  Dr. Komal Patil-Sisodia: Now you've got a mental map for evaluating pretty much any treatment claim you'll see for the rest of your life.
• 5:13
  Dr. Komal Patil-Sisodia: Now let's talk about what I actually prescribe First, for diabetes and metabolic health.
• 5:19
  Dr. Komal Patil-Sisodia: This is probably the biggest bucket of peptides.
• 5:21
  Dr. Komal Patil-Sisodia: Insulin itself is a peptide, and I prescribe it in several different forms every day.
• 5:26
  Dr. Komal Patil-Sisodia: There's lispro, aspart, glargine, detemir, degludec, and glulisine.
• 5:31
  Dr. Komal Patil-Sisodia: These are insulin analogs, meaning scientists adjusted the insulin molecule slightly to change how fast it works or how long it lasts.
• 5:39
  Dr. Komal Patil-Sisodia: Then there's the GLP-1 receptor agonist family, which you've heard a lot about: exenatide, liraglutide, lixisenatide, dulaglutide, semaglutide, which you may know as Ozempic or Wegovy, and there's also tirzepatide, which activates both GIP, which is gastrointestinal peptide, and GLP-1, glucagon-like peptide one receptors that you may know as Mounjaro or Zepbound.
• 6:07
  Dr. Komal Patil-Sisodia: I also use glucagon, which raises blood sugar in an emergency, and pramlintide, an amylin analog that works alongside insulin for some patients with diabetes.
• 6:19
  Dr. Komal Patil-Sisodia: For osteoporosis, I use teriparatide and abaloparatide, both of which are forms of parathyroid hormone that actually build new bone rather than just slowing down bone loss.
• 6:31
  Dr. Komal Patil-Sisodia: For patients who have hypoparathyroidism, which is a rare condition where the parathyroid glands don't make enough hormone, or if they've been damaged in a surgery or surgically removed, that helps increase For patients with hypoparathyroidism, which is a rare condition where the parathyroid glands don't make enough hormone, there's a newer option called palopeptateraparotide.
• 6:57
  Dr. Komal Patil-Sisodia: These three peptides help stimulate the same action as parathyroid hormone and help regulate your calcium balance in your body.
• 7:04
  Dr. Komal Patil-Sisodia: And calcitonin is another peptide I use both for osteoporosis and occasionally if somebody comes in with a super high calcium level and we're trying to give them treatment options to bring that down I also use peptides for reproductive and pituitary conditions.
• 7:20
  Dr. Komal Patil-Sisodia: This is a category people don't usually associate with peptides, but it's a big part of my work.
• 7:25
  Dr. Komal Patil-Sisodia: GnRH agonists, GnRH stands for gonadotropin-releasing hormone agonists like leuprolide, goserelin, triptorelin, histrelin, and nafarelin are used for conditions like endometriosis, fibroids, precocious puberty, and prostate cancer.
• 7:42
  Dr. Komal Patil-Sisodia: In patients who have pituitary tumors and certain hormone-secreting tumors somewhere else in the body, there are medications called somatostatin analogs like octreotide, lanreotide, and pasireotide, which can be used to help treat these tumors.
• 7:58
  Dr. Komal Patil-Sisodia: I'll also mention vasopressin and desmopressin, which are used for water and salt balance in a condition called diabetes insipidus.
• 8:06
  Dr. Komal Patil-Sisodia: I use cosyntropin, which is a synthetic form of ACTH, to test how well the adrenal glands are working, and setmelanotide for a rare form of genetic obesity, and bremelanotide, which is FDA approved for hypoactive sexual desire disorder.
• 8:24
  Dr. Komal Patil-Sisodia: That's a really long list, I know, but notice what all of these have in common.
• 8:29
  Dr. Komal Patil-Sisodia: Every one went through clinical trials.
• 8:31
  Dr. Komal Patil-Sisodia: Every one has a specific and defined use.
• 8:36
  Dr. Komal Patil-Sisodia: And for every single one, I can tell you what evidence supports it, at what dose, and for whom.
• 8:42
  Dr. Komal Patil-Sisodia: Now, let's talk about the peptides you're probably hearing about on social media because it's a very different list.
• 8:48
  Dr. Komal Patil-Sisodia: We talked about them in the last podcast episode, so you may be hearing names like BPC1-157, TB-500, GHK-CU, and they show up constantly along with claims about faster injury healing, anti-aging, better sleep, fat loss.
• 9:07
  Dr. Komal Patil-Sisodia: I wanna be careful here, though.
• 9:08
  Dr. Komal Patil-Sisodia: I'm not going to give you dosing information or tell you where to get these, one, because I don't actually know.
• 9:14
  Dr. Komal Patil-Sisodia: That's not what this episode is for.
• 9:16
  Dr. Komal Patil-Sisodia: And for most, there isn't a dose that I could responsibly give you because the human evidence just isn't there yet.
• 9:22
  Dr. Komal Patil-Sisodia: And here's what I mean.
• 9:24
  Dr. Komal Patil-Sisodia: Some of these compounds have real and interesting data in mice, rats, Petri dishes.
• 9:29
  Dr. Komal Patil-Sisodia: That's how a lot of good drugs start out.
• 9:32
  Dr. Komal Patil-Sisodia: But there's a long road between this helped a rat's tendon heal, and this is safe and effective for you The road that runs through human clinical trials Before we can actually say whether something is safe or effective for you, we have to see human clinical trials with control groups, safety monitoring, and FDA review.
• 9:53
  Dr. Komal Patil-Sisodia: Most trending wellness peptides haven't made that trip.
• 9:56
  Dr. Komal Patil-Sisodia: Some may never make it because what works in a lab animal doesn't always translate to humans.
• 10:01
  Dr. Komal Patil-Sisodia: There's also a practical problem with how many of these products are sold.
• 10:05
  Dr. Komal Patil-Sisodia: Many are marketed as research chemicals, which is a legal way of saying they aren't approved for use in people at all.
• 10:12
  Dr. Komal Patil-Sisodia: That label means there's no guarantee of purity, no standard for what's actually in the vial, and no oversight of manufacturing.
• 10:19
  Dr. Komal Patil-Sisodia: You genuinely don't always know what you're injecting.
• 10:23
  Dr. Komal Patil-Sisodia: None of this means every unapproved peptide is dangerous, and it doesn't mean the researchers studying these compounds are wasting their time.
• 10:30
  Dr. Komal Patil-Sisodia: Early-stage science is how we get tomorrow's real medications, but early stage is exactly what it is.
• 10:36
  Dr. Komal Patil-Sisodia: Early.
• 10:37
  Dr. Komal Patil-Sisodia: Promising is not the same thing as a medication that's been proven to work.
• 10:43
  Dr. Komal Patil-Sisodia: Before I move into how you can apply all of this to yourself, I want to be honest with you about something that happened last week.
• 10:49
  Dr. Komal Patil-Sisodia: I posted about the FDA advisory committee vote on whether certain peptides should be allowed to be made through compounding pharmacies.
• 10:58
  Dr. Komal Patil-Sisodia: It was a quick, short post making a quick comment that most of the data on these peptides was done in mice.
• 11:05
  Dr. Komal Patil-Sisodia: I expected some discussion.
• 11:07
  Dr. Komal Patil-Sisodia: What I got was an extremely polarizing response.
• 11:11
  Dr. Komal Patil-Sisodia: A lot of people pushed back hard.
• 11:13
  Dr. Komal Patil-Sisodia: Several comments said that I was spreading misinformation and that human studies already exist for most of the gray market peptides I was talking about.
• 11:21
  Dr. Komal Patil-Sisodia: One woman told me she had personally seen human data, and when I asked her to send me the actual citations, her response was to tell me to do my own research because Google is free I want to be clear about something.
• 11:33
  Dr. Komal Patil-Sisodia: I did do the research.
• 11:34
  Dr. Komal Patil-Sisodia: That's my job.
• 11:35
  Dr. Komal Patil-Sisodia: I take it seriously.
• 11:37
  Dr. Komal Patil-Sisodia: As of today, there are no published peer-reviewed randomized controlled trials in humans for most of the peptides in the gray market category.
• 11:46
  Dr. Komal Patil-Sisodia: Not hard to find, not buried in page three of a search engine, not published.
• 11:51
  Dr. Komal Patil-Sisodia: If that changes, I genuinely want to see it.
• 11:54
  Dr. Komal Patil-Sisodia: Send it to me directly.
• 11:55
  Dr. Komal Patil-Sisodia: I will update my position the moment the evidence changes, because that's how good medicine is supposed to work.
• 12:02
  Dr. Komal Patil-Sisodia: Some of the comments went further than disagreement.
• 12:05
  Dr. Komal Patil-Sisodia: There were comments that were frankly just hateful, and I won't pretend that that didn't sting a little bit.
• 12:10
  Dr. Komal Patil-Sisodia: I'm, I'm a person, not just a credential.
• 12:13
  Dr. Komal Patil-Sisodia: But what I also want to say is this: a lot of you showed up in that comment section too.
• 12:17
  Dr. Komal Patil-Sisodia: A lot of people agreed that we need real published human data before we call a gray market peptide safe or effective, and that response meant a lot to me.
• 12:26
  Dr. Komal Patil-Sisodia: It's a big part of why I want to put this episode together properly with an actual list and actual reasoning instead of just posting another quick take.
• 12:34
  Dr. Komal Patil-Sisodia: Disagreement is totally fine.
• 12:36
  Dr. Komal Patil-Sisodia: I welcome it, honestly, because that's how ideas get tested and how I stay sharp as a physician.
• 12:42
  Dr. Komal Patil-Sisodia: "Cite your source" is not an unreasonable thing for a doctor to ask.
• 12:45
  Dr. Komal Patil-Sisodia: "Go Google it yourself" is not a source.
• 12:48
  Dr. Komal Patil-Sisodia: If you want to change my mind on something, bring me the paper.
• 12:51
  Dr. Komal Patil-Sisodia: I will read it every time So how do you tell the difference between real evidence and a good marketing story?
• 12:58
  Dr. Komal Patil-Sisodia: I use one question, what high-quality human evidence supports this?
• 13:03
  Dr. Komal Patil-Sisodia: Not animal data, not testimonials, not my trainer swears by it, not I am the human trial.
• 13:10
  Dr. Komal Patil-Sisodia: Human evidence, meaning real clinical trials in real people published somewhere other than a company's own website.
• 13:17
  Dr. Komal Patil-Sisodia: If the answer is there isn't any yet, that doesn't necessarily mean the product is a scam.
• 13:23
  Dr. Komal Patil-Sisodia: It means you're being asked to be the early unpaid experiment.
• 13:28
  Dr. Komal Patil-Sisodia: That might be a risk you're willing to take with your own body, but it should be an informed choice, not an accidental one.
• 13:34
  Dr. Komal Patil-Sisodia: And if a peptide does have that human evidence, then the conversation should be with your doctor about whether it's the right fit for your specific health situation, not a decision made from a sponsored post.
• 13:46
  Dr. Komal Patil-Sisodia: Peptides aren't inherently good or bad.
• 13:49
  Dr. Komal Patil-Sisodia: The word itself just describes the type of molecule.
• 13:52
  Dr. Komal Patil-Sisodia: What matters is the evidence behind the specific ones you're considering, the dose, the source, and whether it's actually treating the condition you have.
• 14:00
  Dr. Komal Patil-Sisodia: As an endocrinologist, my job is to prescribe what's been proven to work and to be honest with my patients about what hasn't been proven yet.
• 14:08
  Dr. Komal Patil-Sisodia: That's what evidence-based medicine actually means, not no to everything new, but show me the data.
• 14:13
  Dr. Komal Patil-Sisodia: Before you spend your money or put something in your body, ask the question, what human evidence supports this?
• 14:21
  Dr. Komal Patil-Sisodia: Evidence over hype every single time.
• 14:25
  Dr. Komal Patil-Sisodia: Thanks for spending this time with me.
• 14:28
  Dr. Komal Patil-Sisodia: If today's episode gave you even one thing to bring to your next appointment or just helped something click, that's exactly why I'm here.
• 14:34
  Dr. Komal Patil-Sisodia: Find me at eastsidemm.com or follow along on Instagram or TikTok at drpatilsisodia.
• 14:41
  Dr. Komal Patil-Sisodia: And if you found this helpful, share it with someone who needs it.
• 14:44
  Dr. Komal Patil-Sisodia: I'll see you on the next episode