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Peptide Therapy Overview

Improving Quality of Life and Age-Management



Peptide Therapy

Peptide Therapy Overview
Improving Quality of Life and Age-Management
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Growth Hormone Replacement Therapy (GHRT) continues to grow in popularity to manage age-related Growth Hormone Deficiency (GHD).

Patients are seeing real benefits to Peptide therapy.

61.6% of GHD subjects reporting an improvement in personal well-being after 1 year of treatment (65.7% after 2 years), as shown in a presentation to the Endocrine Society. In addition, the patients’ physical activity increased as sick days and visits to the doctor decreased.

A series of studies, most notably in the Journal of Clinical Endocrinology & Metabolism, showed reduced fat mass, with the greatest significance a 9% reduction in visceral and trunk locations; increase in lean body mass; improvement in exercise capacity, such as better oxygen uptake and power output with cycle ergometry; as well as a biphasic change in bone mineral density (the first phase, from months 6-12, resulted in an increase in bone resorption, followed by a second phase of overall increase in bone mass).

These outcomes are promising, because the impacts associated with adult growth hormone deficiency are troubling. Clinical Endocrinology reports a 7% higher total body fat and similar number for decreased lean body mass, along with a decrease in strength and cardiac output. Bone density has been established at below the mean level for patients with GHD, according to the Journal of Clinical Endocrinology & Metabolism. Quality of Life Research adds that those with this condition rate themselves as having experienced a reduction in vitality with an increase in fatigue, social isolation and depression.

HORMONES REGULATE what your body does
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Defy Medical seeks answers to help you get back to feeling great again

Hormones regulate most of the processes in the body, so even small variations (too much or too little) can cause significant effects. Defy Medical works with each patient individually to identify symptoms and review comprehensive blood work to find what’s really happening. Defy Medical determines the proper type of treatment, such as Growth Hormone Replacement Therapy (GHRT).

Peptides are hormones that have an effect on the endocrine system, which sends chemical messages to regulate the body’s organs and tissues. They are synthesized in cells from amino acids and travel through blood to the body’s cells. Growth hormones (GH) or somatotropin are peptide hormones that stimulate growth, cell reproduction and cell regeneration.

Growth Hormone Replacement Therapy (GHRT) is a regimen for treating physical and functional problems in people whose bodies, for one or more reasons, fail to produce adequate somatropin (also known as somatotropin, human growth hormone or hGH). During aging, there occurs a progressive decline of hGH production, which leads to a failure in maintaining essential aspects of bodily form and function needed for a healthy life of normal duration. Read more about GHRT.

Defy Medical offers several options that can be used for Growth Hormone Replacement Therapy, including recombinant Human Growth Hormone, Growth Hormone Secretagogues, GHRH, Ghrelin analogs, and peptide hormones.

Here are some of the benefits reported by patients after receiving GHRT:
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Improvement of SLEEP QUALITY
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Increase in MUSCLE MASS
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Reduction of BODY FAT
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AESTHETIC IMPROVEMENTS including hair and skin
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POSITIVE EFFECT on mood and memory
HOW to become a Defy Medical PATIENT.
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Growth Hormone Therapy | Growth Hormone Insufficiency Evaluation and Treatment

Defy Medical is a leading concierge medical practice, expert in both preventative and regenerative therapies, that focuses on the entire person and not just the symptoms. The Defy Medical goal is to improve quality of life and improve overall health by combining proven treatment models for Growth Hormone Deficiency and hormonal imbalance.

Defy Medical physicians receive the most current evidence-based training regarding the evaluation of blood work, symptoms, patient goals, and the application of growth hormone peptides. Learn more about your growth hormone production and specific treatments by requesting a consultation.

New patients will go through the following process: 

(Telemedicine consultations are available)

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Initial Assessment
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  • Blood work panel that may include the following tests in addition to other important biomarkers: Multi-specimen growth hormone (with GhRh/GHS stimulation), Insulin-like Growth Factor (IGF-1), Fasting insulin, Thyroid Stimulating Hormone (TSH), Free T3, Hemoglobin A1C, and additional pituitary and sex hormones may also be evaluated

  • Physical Examination.

  • Consultation with a medical provider.

  • If treatment is prescribed, patients will be given access to a cGMP compounding pharmacy that offers Sermorelin and GHS products.

  • Regular follow up assessments will include blood work and physician consultation.


COMPOUNDED Pharmaceutical Products

Several compounding pharmacies offer Sermorelin and other growth hormone secretagogues. Since commercially manufactured products are limited, and Geref® has been discontinued, a compounding pharmacy may be the only source for these products. 

Growth Hormone Releasing Hormone (GHRH) Analog


  • Description: Sermorelin acetate is a structural analog of naturally occurring, human Growth Hormone-Releasing Hormone (GHRH) consisting of its first 29 amino acids. Sermorelin stimulates production in and secretion of GH from the pituitary gland by activating GHRH receptors on pituitary somatotrophs. As a result, sermorelin has several clinical indications and applications related to GHRH/GH deficiency (GHD), including diagnostic evaluation of pituitary function and management of age-related, maladaptive changes in body composition such as reduced lean body mass (muscle); increased total and visceral fat; and decreased bone mass. It also may reduce risk for developing metabolic diseases such as diabetes. It also is reported to increase physical performance, benefit sleep and enhance quality of life. Unlike gene recombinant hGH (rhGH), sermorelin is less likely to raise serum hGH to unsafe levels because its activity is regulated by negative feedback mechanisms. Thus, sermorelin simulates more physiologic control over hGH and thereby reduces safety concerns associated with rhGH overdosing.
  • Available Dosage Form: Lyophilized powder for subcutaneous injection (must be reconstituted).
  • Strengths: Compounding pharmacies may offer several different strengths and combinations. The most common Sermorelin concentrations offered in a multi-dose bottle are 3mg, 6mg and 15mg. 

Growth Hormone Releasing Hormone (GHRH) refers to compounds that contain analogs that are structurally similar to growth hormone releasing hormone, including Sermorelin acetate. Sermorelin is manufactured to be similar to our own endogenous growth hormone releasing hormone released by the hypothalamus. GHRH stimulates the production and release of growth hormone by binding to the GHRH Receptor on cells in the anterior pituitary.

Ghrelin Analog / GHRP Product


  • Description: Ipamorelin acetate is the prototype of a novel series of hGH secretagogues that are analogs of ghrelin. There are other such peptidyl analogs including GHRP-2 and GHRP-6 as well as the non-peptide mimic of ghrelin called ibutamoren, or MK-677. All of these GH secretagogues release GH with varying degrees of potency. However, in addition to hGH, the other secretagogues also increase prolactin (PRL) and cortisol secretion, indirectly by stimulating pituitary release of adrenocorticotrophin (ACTH). On the other hand, ipamorelin has little tendency to release these secondary hormones and in fact is comparable to GHRH or sermorelin in that regard. This endocrine difference from the other GHRP’s is due to significant modification of its molecular structure, including the addition of alpha-amino-butyric acid (Aib). Thus, ipamorelin is a high potency and efficacious ghrelin-type secretagogue, having effects on plasma ACTH or cortisol levels comparable to the primary hGH releasing compound, GHRH. Consequently, it is the most selective GHRP receptor-active, GH secretagogue currently available.
  • Available Dosage Form: Lyophilized powder for subcutaneous injection (must be reconstituted); Oral Dissolving Tablet (ODT) currently under investigation to confirm oral/SL bioavailability. 
  • Strengths: Compounding pharmacies may offer several different strengths and combinations. The most common Ipamorelin concentrations offered as a multi-dose injection are 6mg and 15mg. Compounded ipamorelin 500mg tablets (ODTs) remain pending until the investigation is completed in 2018


Non-Peptidyl Growth Hormone Secretagogue

  • Description: Ibutamoren mesylate is a novel, orally active, non-peptidyl GH secretagogue. Single oral doses rapidly increase serum GH levels which remain elevated for relatively prolonged periods and concomitantly cause insulin-like growth factor 1 (IGF-1) to be significantly increased. These effects may be useful for opposing maladaptive changes in body composition such as those associated with aging. Ibutamoren also increases bone density, aids in wound healing and tissue regeneration and also improves sleep. Thus, it is a potent GH secretagogue that can be used to stimulate function of the GH neuroendocrine axis thereby producing positive downstream effects when administered orally. In contrast to peptidyl GHRPs and benzolactam secretagogues, ibutamoren elevates GH levels for extended periods of time after administration. Cortisol levels may also increase following administration, but modestly compared to its effects on GH secretion.
  • Available Dosage Form: Capsule.
  • Strengths: Compounding pharmacies may offer different strengths depending on the needs of the patient. 


PHARMACEUTICAL Growth Hormone Secretagogue Products and RELEASING PEPTIDES

These prescriptions are shown for informational purposes and may not be available through Defy Medical providers. If you’re interested in learning more about Growth Hormone Replacement Therapy options, contact Defy at [email protected] or 813-445-7342.


(Tesamorelin acetate)

  • Description: EGRIFTA® is an injectable prescription medicine used to reduce the excess in abdominal fat in HIV-infected patients with lipodystrophy. EGRIFTA® contains tesamorelin which is a synthetic analog of growth hormone releasing hormone. EGRIFTA® is the only commercially available GHRH product available in the U.S. Since it is only indicated for treatment of lipodystrophy, its off-label use will not be covered by insurance. HIV-negative patients receiving treatment for age-related growth hormone deficiency can use a compounding pharmacy to source GHRH and GHS products that are not available commercially and usually at a lower, more affordable price.
  • Availability: Lyophilized powder for subcutaneous injection (requires reconstitution).



(Sermorelin acetate)

  • Description: Geref® (sermorelin acetate for injection) increases plasma growth hormone (GH) concentration by stimulating the pituitary gland to release GH. Geref® is similar to the native hormone (GRF [1-44]-NH 2 ) in its ability to stimulate GH secretion in humans. Geref® (sermorelin acetate for injection) is indicated for the treatment of idiopathic growth hormone deficiency in children with growth failure. Most of these short, slowly growing children retain pituitary responsiveness to growth hormone releasing hormone.
  • Product Update: Geref® was discontinued by the manufacturer in 2008 and is no longer available in the U.S. The active ingredient, sermorelin acetate, is available at specific compounding pharmacies who compound sterile products using this ingredient. Thus, a compounding pharmacy is the only source for sermorelin acetate and is available in several concentrations depending on the pharmacy. 
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There are several compounded GHS combination products that allow patients to co-administer multiple peptides for synergistic effects. Discuss these options with your physician during your consultation.

Learn More



Combining Sermorelin with a GHRP appears to have synergy, resulting in a more robust release of Growth Hormone. There are several pharmaceutical products that can be combined into a single therapy. Although limited in availability, some compounding pharmacies offer custom combination products in all dosage forms including injectable. Compounded GHRH and GHS products offer the physician the ability to customize the ingredients and dose for each patient.

Examples of GHS combination therapies: 


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Rationale for prescribing Sermorelin + Ipamorelin: Severe GHD that is relatively unresponsive to monotherapy of either peptide can be best treated by taking advantage of synergy between both families of peptides. In this case, combinations of Sermorelin and Ipamorelin in a ratio generally representing 2:1 (more or less) will be effective and most appropriate, especially for the older patient. Thus, because of the different properties of Ipamorelin and Sermorelin, they are often used as monotherapies after identifying the condition to be best treated. However, under certain conditions of relatively severe growth hormone insufficiency, combination therapies are indicated.


Sermorelin monotherapy is commonly prescribed for relatively younger patients who have significant pituitary reserve and only need treatment for a few months, to increase exposure to endogenous hGH. 

Since Sermorelin eventually down-regulates, its pituitary receptors and actually “turns off” production of endogenous GHRH due to ultra-short feedback and activation of somatostatin neurons in the hypothalamus. Therefore, its efficacy is slowly lost and recovery is often required for restoration of function.

Recovery may be facilitated by subsequent monotherapy with Ipamorelin which will restore GHRH function and suppress somatostatin activity that is enhanced by Sermorelin therapy. 
Ipamorelin monotherapy is also beneficial when provocative testing reveals that pituitary reserve is low, possibly due to hypothalamic deficiency of GHRH and enhancement of somatostatin influence. This condition often occurs at early somatopause and can be treated well with ipamorelin alone.

sermorelin 6ghrp2 sermorelin 1.8 3

Combining Sermorelin with GHRP appears to have synergy, resulting in a more robust release of Growth Hormone. There are several pharmaceutical products that can be combined into a single therapy. Although limited in availability, some compounding pharmacies offer custom combination products in all dosage forms including injectable. 

Patient HANDOUTS and Product FACT SHEETS.

Are You an International Patient?
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Options for patients who reside outside of the U.S.

If you live in the United Kingdom, Canada, or another country outside of the U.S. and you're looking for guidance on peptide therapy – Defy Medical can help you. Our International Consultations allow you to talk with an expert to receive informed recommendations on care.

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Defy Medical is staffed by knowledgeable medical professionals including medical doctors, experienced healthcare professionals, and administrative teams who are qualified and trained to deliver a high level of care.