Peptides 101: Why gay men are turning to black-market injectables to build muscle

What are peptides?

Injectable peptides, which users are using largely for muscle growth, are a group of amino acid-based drugs that act as signaling molecules inside the body, as opposed to being a direct-acting drug.

“You can think of them like keys designed to fit specific locks,” says Dr. James Chao, a board-certified plastic surgeon and cofounder of VedaNu Wellness. “Your body produces thousands of them naturally. Synthetic peptides mimic that process.”

There are legal prescription peptides like insulin and GLP-1 drugs (the “P” stands for “peptide”), but people seeking physical enhancements have turned to off-label use of more than a dozen kinds of synthetic peptides that are being sold on sketchy websites, on the black market, and in gyms and beauty salons across the country. These peptides aren’t FDA-approved, which means that both their efficacy and safety are questionable. And because they are marketed as being a wellness product and great for "bio hacking," people think they are safer than steroids.

“I know it looks attractive,” Dr. Stephen Cosentino, the founder and CEO of Empire Medical Training, tells Out. “However, sometimes the advertising precedes the research too much. Yes, some peptides may affect growth hormone secretion and/or recovery mechanisms, however, it doesn't mean that you should inject or buy peptides on any website.”

Why are peptides being used for bodybuilding?

More people are turning to peptides every day to stave off aging and gain lean muscle. Peptides that are used for bodybuilding fall into two camps: growth hormone secretagogues (like ipamorelin, CJC-1295, and sermorelin) that signal the body to release more growth hormone and others that accelerate recovery and tissue healing (like BPC-157 and TB-500). Both types are being heralded as miracle drugs by users who swear by the ability of peptides to see faster results in the gym.

“The appeal to peptides is that they are being marketed with the promise of more lean muscle retention, faster recovery from exercise and loss of fat while having what they believe is softer side-effect profiles than something like anabolic steroids,” says Dr. Frank Agullo, a double board-certified plastic surgeon and a clinical associate professor of plastic surgery at Texas Tech University who regularly counsels LGBTQ+ patients about peptides, GLP-1s, and other body-optimization tools.

Chao agrees and says that while “peptides can increase natural growth hormone production in the body, which can help with muscular repair from intense workouts,” he recommends not buying into the inflated claims because “the peptide hype is far outpacing any real-world results at this point.”

Peptides are also being touted as the answer to aging because they help your body create more collagen and elastin — Jennifer Aniston credits peptides for her youthful glow — and the Mayo Clinic reports that the synthetic peptide bremelanotide has been FDA-approved to help premenopausal women who suffer from hypoactive sexual desire disorder.

Why are gay men using peptides?

Toxic gym culture, the pressure to look hot at a circuit party, and the casual fatphobia on hookup apps mean that gay men are under immense pressure to not only look good, but be incredibly fit. This obsession with being lean and muscular means that “the proportion of gay and bisexual men with symptoms related to disordered eating was 10 times higher than among heterosexual men,” a study by the National Library of Medicine found.

“The point is that peptides become trendy among people who care about their body composition, recovery process, appearance, and sexuality. This involves gay men in particular, who live in communities where there is much pressure concerning their appearance and youth,” Cosentino says. “Of course, there is a cultural aspect in this situation. If people feel much social pressure because of their appearance, they will seek any way to receive what they want. This is one of the reasons why this topic should be discussed without judging.”

Chris Bustamante, an aesthetic nurse practitioner and owner of Lushful Aesthetics, tells Out that gay men have to contend with living in a world where they are expected to participate in “a very visual dating and social culture,” which acts like a pressure cooker that leads them to ignore the risks of performance-enhancing peptides.

“There can be strong pressure to be lean, muscular, youthful, and sexually desirable,” he says. “That does not mean every gay man feels this way, and it does not mean these pressures are unique to gay men. Straight men are absolutely affected by gym culture and social media too. But in gay male spaces, the body can sometimes become a major form of status, desirability, and belonging.”

Peptides live at the intersection between “fitness, appearance, anti-aging, sexual confidence, and wellness,” and these are all areas “that can be especially charged for gay and queer men,” he says.

Are peptides safe?

Most people know that anabolic steroids give fast results at a high cost to their health, but peptides have drawbacks too. There are generally fewer side effects with peptides, but because they’re not Food and Drug Administration-approved, they are still high-risk. FDA-approved peptides like GLP-1s are manufactured by companies with medical oversight, but Chao says you “are literally rolling the dice when you inject black-market peptides."

The regulatory status of 19 peptides was changed by the Biden era-FDA, which effectively banned compounding pharmacies from producing them because of safety concerns. So now there is little to no oversight for how they are made and what you’ll get if you buy them.

“Undeterred, peptide users simply went underground, where they found groups of fellow travelers on Discord or Telegram, or they formed groups of their own to track down the drugs they wanted,” Bloomberg reports. “To get them, these groups began to go straight to the source, ordering active ingredients in bulk from Chinese pharmaceutical manufacturers through WeChat, WhatsApp, or other apps, and paying in cryptocurrency.”

Chao says that there is much less risk if you get these drugs from a qualified medical professional who orders regular lab work and uses a qualified compounding pharmacy, but he warns that safe “is a loaded word” because peptides can “wreak havoc on your hormones.”

“Medicinal peptides that are FDA-approved for specific conditions and used under the supervision of a doctor at therapeutic dosages have established safety profiles,” he says. “We lack that information for many of the peptides being sold online to people who are hoping to boost workouts.”

The risk with getting peptides on the black market or from unregulated sources is that they can’t guarantee that the peptides are sterile, that you’re getting the correct dose, or that you’re getting the medications they say you are, Agullo says.

“It is difficult to assess the safety of peptides being sold in gyms, beauty salons, or by non-medical professionals,” he says. “A peptide dispensed via pharmacy has to adhere to medical and manufacturing standards. A vial of peptides sold on the internet has no oversight, maybe mislabelled or contaminated, and may not be intended for human use.”

What are the side effects?

The peptides most people are taking to get better results in the gym haven’t been studied enough to know what the long-term effects will be on the body. So even if you get a pure form of the medication, you’re still at risk of experiencing side effects. According to Agullo, symptoms including “water retention, tingling and numbness of extremities, changes to blood sugar and insulin sensitivity, joint discomfort, and increased appetite” have been reported.

Bustamante says that while peptides are relatively safe if you are being overseen by “a qualified medical provider who can review labs, medical history, contraindications, and sourcing,” because they affect your hormones, there can be unwanted side effects.

“Peptides that affect growth hormone or insulin-like growth factor pathways may affect blood sugar, fluid retention, blood pressure, sleep apnea, carpal tunnel symptoms, and potentially stimulate unwanted tissue growth in certain contexts,” he warns. “Other peptides may affect appetite, mood, hormones, inflammation, or immune function. We also do not always have good long-term safety data, especially when people are stacking multiple products.”

And if you are injecting peptides into your body, there is also a risk of “infection, abscesses, or systemic illness,” Bustamante says. The bottom line? Stay away from black-market peptides, and don’t fool yourself into thinking that “research use only” peptides are safe.

"Peptides are not magic, and peptides are not as safe as people think," Cosentino says. "They can be used in medicine, but when used casually for muscle building, peptides become dangerous."

Sources cited:

Dr. James Chao is a board-certified plastic surgeon and cofounder of VedaNu Wellness.

Dr. Frank Agullo is a double board-certified plastic surgeon and a clinical associate professor of plastic surgery at Texas Tech University.

Chris Bustamante is an aesthetic nurse practitioner and the owner and CEO of Lushful Aesthetics.

Dr. Stephen Cosentino is the founder and CEO of Empire Medical Training.