What are peptide injections? | Sports Medicine News

Requests for guidance on emerging biologic therapies are becoming increasingly common in sports medicine practice, particularly as interest in performance optimization expands beyond elite athletes. Recently, a pediatric case prompted inquiry into the use of peptides, including BCP-157, to accelerate recovery from an overuse injury in a 12-year-old athlete. Currently, there is limited expertise within the sports medicine community regarding peptides such as BPC-157, and uncertainty surrounding their clinical application remains widespread.

As of 2026, the wellness industry has expanded rapidly across online marketplaces, driven by growing interest among influencers and athletes in optimizing physical performance and recovery. This trend places healthcare providers in the position of distinguishing evidence-based practices from theoretical or commercially promoted interventions to appropriately counsel patients. Within sports medicine, peptides have emerged at the forefront of this movement and are frequently marketed as compounds capable of accelerating tendon, ligament, muscle, and bone healing to enhance performance and expedite recovery. Despite widespread anecdotal claims—some describing these agents in near-miraculous terms—the extent to which peptides deliver meaningful clinical benefit remains uncertain.1

The Musculoskeletal Journal of Hospital for Special Surgery recently published a review on the current evidence behind ​body protection compound​-157, commonly referred to as ​BPC-157, a particular peptide synthetically designed from protein fragments of human gastric fluid.2 In animal models, ​​BPC-157​​​ has been associated with enhanced angiogenesis, modulation of nitric oxide pathways, improved fibroblast migration, and more organized collagen deposition.3-7 This translated to improved healing in tendon, ligament, muscle, and even nerve injuries in these rodent models. However, there is no high-quality clinical evidence in human subjects supporting BPC-157.2 ​​Further, there​​​ are no large, multicenter trials to evaluate safety, dosage, or long-term use of these compounds in athletes. Data in human subjects are mostly observational and lack randomized controlled trials. BPC-157 is only part of a larger category of peptides currently available to athletes. Other commonly marketed injectable peptides include TB-4, TB-500, CJC-1295 with ipamorelin, tesamorelin, and GHK-Cu.8 To date, all these peptides have followed similar trajectories: promising animal data with no evidence of efficacy in humans, despite extensive advertising and widespread availability of these compounds to athletes. The expansion of online peptide vendors has outpaced peer-reviewed evidence.

It is understandable that these peptides are generating much enthusiasm for athletes given the reported success in animal models. However, the translational gap between rodent studies and meaningful clinical human studies is large. For providers committed to evidence-based practice, the lack of strong clinical relevance of peptides warrants further investigation. The recent ​popularity of peptides​ as well as increased rates of unregulated use in athletes​ supports the need for sports medicine provider education on not only the evidence of individual peptides​ but also the regulatory framework that governs peptide use​​.​​​

Regulations in the pharmaceutical industry are constantly evolving; therefore, organizations like the World Anti-Doping Agency (WADA) help to streamline these regulations across sports. ​As many athletes are subject to anti-doping regulations, ​​​​​​it​​ is crucial to understand​ WADA’s position ​​on​​​ safe and compliant athlete care​. ​WA​DA maintains an updated “Prohibited List” identifying what substances are prohibited in sport and when. ​​WADA ​​prohibits​​​​ ​​r compounds based on meeting two of the three criteria: potential to enhance performance; actual or potential health risk; or violation of the spirit of sport.9 ​When it comes to enforcing these guidelines, WADA adopts a principle of strict liability in which athletes are held responsible for all substances found in their bodies. ​​Misunderstanding regulations or claiming accidental use does not protect an athlete from sanctions. ​​Laboratory testing methods can detect fragments and metabolites of peptides, emphasizing the reality of a risk of a positive test.11 ​

Section S0, Non-Approved Substances, in WADA’s classification system encompasses any compounds without approval by a governmental regulatory health authority for human therapeutic use, which would include all these injectable peptides.9 This classification always prohibits the use of these substances, regardless of whether the athlete is in competition or not. Therefore, even if a physician were to recommend one of these compounds, there is currently no mechanism to permit use in athletes bound by WADA guidelines. These guidelines are intended to ensure no athlete gains an unfair competitive advantage. Examples of peptide compounds within WADA’s regulatory framework are summarized in Tables 1 and 2, which distinguish between non-prohibited peptides and peptide hormones, growth factors, and related substances that are prohibited.

Table 1. Examples of Non-Prohibited Peptide Compounds Under WADA

Nutritional Peptide Supplements	Examples	Typical Uses
Collagen	Hydrolyzed collagen, gelatin peptides	Joint and tendon support
Dietary Protein	Whey peptides, casein peptides	Muscle recovery, protein supplementation
Creatine conjugates	Creatine monohydrate, creatine salts	Strength, power output support

Hormone Peptides and their analogs
GLP-1 receptor agonists	Semaglutide, Liraglutide, Dulaglutide	Type II Diabetes Mellitus, Obesity
Calcitonin	Calcitonin	Osteoporosis
PTH	Teriparatide, Abaloparatide	Osteoporosis
GnRH	Leuprolide, Goserelin	Endometriosis, Precocious Puberty, In Vitro Fertilization
GLP-2	Teduglutide	Short Bowel Syndrome
Insulin*	Aspart, Lispro, Glargine	Diabetes Mellitus
Vasopressin	Desmopressin	Diabetes Insipidus, von Willebrand Disease
Oxytocin	Oxytocin, Carbetocin	Labor induction
Somatostatin	Octreotide, Lanreotide	Acromegaly, Neuroendocrine Tumors

*Note: Insulin requires a therapeutic use exemption for athletes with diabetes mellitus under WADA.

Table 2. Prohibited Peptide Hormones, Growth Factors, Related Substances, and Mimetics Under WADA

Erythropoietins (EPO) and Agents Affecting Erythropoiesis	Examples
EPO Receptor Agonists	Darbepoetins (dEPO), erythropoietins (EPO), EPO-based constructs, EPO-mimetic agents
Hypoxia-Inducible Factor (HIF) Activating Agents	Cobalt, daprodustat, IOX2, molidustat, roxadustat
Transforming Growth Factor Beta Signalling Inhibitors	Luspatercept, sotatercept
Innate Repair Receptor Agonists	Asialo EPO, carbamylated EPO
GATA Inhibitors	K-11706

Peptide Hormones and Their Releasing Factors
Testosterone-Stimulating Peptides	Chorionic gonadotrophin (CG), lutenizing hormone (LH), Gonadrophin-releasing Hormone (GnRH), Kisspeptin
Corticotrophins	Corticorelin, tetracosactide
Growth Hormone	Lonapegsomatrophin, somapacitan, somatrogon, AOD-9604, hGH 176-191
Growth Hormone Releasing Factors	Growth hormone-releasing hormone (GHRH) and it analogues, growth hormone secretagogues (GHS) and their mimetics, GH-releasing peptides

Growth Factors and Growth Factor Modulators
Growth Factors and Modulators	Fibroblast growth factors, hepatocyte growth factor, insulin-like growth factor, mechano growth factors, platelet-derived growth factor, thymosin-B4, vascular endothelial growth factor

Beyond fairness in competition, the lack of regulatory oversight exposes athletes to the risk of potential harm. These injectable peptides are not approved by the United States Food and Drug Administration (FDA), and there is no FDA oversight of their manufacturing for consumer use. This creates variability in purity, dosing, and composition. Athletes can obtain these compounds through websites that sell directly to consumers with products labeled “research chemicals” or “not for human consumption” to maneuver through regulatory gray areas. The difference between labeled use and intended use raises further safety concerns as these substances do not have to undergo quality control or safety monitoring, unlike FDA-approved substances. As a result, the burden of addressing unknown complications can fall on providers.

Most of the risks of these compounds stem from the absence of clinical trials and reliable data in humans, making it impossible to establish appropriate dosing, long-term safety, or adverse event profiles. In addition​​, there are also inherent dangers with unnecessary injections and medications. These potential risks include contamination of the vials, inadequate sterility protocols, pain or irritation at the injection site, allergic reactions, or even possible drug interactions. The consequences of these risks could be severe and maybe even life threatening for some.

Sports medicine providers should counsel athletes explicitly on the prohibited status of peptides. ​​Due to the marketing of peptides​​​​​​, especially on online marketplaces, as either “natural” or “regenerative,” it​​ is​​​ ​likely that many athletes do not assume WADA prohibits these peptides. They may not know these compounds have risks associated with them. Athletes bound by WADA should be warned about the implications of testing positive to prohibited drugs, such as possible sport suspension and financial penalties. Additionally, it would be prudent to include questions specifically about peptides, research chemicals, or other injections when obtaining a medication history as athletes may not volunteer this information.

The interest in peptides opens the door to a larger conversation. Athletes are continually seeking strategies to enhance tissue recovery and minimize time away from sport. Providers should reinforce proven recovery strategies and emphasize adequate rest. It is important to emphasize the distinction between promising rodent studies and clinical relevance in humans. It is easy for athletes to get disillusioned by the promise of accelerated healing without fully contemplating the risks of injecting these compounds. Before peptides should be considered for use in athletes, clinical trials with adequate sample size and randomized controlled design must answer questions about dosing, safety, and other side effects. Until these questions are addressed, recommending or facilitating access to prohibited substances such as peptides with limited evidence in human subjects is not within best practice for evidence-based sports medicine providers.

To summarize our recommendations for guiding providers to counsel patients regarding peptides:

• Take detailed medication histories specifically asking about peptides and other over the counter “healing” compounds.
• Discuss the prohibited status of peptides under WADA, National Collegiate Athletic Association (NCAA), many professional sports, and potential sanctions.
• Discuss the limited human evidence supporting peptides for tissue healing.
• Emphasize the lack of regulatory oversight and manufacturing standards.
• Discuss the possibility of unknown side effects and potential health implications of taking peptides.
• Stay up to date on the latest research and advances surrounding these evolving compounds and annually review WADA Prohibited List updates.

The AOSSM STOP Sports Injury Working Group is committed to educating sports medicine surgeons. As research continues and peptides become more available to patients, ongoing education about these substances is essential. At the 2026 AOSSM Annual Meeting in Seattle this July, the STOP Sports Injury campaign is sponsoring experts to inform us on the latest of peptides, BPC-157, and other alternative treatments to better serve and inform athletes.

References

1. Axe J. After a major spinal injury, I truly believe BPC-157 helped save my life [Facebook video]. Facebook. Accessed February 4, 2026.

2. Vasireddi N, Hahamyan H, Salata MJ, et al. Emerging Use of BPC-157 in Orthopaedic Sports Medicine: A Systematic Review. HSS J. 2025:15563316251355551.

3. Brcic L, Iva B, Mario S, Novinscak T, Sikiric P, Seiwerth S. Modulatory effect of gastric pentadecapeptide BPC 157 on angiogenesis in muscle and tendon healing. J Physiol Pharmacol. 2009:60 Suppl 7:191-196.

4. Staresinic M, et al. Gastric pentadecapeptide BPC 157 accelerates healing of transected rat Achilles tendon and in vitro stimulates tendocytes growth J Orthop Res. 2003;21(6):976-983.

5. Cerovecki T, et al. Pentadecapeptide BPC 157 (PL 14736) improves ligament healing in the rat. J Orthop Res. 2010;28(9):1155-1161.

6. Chang CH, Tsai WC, Lin MS, Hsu YH, Pang JHS. The promoting effect of pentadecapeptide BPC 157 on tendon healing involves tendon outgrowth, cell survival, and cell migration. J Appl Physiol (1985). 2011 Mar;110(3):774-780.

7. Šebečić B, Nikolić V, Sikirić P, et al. Osteogenic effect of a gastric pentadecapeptide, BPC-157, on the healing of segmental bone defect in rabbits: a comparison with bone marrow and autologous cortical bone implantation. Bone. 1999;24(3):195-202.

8. Mayfield CK, Bolia IK, Feingold CL, et al. Injectable Peptide Therapy: A Primer for Orthopaedic and Sports Medicine Physicians. Am J Sports Med. 2026;54(1):223-229.

9. The Prohibited List. World Anti-Doping Agency. Accessed February 4, 2026. https://www.wada-ama.org/en/pr...

10. World Anti-Doping Code International Standard Prohibited List. Accessed February 4, 2026. https://www.wada-ama.org/sites/default/files/2025-09/2026list_en_final_clean_september_2025.pdf?utm_source=chatgpt.com

11. Tian T, Jing J, Li Y, Wang Y, Deng X, Shan Y. Stable Isotope Labeling-Based Nontargeted Strategy for Characterization of the In Vitro Metabolic Profile of a Novel Doping BPC-157 in Doping Control by UHPLC-HRMS. Molecules. 2023;28(21):7345.