These get sold as a menu of interchangeable “GH peptides.” The evidence behind each is very different.
Compound Class Human evidence for body composition Approved? US compounding status (Sept 2026)
CJC-1295 without DAC (Mod GRF 1-29) Short-acting GHRH 1-29 analogue None. Never studied in humans in any form No PCAC voted 0–13 against, Dec 2024. Not lawfully compoundable
CJC-1295 with DAC Albumin-bound GHRH analogue, week-long half-life GH and IGF-1 rise in 63 healthy adults, mostly single dose. No body-composition outcome. Patient trial halted after a death No Same vote. Not lawfully compoundable
Ipamorelin Selective ghrelin-receptor agonist One GH pulse in 40 men. Negative ileus trial. No body-composition outcome No PCAC voted 0–12 against, Oct 2024. Category 2 for 503B facilities. Not lawfully compoundable
Tesamorelin Full-length GHRH 1-44 analogue, stabilised Two Phase 3 RCTs, 806 patients: visceral fat down ~15%, all in HIV lipodystrophy Yes, Egrifta, since 2010 Approved-drug ingredient; “essentially a copy” rule applies
Sermorelin Unmodified GHRH 1-29 None for fat loss or muscle Was (Geref, paediatric GH deficiency); withdrawn 2008 Compounded on its history as an approved ingredient
MK-677 (ibutamoren) Oral ghrelin mimetic Two-year RCT in 65 older adults: fat-free mass +1.1 kg vs −0.5 kg on placebo, no change in strength or function, appetite and fasting glucose up No PCAC voted 0–11 against, Oct 2024. Category 2
Growth hormone (somatropin) The hormone itself Improves body composition in diagnosed GH deficiency Yes, for named conditions Approved product only; distributing it for any non-approved use is a federal offence
The MK-677 row deserves a second look
It is the closest anyone has come to testing the idea behind the stack in a controlled trial. A ghrelin mimetic, taken daily for a year by healthy older adults, restored growth hormone and IGF-1 to young-adult levels and added about a kilogram of fat-free mass. It did not change strength or physical function. It increased appetite, body weight went up 2.7 kg against 0.8 kg on placebo, fasting glucose rose, insulin sensitivity fell, and cortisol went up. That is what a year of a ghrelin-receptor agonist looks like when someone actually measures it. Ipamorelin acts on the same receptor.
Conclusion
Five options, five different levels of evidence. Understanding these differences matters more than treating them as interchangeable.