Transcript
Speaker: So I had a patient recently who was telling me, you know, she's going through menopause and noticing a lot of changes, not just the classic menopausal sleep changes, changes hot flashes, but also, you know, the skin changes, some things that we associate with aging and not specifically menopause. And she said that she was taking... GHKCU and all of these things, all these letters. had no idea what she was talking about. It turns out she was talking about peptides and I was a little bit unclear about where she was getting them from, what even the pharmacy that was making them, what that source was. And I just realized, okay, I know this is more than just a social media thing.
Speaker: fad. I've got to learn more about this because my patients are asking me now and I owe it to them, right? So I have on today, Jackie Gianelli, because she's somebody that I trust who knows about this information. She's a board certified nurse practitioner and she's a menopause society certified specialist with deep expertise in hormonal health, menopause, and longevity medicines. Her clinical practice spans hormone optimization, peptide therapy, sexual wellness, and evidence-based longevity protocols. She treats women across the full arc of perimenopause through postmenopause. She's the founder of the Well-Versed Collective, a media and educational platform that advances women's health literacy and serves as a clinical strategist for Mount Sinai's Carolyn Rowan Center for Women's Health. Jackie previously led clinical practice at Electra Health, advises in the digital health space, and is a newsletter writer and content creator. With active clinical roles in both Connecticut and New York City, she maintains a patient-facing practice grounded in functional and integrative approaches alongside her strategic work.
Speaker: Her work bridges clinical excellence, tech-enabled care, and cultural relevance in longevity medicine. I think you can see now why wanted her to teach me and teach you about peptides. I am so excited to have you on, Jackie. Thank you so much for your time. You know, like I said in my introduction, I just need to educate myself and you are a trusted source. So I'm so glad that you're here to kind of explain this to everybody. So thank you for your time this morning. Rachel, it's wonderful to be here. I feel passionately because we as clinicians do need to you know meet our patients where they are and they are asking about this. I get asked about it all the time. So I did quite a deep dive on it last year to really understand the space from a clinical perspective, from a regulatory perspective. And the the timing was, you know, fortuitous as it was moving into FDA advisory committee, which I'm sure we'll get into. But I learned a lot in the process. So excited to share those nuggets here with you.
Speaker: That's awesome. Okay, so let's talk about definitions because peptides are, you know, a term that are used for medications that are FDA approved. Like we know semaglutide and there's lots of medications that are technically peptides, vaccines, etc.,
Speaker: But then I hear peptides used for like collagen powders and then injectables. And I guess it's it's hard for me even to understand and I'm a physician. So I'm assuming it's hard for other people to understand what peptides are and what the categories are that are relevant for women's health or for the longevity space. Can you break that down for us?
Speaker: Yeah. So this is probably where some of the confusion even begins, just because we haven't come up with a like a agreed upon way of talking about this sort of thing, because peptides are naturally just endogenously, meaning like naturally occurring in our own body. They're substances we make. They're substances that can be introduced from the outside. And they are in everything, as you said, in you know the collagen that we're putting in our coffee to the lip gloss, even that we're putting, you know or our skincare. like hormone therapy used to be, has become a bit of a marketing term and something people think that they need, but they don't know why they need it. So peptides, just, on a fundamental level, are just chains of amino acids, sometimes as little as three, sometimes as many as 40 or 50, that are sort of strung together and introduced either topically or they can be introduced orally, you know subcutaneously through you know through the skin into the subcutaneous tissue as a signaling molecule. well I'll explain what that means in a moment. But when we're talking about collagen peptides, for example, those are really just like the building blocks, the amino acids. They really get broken down you know by our stomach acid, by our bile and our GI tract. And they're more of a nutritional source rather than the the way I think your patients are probably asking you about when it comes to peptides. So- you know To jump to really the way most people are referring to them now, they're talking about the peptides that are injected. So they kind of bypass RGI tract altogether, and they're being used off-label in most or you know all of the cases in order to signal to a cell. So they go into our body, they float around, they go to their intended destination, often which is local to where it was injected. They don't usually travel very far. And they bind to a cell, and they speak to the cell, and they tell the cell to do
Speaker: more of what it would naturally or its intended purpose, just do it better, stronger, faster. It's not the same thing as introducing a substance that is foreign to the body or different to the body than what it already knows what to do with. And that's why it's become this sort of like wellness. Interesting.
Speaker: phenomenon because it feels like a biohack, right? And it it sits so nicely in the wellness space. And yeah many have positioned it to be equivalent, which I hate, equivalent to us like taking a supplement, which it really is not. These are medications and they need to be stewarded by clinicians with licenses. Yeah.
Speaker: Yeah, that makes sense. Okay, so I had some friends, I'm not going to name names, but someone was saying, Oh, you know, I've had this terrible tendinitis, the more I work out, the worse it is. And I don't really want to stop working out, but I have to rest in order for it to heal. And our other friend was like, well, there's peptides for that.
Speaker: And that is kind of what you're saying. It enhances your body's own pathway. i guess and that's where then I start to get a little lost. Like is that for, can see in a tendonitis, it's enhancing the healing there, but people are using them for lots of different things more than just healing properties, right? Yes. So there's a few different cats categories of these injectable peptides.
Speaker: The one you're referring to really are the like regenerative, restorative healing peptides. So those are like BPC-157 is a good example, TB-500, TB-4, or, you know are you know, there's a few others in the category, honestly. And they do exactly what your friend is saying. They kind of help, you know, a situationally. And sometimes people use them off-label in different ways, but for an intended purpose. So you have a surgery and you want to heal faster from your surgery. Sometimes these peptides are injected around the site of the surgery, even locally or into a joint some people have, you know, have tried. Very, very little data to support this, of course, but the idea is that it would help your body to do what it's trying to do. But as we age, we're not able to do that thing as well as we did because our cells are just aging, right? And the way they turn over and the way that they function in their mitochondria... just aren't as good or as powerful. That plays me just sort of a second category, which are mitochondrial peptides. And you remember from science from science class that these are the powerhouse of the cell. And so those are really being used very much in the longevity space. Like how do we not only extend the duration of years we live, but how do we improve our cellular processes so our energy is better? This is like definitely coming from
Speaker: like The longevity space where everyone everyone really wants to extend their usefulness in the world, their ability to work, their ability to exercise, strength train, performance medicine, all of that. And so mitochondrial peptides are definitely a hot category. There are weight loss peptides, which are FDA approved, which we're all familiar with. right? The random drugs. There are beauty peptides, collagen and elastin. There are peptides for the immune system. There are peptides that are approved for sexual medicine and for bone health. and And those don't get as much, I think, love in the wellness space, probably because they are FDA approved. That is interesting, right? They exist. Exactly. So I think that the marketing here is super interesting.
Speaker: Oh, that's a really interesting point. So for the ones that are FDA approved, they may not be as hyped up because you can basically use your insurance to get coverage for them. Is that what?
Speaker: Pretty much. And I think, is yeah, I think once it's FDA approved for something, you know, yeah what's nice about that is that someone's invested into that molecule in order to understand what it does. Is it safe? Is it efficacious? Yeah. know, how can it be used? What are the indications? yeah but That makes it a little bit harder sometimes to use in the wellness space where we're not using it for one of those indications, but really more off label. And honestly, it just becomes less sexy, right? When something is FDA approved, part of the allure of these things is that they're an alternative to the conventional system. So, you know, it's it's funny, but we think a lot about these these drugs as being cool or different, but insulin is a peptide and that's been around since the beginning of time. So there's a lot. Yeah.
Speaker: So do you think they will all eventually go under investigation to be FDA approved? Or do you think some of them that are for like, you've mentioned some of the beauty wellness, like the one that one of my patients mentioned was for her hair, like would that do you think there's any reason for companies to bring those under investigation to be FDA regulated?
Speaker: i think if there's money to be made, then certainly that is the case, right? As was is the case with our GLP ones. And we know there's quite a booming industry around that as well. I mean, certainly the beauty industry would love that. There are, you know the the peptide you're mentioning, which is GHKCU, which is a copper peptide combined with a tripeptide, has actually been studied and there is some modest, you know, modicum of data that it can be helpful in the dermatologic space for improving skin quality, skin laxity.
Speaker: topically, solely. There has been data. Yes. So dermatologists you know can pull those studies and reference them. And we do know it to be a safe molecule to use topically in skincare. So that's something that I'm comfortable doing, right? And and I'm comfortable saying there is a little bit of data. We know that it's safe, whether it's going to help you or not. you know we We're just not sure. But like many things in beauty, that's okay with a lot of people, as long as that transparency is there where there is no data, unfortunately, is the way that most people are using GHKCU and that is injected. When I say no data, what I mean is that there are no randomized control trials. There may be a small amount of human trials, like you know maybe a handful of people for a short duration of time, or we are extrapolating data from mice and rodents, or we are really just you know going off the the reservation and just pulling this stuff and it's really never been tested on it. There is that gradient. of safety data. And it's very hard to know which molecule you're talking about. And when you're talking about you know topical versus injected, it's easy to see how that could be confusing. And I think maybe that's where we could even pause and break it down for listeners that the traditional route for getting a medication or treatment or really anything through the FDA is first, you know there's these phase one trials where you may just be doing trials in a research lab.
Speaker: And then you're testing on animals, right? And mice are very commonly used as that good mirror of something that would be used in humans eventually. And that's what we do for cancer research, like all the chemotherapies, all of those typical things. And then we start to move to a human model. And I guess what I didn't realize is and this is where people are like skeptical, is that some of the peptides have not been moved to the human model. Gosh, that's like kind of scary, right? Because we get a lot of information from the animal models, but i do want to know that humans have tried this before I try it. Well, to that point, I think, you know, when the FDA advisory committee met and that happened this past summer, July, 2026, group of of scientists, researchers, physicians, they all got, you know kind of gathered and and looked at this. And just so your audience understands these molecules were moved onto what's considered category two, which is essentially a banned substance back in 2023.
Speaker: So there was a good decade prior to 2023 when these were not banned and where they were being used by a lot of regenerative medicine physicians, longevity practices, where it kind of wasn't on the radar. So we do have quite a data set of what we call real world evidence, which is essentially just like yeah records. What I think the FDA advisory committee, the leg that they stood on in July to say these peptide should be moved back off the banned list and back into what's considered category one, which is just that it's safe to be compounded, not that it's going to be you know efficacious and do what it says it's going to do. think that it's not going to cause harm.
Speaker: Right, right. Cause harm. Based on the large pool of data that basically showed that there were not many incident reports or adverse events. or safety issues that they were able to find from pulling from compounding pharmacy records is my understanding of of sort of how that happened. I think that in them recommending that these peptides, which by the way, at this very moment sort of sit in this waiting room, right? They're recommended to be moved off and there's about seven or eight of them, but they're not quite yet on category one. So to, you know, to timestamp this, they are still technically not available for compound. even though that is happening. And you know really that's just based on the fact that we just know that they're very unlikely to cause harm. That is the framework of thought that a lot of longevity practitioners are using today to under like explain to their patients why we can use these, even though they might technically not be studied by you know a major a major company, i have a ton of data behind them. And that is unfortunately the current state of where we're at Yeah. Okay. I mean, but I think that's helpful, at least if somebody were interested in what would be available to them, kind of knowing, all right, here is the one that has tons of research. Here's the one that has a little bit. And for me personally, I want to know which one has been studied in humans and which one has not. think that might be my litmus test. Right. And I think there's everyone else has their, you know, I'm, I'm okay with these things as long as we are really being transparent and making that um sort of a mandatory part, right? What's happening is that because we have been dancing in this gray area for the last three years, patients are going and getting these peptides off of a a gym guy on Instagram, or they're, you know, buying it off of a site and paying with cryptocurrency, you know, because they know that it, so it's really bad things that are are happening to patients as a result. I mean, Independent research companies have looked at these vials that say that they contain GHKCU and there's almost no GHKCU in the vial. So it's not what it says that it is, or you know they have no purity or sterility testing associated with that. That really only comes from a compound, 503A or compounding pharmacy where you can pull their certificate of analysis and ask for these reports on how they test their products. At least then you know that what you're getting is not going to guarantee contain toxins, impurities, you know, that could really harm your health, right? It'd be better to pay for nothing than for something that's going to harm you, but yeah. 100%, yes. Okay. it is it's It's fascinating. And I guess that's, again, where, yeah it would be nice if the FDA could offer some regulation around it because then the typical consumer knows what they're getting, right? But that always takes a long time and we usually don't want to wait for that, which i you know I get. Okay. Tell me about peptides for women going through their midlife? Because like I mentioned, you know, my patient was kind of using all of these different ones and menopause affects women from head to toe. And so what do you see as the big benefits or like, where should women who are listening, who are going through perimenopause and menopause, where should they be maybe wondering about peptides or considering a peptide? Yeah, and in the space that we both work in, this is a common question. And the first thing i want to say is that there is no peptide that is going to really be worth your money unless you are doing the basics first. like You have to be sleeping. You have to be moving and eating well. If hormone therapy is something that is you and your providers share decision-making for you to be on, like that really does also make a big difference as far as how your peptides work. And we do have studies to back this up, right? We know that GLP-1s, which are FDA approved peptides or, you know, GLP-GIP, or eventually the, you know, the next phase of drugs that will come out, we have looked at their ability to help women lose weight or just people in general to lose weight, we know that they work better and women lose more weight when they are also taking menopausal hormone therapy. yeah So those endpoints are super interesting and and validating when we think about these peptides, again, as signaling molecules. The cell is only capable of a baseline of what the cell is capable of. Your cells will work better when they have their hormonal pathways regulated and established before you add in these
Speaker: fancy, you know, signaling molecules on top of that. So yeah certainly that's paramount and and step one in any, in any situation. In a patient then who really has like done all this, they're really, you know, they're doing everything right. You feel like they're in a great spot with their hormones and they are like asking you, okay, what now? Certainly, you know, I really am a big fan of using GLP-1s in midlife. I use them in quite a number of my patients. I sometimes do use them in smaller doses and then what is FDA approved and what's considered a microdosing strategy only because I find that I'm very concerned about muscle mass loss in this population and how that will impact our bone health, our longevity, our cognitive health long-term. We know that our muscle is our currency of longevity. So it is really important to me that we don't lose muscle and we still don't understand exactly what the right dose is for exactly like what woman in what age and range of her perimenopause or menopause journey. yeah So I do like taking a microdosing or personalized approach to really kind of curate specific doses for specific people based on what they need at that time. Then, you know, as far as other peptides go, there are a lot of questions about, we haven't talked about it, the growth hormone secretagogue peptides. This is not necessarily something I think should be in a woman's toolbox, but I get asked about it all the time because a lot of patients' husbands are using these peptides. because they are using them to help increase IGF-1 or their insulin-like growth factor, which is your natural peptide that helps you to maintain your muscle mass and to recover after strength training. And there are a few FDA-approved growth hormone secretagogues, namely tesamoralin, which is FDA-approved for visceral fat, and mostly studied in men with HIV.
Speaker: So not a great option. Yeah, and they're out there. But we are taking that tiny little indication and sort of extrapolating it. And at least we know that it's been studied and it's safe, right? So at least we got the human study. At least we got that. Yeah. So Morlin is another super common one and that has been around for gosh many decades. Morlin was FDA approved at one point for growth hormone deficiency in children. It was pulled off of that not because of any safety issues but for think just like pharma related issues. And so that is still on category one and so that is a growth hormone secretagogue meaning that it's going to help your own pituitary gland. secrete more of your own IGF-1 while you sleep, not giving you back growth hormone. There's a big difference there. Yeah. Sort of like, you'll know this, but like in reproductive medicine, like there's giving testosterone and there's giving Clomid and they work differently in the HPA axis. So I think that this is a situation similar where it's like,
Speaker: it really can help the person who is also getting the right amount of sleep. We secrete growth hormone while we sleep. So if you're staying yeah up all night, burning the midnight oil, and then using these peptides at night, you're not going to reap the benefit. So here we are marrying this lifestyle, right? and And regenerative approach. Those peptides, you know, if my patients do want to try them and and they're really starting off with a low muscle mass, because I do check body composition on the majority of my patients who are on GLP-1s and they want to try it, I do feel comfortable knowing that there is good safety data for those patients. I haven't personally seen great results, you know, in terms of that being helpful in any way, but I do feel like it's- Again, being helpful in like almost counteracting the muscle mass loss with a GLP-1 or potentially helping to build muscle because it's so hard to build muscle after. Exactly. I mean, there are plenty of patients that will tell you otherwise that they've found success in doing this. I just personally in my small, you know, end of one practice haven't seen that be true, but I'm okay trying if somebody wants to and understands. So there's that. I mean, we could go on and on, but I love...
Speaker: The FDA approved bremilanitide, right? Which is known in the wellness basis PT141 to help the sexual function. I never thought of that as a peptide. i love bremilanitide, otherwise known as Vileci. It's for hypoactive sexual desire disorder. i'd never thought of it as a peptide, but you're right. It is like enhancing your own natural process.
Speaker: Yes. So and it's using those amino acids. And I think it's really effective for people. I wish that I get more of my patients to try it. When I see people and talk to them about their options for hypoactive sexual desire disorder, it is their last choice because it's an injection. don't know about you. even with the GLP ones, I think that people are more accustomed to injections and yet they still don't want that for sexual desire. And like, just try it. You're going to love it. So I've started changing the way that talk about it. Oh, tell me. How do you? Yeah. I say, you know, there's this peptide out there, you know, that can I, I literally just don't start by using the brand name. I start by meeting with this sexiness of it, you know, and then...
Speaker: And then I mentioned that it's an FDA approved and it's been well studied and I feel really good about offering it. and i And I've seen patients benefit from it and patients, you know, sometimes then it changes their perception. So interesting. Yeah, honestly, i think it should be reused recreationally. I think it is such a good medication. I know probably the company would not be happy to hear me say that, but I do. think it's so, I think it's so effective for people. And I i would like to see more women try it because I think it would really change things up and help people get through the ruts that they might experience. And especially in long-term relationships. Right. It could it can mix it up.
Speaker: Yeah. It's not a medic. I think a lot of my patients, don't know how you feel, but like a lot of them don't want to go on a medication that they have to take every single day. Like they're tired of adding to their pill box and feeling like an old lady, you know, because they have so many things to take. This is, these are the words that they use. yes feel that way And so an injectable, kind of, you know, puts it on site, you know, you do it just as you need. And that might just be a couple of times a month. And I do also like, since we're talking about peptides, combining it with a neuropeptide oxytocin right which is well studied very safe really you know can be a wonderful molecule to combine with bremilanitide together to really kind of i have not done that tell me more about that haven't combined them that's really cool idea
Speaker: Yeah. So you can combine them. A lot of um compounding pharmacies will offer them to get compounded together, now not in a syringe, but in an under the tongue, what we call a truncary or a melt that gets absorbed through through the oral mucosa and can you know is less effective and sort of less strong, certainly than the injectable, like all things. But yeah the the mucosa does, you know I would say it gives about, i would say 60% as compared to the injection of how it how it behaves. It's a very safe way of giving, you know, peptides, especially for people who are more needle averse and do still want to try something. Good enough to get your formulation for that. i That's brilliant. I love it. I have a whole clinical protocol that I wrote and I'm happy to share it with you. Thank you. The women and in Ohio, thank you.
Speaker: if my patients really love their vileci, right? And they don't want to use something like, well, just add in an oxytocin melt or troche or oxytocin nasal spray right and do those two things together. most it and they they're really wonderful ways, again, crossing the blood brain barrier, getting in, modulating our on neurotransmitters. And actually there's a lot of good data on oxytocin, even as it's anti-inflammatory and antioxidants effects in the brain. So more wellness benefits than just sexual medicine benefits.
Speaker: Yeah, exactly. Oh, that's so, I mean, oxytocin gives people the sense of like wellness, right? It makes you even just feel better bonded to each other, right? It's like the love and love hormone. yeah And that's what we need more of in this world. And very few side effects, very few, I mean, the adverse, you know, the the negative, there's like not a lot to be worried about when you're using oxytocin. You know, there's a lot of side effects with a lot of FDA approved drugs or even some of these compounded molecules, but oxytocin, Oxytocin really, I think, doesn't get enough love or enough air time for what it can do. Oh, that's so interesting. Okay. So speaking of sexual function and, you know, using vialisi and oxytocin, let's talk about sexual side effects that you've seen from other peptides. What have you noticed in your practice? Yeah, so I've been prescribing GLP-1s since like 2019 when I worked in Men's Health, actually, yes. And so in the beginning, you know, we just had, we had Osempic and then of course Munjaro came out and we were so excited and we were just like throwing these drugs at people, meaning like, you know, just dose escalating according to protocol and getting some of these guys who had a lot of weight to lose, right? Up to like these higher doses and women too. And what I noticed and started noticing early on is that as we sort of reached a certain threshold, these patients, I worked in a sexual medicine practice at the time, so we were directly asking this question, but they were finding it more difficult to to have an orgasm, to climax, to ejaculate, right? Their just general libido was down. And that makes sense, right? Because these drugs do partially work by decreasing excitation and cravings and whole dopamine thing, right? Like this reward center of our brain.
Speaker: That's right. And so you see we see that, you know, not discriminate. I mean, in other wonderful ways, it can help you know us to drink less alcohol or for gambling addictions or for sex addictions even, right? So then that makes sense why I would do that also for people's libido in general. And so that is something that I obviously ask directly about, putting patients on these medications. so And we're talking about the potential side effects, but I don't think a lot of other clinicians are necessarily doing that. It's not in their in their wheelhouse. But because of that, I've sort of learned different tips and tricks to sort of augment it. Of course, it teach us I mean, obviously, hormone therapy, right, is like you have to have that. And in in women and men, you know, testosterone can be an important augmenter here, obviously, making sure that we have adequate physiologic testosterone levels. Not only can it help with, you know, sort of just the arousal, or orgasm and libido component, but also with lubrication. And even sometimes with just general energy, you can feel a little fatigued. while on these medications, especially as your body's being asked to sort of burn, burn, burn, right? It can really kind of make you feel tired before you feel better. I find the testosterone, I know it's not studied this way, but anecdotally, my patients do tell me that it helps them to have more energy. I find that to be helpful.
Speaker: Oh, that's really helpful to know. And do you find the same things with the micro dosing? Because I guess I would hope that with micro dosing, maybe wouldn't have as many, but I but i don't know. It's be honest. I do find way less of that. It's partly why I really started microdosing was that I wanted to get some of the benefits. And some of my patients, they don't have 50 or more pounds to lose. They maybe have 20 pounds to lose. And so we don't need to use a lot anyway. I'm also very careful, obviously, like if someone's starting off with a smaller frame, I want to start at a lower dose. But with that said too, one of the one of the other ways when someone does report to me that their sexual health has been impacted, we sometimes can lower the dose of the GLP-1 back, you know, let's say they're at five and go to 2.5 on a ZetBound, for example. And then sometimes I do like to augment that with bremilanotide, Vileci, PT-141, they're all the same thing. And oxytocin, PT-141, Vileci's peptide, it actually also works in the gut. So if you think about it, one of the side effects we counsel our patients on is slow gut function and nausea, right? Which is...
Speaker: why it also works there. So it does help a little bit with the weight loss piece, not necessarily and yeah on its own, but just helping to augment where can use a little bit of ah like um a blended strategy to help with making sure that patients still feel like they can enjoy their sexual lives. While still losing the weight they want to lose. Oh, that's good to know because I have wondered if I'm starting Vilesi on my patients that are using GLP-1s and if there's already some gastroparesis happening or slowing down of the gut mobility, if the Vilesi would make that worse. Have you found that it bothers them or no? I have found that for patients already on GLP-1s who've kind of gotten through that first exposure to the gut, that adding in the vitality at that point actually really doesn't impact them very much.
Speaker: Okay, that's good. I feel like the GLPs are stronger in that regard. So it's just more, you know, it's just another way. and and And it does protect sort of their dopamine pathways, which I really like. Yeah, that's awesome. Okay, I have one more follow-up question. I'm sorry. Do you find that, you know, people are doing great on this, but can they come off? Like, will they be able to stop taking them? Especially, i guess I'm thinking my practice, i have a lot of women in their mid-lives who just want to get rid of their midsection. They don't have a lot of weight to lose. Then they're successful in doing that. Can they come off?
Speaker: Such a loaded question. So no, no, it's okay. How much time do you have? I mean, this is a podcast. but um I think it's really situational. I think it depends on a lot of different things. I think that for someone who really did just gain weight, like most of us do in midlife, and you hit 40 and all of a sudden there's a body composition change and you're like, where did this belly come from? And you really are doing everything else right. And your nutrition is dialed in and you're doing the strength training.
Speaker: i do find that there's a group of those women that can use a very small dose of GLP-1 for a very, the smaller, the better in this situation, right? And a small dose over a longer period of time, we'll be making sure we don't lose any muscle in the process. Once we start losing muscle, you come off the GLP-1, you're in a worse position than when you started. Right. Because now your basal metabolic rate is going to be not in the same place to support your calorie burning endeavors. And and it's harder to to build that back up after that pause, unfortunately. So I'm careful there. I think when we're using GLP-1 sometimes for other reasons, a lot of women are using it. I like it for sometimes for autoimmune conditions, for inflammatory conditions, for women you know who are at high risk for cardiovascular disease. like I'm using it a little more off-label. Those are things that may not, are not going away. So you can stop them, but like you're going to lose the benefits eventually. And so but I think if it truly is just very specific individual who gained weight in perimenopause, wants to come off their testosterone style, then their estrogen style, then they're really committed. to maintaining, I think that they can probably keep off, I would say a good like 60 to 80% of the weight that they lost, but like um any aging processes, our bodies are going to continue to evolve. It becomes harder and harder. So yeah I find that most of my patients who start these things find so many other benefits than just the weight loss. They really, their mental clarity changes Their confidence changes. Their bloating, you know, the way the foods that they can eat. all of a sudden they can eat dairy when they couldn't have dairy. I mean, it's just the quality of life improvements. Yeah. but they don't want to risk it. They don't want to risk just going for a turkey. A lot of them want to use less. And we do that. So we use- okay
Speaker: Instead of weekly, I'll use it every other week in a much smaller dose as a mechanism of sort of like titrating down. I know this is all off label, but this is what I've done. No, it makes sense. This is what, yeah. And that gets them to a place where they feel like they can hold on. don't want to lose any more. They just want to maintain. They want to retain some of the other quality of life benefits. I find that to be the sweet spot. So that's usually where we land. But I have patients who have come off and a few of them have been able to maintain, but they're the really, really diligent, well-dialed in patients.
Speaker: Yeah, that makes sense. Okay, so for anybody who's listening and they're thinking, okay, I want to figure this out. I want to go try something. What would you tell them the practical tips in terms of like steering clear from potentially getting, i can't even say prescription because these are not necessarily prescriptions if you're getting them from someone who's not a...
Speaker: not a practitioner. Research grade, right? So we don't have that term, yeah. But that's what most people are buying. When you buy without a prescription, you are getting what ah you know we were like calling research use only RUO, you might see it abbreviated as, or now they've got really tricky and fancy and started calling it physician use only. And that is, it's leveraging a loophole. But now with the FDA advisory committee and and the convening around this, there have been some crackdowns by the FDA. and Really a lot of these research companies that were making so so much money really in the market here, were forced to shut down because they were being sued. And so yeah that is a good thing yeah because obviously we don't we don't want that. Specifically, Reddit True Time, which is Eli Lilly's next generation, know that's going to come out after Zephound, and it is has huge potential to change so many lives. And so Eli Lilly really is cracking down on those who are not compounding, but just using research use only resources.
Speaker: retatratide or retatratide. And so if you're getting that drug right now, you are getting it from a black market. It's coming from a very sketchy source. It's definitely not coming from a 503A or 503B compounding pharmacy, which are the compounding pharmacies that I can say are earn the best, you know sort of the highest standard of compounding. And you're really taking a huge risk. And the provider you're working with is also doing that. So i at this point, do not recommend stay far, far away from that. But yes, and then thinking about asking your provider, know, not only what pharmacy they're getting it from, but has that provider looked at their certificate of analysis? You know, do you feel comfortable with the product? How long have you worked with this compounding pharmacy? i think more than that, though, why are we using this peptide?
Speaker: What is the intended outcome that we are yeah moving towards? Over what duration of time will we... assess its efficacy. Like where will we say on three months, if X, Y, Z are true, this was successful. And if not, then maybe this didn't work so well. You know, how to keep track of that over over the course of time, Because these things don't work overnight. They're meant to be used and then signaling, signaling, and then the body responds. It responds over time. For most peptides, you know, they should not be used continuously. Most peptides should be What's, you know, cycled for lack of a better word, which is giving the cells a break from them to sort of like let them rest and recover and and then be able to respond again. Certainly anything that increases growth hormone falls into that category because again, you're not always trying to regenerate. You do want to rest and recover as well, like any good physiologic processes. You definitely want to ask and be sure that you are up to date on all of your preventive health and cancer screenings. These growth hormone secretagogues that help us build muscle, they help us build all cells, including potentially cancer cells. So we are really, you know, we really want to be very, yeah, very careful that you are up to date with your mammograms and your PSA has been checked and all the things that, you know, both men and women need to think about but when it comes to cancer.
Speaker: to using these. You're not getting these mixed in a syringe already or mixed in a vial together. You should only be using one peptide really at a time, unless it really is meant to be done that way. And that again, like how familiar your own provider is with this stuff. if they're just writing it to make you happy, it's probably not the right provider. It's nice of them to do that maybe, but like, that's really not the provider you want to be working with.
Speaker: Yeah, exactly. And I think that's the thing. It's hard to find people. i mean, even myself, like I admit, i am not up to date on this and I'm so grateful for you teaching me so much today, but I have to keep up and keep reading and stay on. And I'm, I'm not going to write something that I'm not comfortable with, but you know,
Speaker: Women and men, I think people in general, if they don't get what they're looking for from one person, will look somewhere else. And it's important for us as practitioners to know that and and kind of know like, all right, what are the red flags that people should be looking for and help our patients kind of make those informed decisions too.
Speaker: Yeah. And at least educate, right? Like we've learned, you know, women's health, like we cannot, we cannot dismiss our patients. They're coming to us with real questions. And part of our job as really good clinicians is to help them interpret what they're seeing in, you know, on social media, what they're reading about, you know, and what their friends in the group chat are coming to them with. And those are their trusted sources. And so the fact that they are looking to us, you know, if we betray that relationship and we just say, oh no, that's, that's ridiculous. I don't do that. You know, like ignore that. Then they are going to go somewhere else. So it is something you, you know, education always works.
Speaker: And when they trust you and you have a good rapport and and you're helping them feel better in other ways, right? They're going to respect that potentially this isn isn't something they should do. then go back and tell their friends that, you know, maybe they should be careful too. Yeah, exactly. Well, thank you so much for your time. i really appreciate it. And thank you for doing the deep dive. So I time really like we we both work in and sexual medicine or, you know spend time in this space. And I think as we as as a bunch of clinicians are very comfortable, like thinking outside the box and like being creative with how we practice medicine. And so this felt like a natural segue from that. We're already familiar with compounding. And so we we had a lot of the foundational knowledge, I think, to really yeah
Speaker: understand this space and to be really good partners and care to our patients who trust us. yeah And so I really wanted I just wanted to rise to that occasion. Oh, I so appreciate it. And I've got listeners all over the place. I'm sure that there are people in your area who would love to see you. But also you've got such a great social media platform. So I'd love to just ask where people can follow you where they should be looking for you if they want to learn more, more from you. Absolutely. Yes. So I, of course, I'm on, you know, all the social media channels, but primarily on Instagram. I'm sure you can look down. i have a lot of letters in my last name. So at Jackie.giannelliNPTalks on Instagram. I'm on LinkedIn as well, if anyone's so inclined to find me there.
Speaker: I write a newsletter called In The Saddle, which is for midlife women who are really looking to talk about exactly what we've talked about here today and make sense of kind of the craziness that's out there from a licensed clinician who knows this stuff. So that is available on my website, JackieGiannelliNP.com. You can sign up for it also at InTheSaddle.com, you know, and or just send me a DM. I'm always happy to to connect with anyone who has questions. Awesome. Thanks so much, Jackie. I really appreciate it. And I hope to see you at the next conference. I'm sure we'll catch up then.
Speaker: Yeah, that'd be lovely. Thanks Rachel. And if you're in my neck of the woods and you're looking for someone who could give you peptides or at least some information on them or do an assessment for you, i would recommend checking out Kinetic Edge. Kinetic Edge Health is a longevity and performance practice run by two practicing surgeons, a urologist and a vascular surgeon.
Speaker: So they know a lot. They start with a full lab panel, over 100 markers, and a physician builds your protocol from your numbers. Nothing's prescribed before you have a conversation. Find them at kineticedgehealth.com.
