Emerging Therapies

Peptides are short chains of amino acids, the building blocks of proteins. Your body makes many of them naturally to send signals between cells. Several synthetic peptides are now marketed for recovery because early research suggested they might influence blood vessel growth, inflammation, or tissue repair.

What Is BPC-157?

BPC-157 is a synthetic peptide based on a protein fragment found in stomach juice. It is the most heavily promoted recovery peptide. In animal and laboratory studies, it has been reported to support tendon, ligament, and muscle healing. In humans, the evidence is limited to very small case series and pilot safety studies. No well-designed clinical trial has shown that BPC-157 speeds healing of a tendon, ligament, or surgical repair in people.

What About TB-500?

TB-500 is a synthetic fragment of thymosin beta-4, a natural protein involved in cell movement and tissue repair. As with BPC-157, most of the supporting data come from animal and laboratory work, and products sold online are not necessarily the same molecules studied in research.

What About the Other Peptides I See Advertised?

You may also see CJC-1295, ipamorelin, GHRP-2, GHRP-6, MOTS-c, KPV, or GHK-Cu. These act through different pathways, including growth hormone signaling, metabolism, and inflammation, and they should not be lumped together as if they share one safety profile. For several, the FDA has noted limited human safety data or concerns about immune reactions, impurities, and metabolic side effects. None has enough evidence for me to recommend it for orthopedic healing.

Didn’t the FDA Just Approve These?

No. In July 2026, an FDA advisory committee narrowly voted to recommend that compounding pharmacies be allowed to prepare BPC-157, TB-500, and KPV (8–6) and MOTS-c (7–5) with a prescription. That recommendation is not binding and is not FDA approval, and formal rulemaking must still follow. During the meeting, FDA scientists raised concerns that it is not always clear, chemically, what these products contain, and the agency stated that there was not enough evidence to judge their safety and effectiveness. Access may expand, but the evidence for orthopedic healing has not changed.

Can I Use Them If I Compete?

BPC-157 and TB-500 are prohibited by the World Anti-Doping Agency. If you compete in a tested sport at the high school, collegiate, professional, or Olympic level, using them can lead to a positive test and suspension regardless of where the product came from.

Is It Safe to Buy Peptides Online or From a Wellness Clinic?

Even when a peptide has interesting early research behind it, a product bought online or from a clinic raises more questions:

• Is the active ingredient what the label says?
• Is the dose accurate?
• Was it made under proper quality controls?
• Is it sterile if you inject it?
• Does it contain breakdown products or contaminants?

Peptides are complex molecules, and product quality directly affects safety. Being sold through a clinic or compounding pharmacy does not mean a product is FDA-approved, effective for your injury, or safe over the long term.

Testosterone is an established prescription hormone that affects muscle, bone, red blood cell production, and more. Testosterone replacement therapy (TRT) can be appropriate for patients with confirmed low testosterone (hypogonadism) when managed by an experienced clinician. It is not an established treatment for healing tendons, ligaments, cartilage, or surgical repairs in people whose hormone levels are normal.

There is not enough evidence to recommend testosterone solely to speed orthopedic healing, and it may carry risk around surgery. A 2025 study in the Journal of Shoulder and Elbow Surgery found that patients using TRT before shoulder replacement had higher rates of joint infection, kidney injury, and emergency department visits afterward.

Isn’t TRT the Same as What Athletes Use to Get Bigger?

No. Medically supervised replacement treats a diagnosed condition. High-dose testosterone or anabolic steroid use for performance carries significant risks to the heart, blood, liver, fertility, and mood. Testosterone is also a controlled substance that requires monitoring of blood pressure, red blood cell counts, clotting risk, prostate health, fertility, and sleep apnea.

I Already Take Testosterone. What Should I Do Before Surgery?

Tell me and your anesthesia team. Do not stop, increase, or change your dose on your own to try to heal faster. I coordinate a plan with your prescribing clinician when needed.

GLP-1 medications such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are now among the most commonly prescribed drugs in the country. The orthopedic research on them is growing quickly, and it shows both benefits and trade-offs.

How Can GLP-1s Help?

• Knee arthritis. In the STEP 9 randomized trial in the New England Journal of Medicine, patients with obesity and knee arthritis who took semaglutide had substantially greater improvement in knee pain and function than those on placebo.
• Large studies presented at the 2026 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting linked GLP-1 use to fewer emergency visits after surgery and lower infection rates after hip and knee replacement. A 2026 study of Achilles tendon repair found fewer wound infections in GLP-1 users.
• Rotator cuff repair. Recent studies have not found a higher reoperation rate in GLP-1 users, and some report fewer retears, particularly in patients with obesity or diabetes.

What Should I Watch For?

• Tendon ruptures. A 2026 AAOS study found that patients with obesity on GLP-1s had a higher five-year risk of rotator cuff, Achilles, and pectoralis tendon ruptures than matched patients. The absolute increase was small (about 9 additional rotator cuff ruptures per 1,000 users) and shows an association, not proof of cause.
• Bone health. Another 2026 AAOS study of more than 70,000 matched patients found higher five-year rates of osteoporosis, gout, and osteomalacia (bone softening) in GLP-1 users.
• Muscle loss. Rapid weight loss includes lean muscle, not just fat. For active patients and anyone recovering from surgery, losing muscle can slow rehabilitation and affect joint stability.

Should I Stop My GLP-1 Before Treatment?

For most patients, the benefits of treating obesity and diabetes are significant, and I do not ask patients to stop a GLP-1 because of orthopedic concerns alone. Instead, I build my plan around it: enough protein, progressive resistance training to protect muscle and tendon, bone health screening when appropriate, and coordination with your prescribing clinician and anesthesia team before surgery. Guidance on pausing these drugs before anesthesia is individualized, so always tell your surgical team you take one.

Female athletes tear their ACL at higher rates than male athletes in the same sports, and researchers have long asked whether hormones play a role. As a former collegiate soccer player, this question is personal to me as well as professional.

What Does the Newest Research Show?

• After ACL reconstruction. A 2026 study in Sports Health analyzed more than 26,000 female patients who had ACL reconstruction. Those taking oral contraceptives at the time of surgery had a 25% lower risk of needing another ACL reconstruction on the same knee within five years, with the biggest difference in the first year. They also had a 73% lower risk of surgery for knee stiffness in the first year, with no significant increase in blood clots.
• Graft healing. Other 2026 studies linked oral contraceptive use with better ACL graft maturation on MRI and less knee instability two years after surgery.
• Preventing a first tear. This is less clear. A large 2025 study found fewer ACL reconstructions among women using hormonal contraception, but a 2026 meta-analysis of more than 18 million people in the American Journal of Sports Medicine concluded that oral contraceptives do not meaningfully reduce the risk of a first ACL tear.

Should I Start Birth Control to Protect My ACL?

Not for that reason alone. These studies show associations, not proof of cause, and oral contraceptives carry their own risks. If you are already considering hormonal contraception, this research is a reasonable part of the conversation with your gynecologist or primary care clinician. The best-proven ways to lower ACL injury risk remain neuromuscular training, good strength and landing mechanics, and a criteria-based return to sport after surgery.

Why Do You Ask About My Periods?

Missed or irregular periods can be a sign of low energy availability (relative energy deficiency in sport, or RED-S), which is linked to low bone density and stress fractures. I ask every female athlete I see.

Bone health is not only a concern after a hip fracture. It affects how well a rotator cuff repair holds, how securely anchors and implants fix to bone, how you recover after a shoulder or knee replacement, and why some athletes develop stress fractures. It matters even more if you take a GLP-1, use long-term steroids, or have low energy availability.

What Medications Treat Low Bone Density?

• Antiresorptive medications slow bone breakdown. These include bisphosphonates (alendronate, risedronate, zoledronic acid) and denosumab (Prolia). Denosumab should never be stopped abruptly without a transition plan, because stopping it can cause rapid bone loss and spine fractures.
• Anabolic (bone-building) medications stimulate new bone. These include teriparatide (Forteo), abaloparatide (Tymlos), and romosozumab (Evenity). For patients at very high fracture risk, current practice increasingly favors starting with one of these.
• The foundations for everyone are adequate calcium, vitamin D, protein, weight-bearing and resistance exercise, and fall prevention.

Can These Medications Help My Surgery Heal?

A 2025 meta-analysis found that patients who received osteoporosis medications around the time of rotator cuff repair had lower retear rates and some gains in shoulder function, although the number of studies was small. Anabolic medications also have supportive data for fracture healing. Finding low bone density before surgery lets me plan fixation, timing, and rehabilitation accordingly.

I Broke a Bone From a Simple Fall. Does That Matter?

Yes. A first fragility fracture is one of the strongest predictors of another, yet most patients are never evaluated or treated for osteoporosis afterward. Orthopedic surgeons are often the first physicians to see these patients, which puts us in the best position to close that gap.

Too often, care is fragmented: one clinician prescribes a weight-loss drug, another manages hormones, an online clinic sells peptides, and the surgeon learns about all of it the morning of surgery. My goal is to bring those pieces together.

• Bone health, managed in my practice. I evaluate bone health with DEXA scans and lab testing and work closely with my endocrinology and primary care colleagues to start and manage osteoporosis medication when appropriate. I want to help you protect your bones, so I am not seeing you with another broken bone years after surgery.
• Every medication reviewed. I review GLP-1s, testosterone, hormonal contraception, supplements, and any peptides you use, and I coordinate with your prescribing clinicians and anesthesia team so there are no surprises.
• Care built for female athletes. I bring my experience as a collegiate athlete who returned to play after injury, along with attention to menstrual health, bone density, and the latest research on hormones and ACL injury.
• Evidence first. Trained at the two best orthopedic hospitals in the nation, NYU Langone Health and Hospital for Special Surgery, I bring New York sports medicine care to South Florida. I will tell you plainly what has been proven, what is promising, and what is still marketing.

• What exactly is the active ingredient, and who makes it?
• Is it FDA-approved, compounded, or investigational?
• Is it approved for my specific condition?
• What human studies show benefit for my injury or surgery, and how large was the benefit?
• What are the known short- and long-term risks?
• How are purity, sterility, and dose verified?
• Could it affect my fertility, heart, blood counts, blood sugar, bones, or other medications?
• Is it prohibited in my sport?

Peptides, hormones, and newer metabolic medications are an exciting area of research, and some may eventually become valuable treatments. Today, BPC-157, TB-500, and similar peptides remain investigational for orthopedic healing. Testosterone should be used for a true medical indication, not as a recovery drug. GLP-1 medications offer real benefits but call for a plan to protect muscle, tendon, and bone. And bone health deserves attention in every patient, not just after a fracture.

I remain open to innovation while separating early science from proven treatment. When stronger human evidence becomes available, my recommendations, and this page, will evolve with it.

Peptides and regulation

1. Certain Bulk Drug Substances for Use in Compounding That May Present Significant Safety Risks. FDA — Includes BPC-157, TB-500–related products, ipamorelin, and other peptides.
2. July 23–24, 2026: Meeting of the Pharmacy Compounding Advisory Committee. FDA — FDA review materials for BPC-157, TB-500, KPV, and MOTS-c.
3. FDA Panel Votes to Loosen Restrictions for Four Peptides. Pharmaceutical Executive. 2026. Link — Summary of the committee votes and FDA staff concerns.

Testosterone

4. Testosterone Information. FDA — Approved uses and labeling.
5. Testosterone Cypionate Prescribing Information. DailyMed. DailyMed — Indications, contraindications, and warnings.
6. Preoperative Testosterone Replacement Therapy Is Associated With Increased Rates of Periprosthetic Joint Infection, Acute Kidney Injury, and Emergency Department Utilization After Total Shoulder Arthroplasty. J Shoulder Elbow Surg. 2025. PubMed

GLP-1 medications

7. Bliddal H, et al. Once-Weekly Semaglutide in Persons With Obesity and Knee Osteoarthritis (STEP 9). N Engl J Med. 2024. PubMed — Randomized trial of semaglutide for knee arthritis pain and function.
8. AAOS 2026 Annual Meeting. Studies Explore GLP-1 Receptor Agonist Use and Its Impact on Long-term Musculoskeletal Health and Orthopaedic Surgical Outcomes. AAOS — Postoperative outcomes and long-term osteoporosis, gout, and osteomalacia risk.
9. Lawand J, et al. GLP-1 receptor agonist use and tendon rupture risk in patients with obesity. AAOS 2026 Annual Meeting. UTMB — Rotator cuff, Achilles, and pectoralis rupture risk.
10. Rai, et al. Association of GLP-1 Receptor Agonists With Post-operative Outcomes After Achilles Tendon Repair in Obese Patients. J Foot Ankle Surg. 2026. PubMed
11. Omurzakov, et al. Glucagon-Like Peptide-1 Receptor Agonist Use in Obese Patients Is Associated With Decreased Risk of Revision and Retears After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2026. PubMed
12. Glucagon-like Peptide-1 Receptor Agonist Use Is Not Associated With Increased Reoperation Risk Following Rotator Cuff Repair. J Orthop. 2025. PubMed
13. GLP-1 Receptor Agonist Therapy and 2-Year Structural Outcomes After Arthroscopic Rotator Cuff Repair in Type 2 Diabetes. BMC Musculoskelet Disord. 2026. PubMed

Oral contraceptives and ACL injury

14. Garlapati S, Agarwal R, Bishop M. Oral Contraceptive Use at the Time of ACL Reconstruction Decreases Risk of Revision Surgery. Sports Health. 2026. PubMed
15. Masferrer-Pino A, et al. Oral Contraceptive Use and Improved Graft Maturation After Anterior Cruciate Ligament Reconstruction in Female Patients: An MRI-Based Study. Am J Sports Med. 2026. PubMed
16. Mahatme RJ, et al. Oral Contraceptive Use Associated With Lower Rates of Knee Instability After ACL Reconstruction. Cureus. 2026. PMC
17. Fry SA, et al. Use of Hormonal Contraceptives Is Associated With Decreased Incidence of Anterior Cruciate Ligament Injuries Requiring Reconstruction in Female Patients. Arthroscopy. 2025. PubMed
18. Paska J, et al. Has the Protective Effect of Hormonal Contraception Been Overestimated? A Systematic Review and Meta-analysis of Oral Contraceptive Pills and ACL Injury. Am J Sports Med. 2026. PubMed

Osteoporosis medications and bone health

19. Hao, et al. The Effect of Applying Anti-Osteoporosis Drugs on the Rehabilitation of Patients With Rotator Cuff Tears After Arthroscopic Rotator Cuff Repair: A Meta-analysis. J Orthop Surg Res. 2025. Link
20. Closing the Osteoporosis Care Gap: System-Level Fracture Liaison Service Implementation and a Patient Education Intervention in an Open Health System. PMC — The post-fracture treatment gap and how to close it.