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Telomere, mitochondrial, GH-axis, and immune-related compounds — Sermorelin, Epitalon, NAD+, and others. Mostly research-stage; we mark the evidence tier on each entry.
Longevity is the category where the marketing leads furthest ahead of the data. Some compounds in this category have solid mechanism stories and credible early-stage human evidence; others are extrapolated from rodent assays, decades-old eastern-European literature, or single-investigator research programs that the broader field has not independently replicated. None of the compounds in this category currently carries an FDA approval for "anti-aging" or "longevity" as an indication — FDA does not recognize aging as a treatable disease, which shapes everything about how these products reach patients. This page lays out what each compound actually is, what the evidence looks like, and where we would be cautious.
No FDA-approved compound in this category carries a longevity or anti-aging indication. That sentence is the most important framing on the page. Aging is not a recognized disease at FDA — it is a biological process — which means no compound can be approved with that label, no matter how strong the science gets. Approval pathways are tied to specific disease indications (sarcopenia, mitochondrial myopathy, age-related macular degeneration, etc.); longevity products that reach US patients reach them through compounding, supplement channels, or off-label prescribing — not through approved drug labels.
Historically FDA-approved, now compounded. Sermorelin acetate was FDA-approved as Geref by Serono in the 1990s for pediatric growth-hormone deficiency indications (initially the diagnostic-challenge use, with subsequent approval for treatment-related indications). The product was voluntarily withdrawn from the US market in the late 2000s for commercial, not safety, reasons. There is no currently marketed FDA-approved sermorelin product. The compounded sermorelin sold by telehealth platforms today operates under 503A patient-specific compounding rules; the regulatory architecture is detailed in our compounded vs branded peptides explainer.
Coenzymes and supplement-channel compounds. NAD+ and its precursors (nicotinamide mononucleotide, NMN; nicotinamide riboside, NR) are not peptides — NAD+ is a coenzyme central to cellular energy metabolism. They are sold variously as dietary supplements (oral NR is the most established commercial product), as compounded injectable preparations through telehealth platforms, and as IV infusions in wellness clinics. The supplement-side products are not FDA-approved drugs; the injectable compounded products operate under 503A.
Research-stage compounds. MOTS-c, epitalon (epithalon), and thymalin are not FDA-approved and do not have established commercial drug products in the US. Their evidence base is preclinical, early-clinical, or — in epitalon and thymalin's cases — derived primarily from a single research lineage (the Khavinson group at the St. Petersburg Institute of Bioregulation and Gerontology) that has not been independently replicated at scale by Western groups.
NAD+ (nicotinamide adenine dinucleotide) is the most mechanistically grounded longevity-adjacent compound in this category. It is a coenzyme required for several hundred metabolic reactions, and its tissue levels decline with age — a pattern documented across mammalian species and reproduced in human biopsy data. A 2021 Nature Reviews Molecular Cell Biology review summarizes the metabolism and the aging connection [1].
The clinical question is whether replenishing NAD+ levels by supplementing with precursors — NR or NMN — produces measurable benefits in humans. The trial dataset is still maturing.
- A 2021 Science paper reported that NMN supplementation increased muscle insulin sensitivity in prediabetic women in a small, well-controlled trial [2]. The mechanism was attributed to restoration of NAD+-dependent metabolic pathways. - The 2022 NADPARK trial published in Cell Metabolism reported that NR supplementation in patients with Parkinson's disease was safe and produced measurable increases in brain NAD+ levels, with signals on motor outcomes that warranted continued investigation [3]. - A 2023 GeroScience randomized trial of NMN in healthy middle-aged adults reported safety across the dose range tested and dose-dependent biomarker effects [4]; the clinical-outcome significance is still being established. - A 2024 systematic review of NAD across clinical conditions surveyed the broader trial literature and concluded the safety profile is generally favorable but the disease-modifying effect remains incompletely demonstrated [5].
What this means for a patient considering NAD+ injection or IV. The mechanism is real. The clinical signal is positive but small and not yet on the FDA-approval threshold. The supplement-route products (oral NR) have the most rigorous safety data; the compounded injectable and IV-infusion routes have less independent quality oversight. A wellness clinic offering an "NAD+ drip" is selling a route of administration that does not have the same clinical-trial dataset behind it as the oral supplement formulations.
Sermorelin is a 29-amino-acid analog of growth-hormone-releasing hormone (GHRH). It stimulates endogenous growth-hormone release from the pituitary — a different mechanism from exogenous recombinant human growth hormone (rhGH), which is FDA-approved for specific pediatric and adult deficiency indications but tightly controlled.
The historical context matters. Sermorelin was FDA-approved as Geref in the 1990s for narrow pediatric GH-deficiency indications (diagnostic challenge initially, with subsequent therapeutic-use approvals). The Serono group voluntarily withdrew it from the US market in the late 2000s. The withdrawal was driven by commercial considerations — small market, limited indication — not by safety signals.
The current commercial reality is that sermorelin is dispensed by compounding pharmacies under 503A for off-label adult use, typically marketed for sleep quality, body composition, and recovery support. A 2020 Translational Andrology and Urology paper reviewed GH-secretagogue use in body composition management in hypogonadal men and is the cleanest summary of the off-label use case [6]. A 2026 Journal of Sports Medicine and Physical Fitness review covered the broader doping and recreational-use context for GH-secretagogue peptides [7] — relevant because sermorelin and all GH secretagogues are on the WADA Prohibited List at all times [8], not just in-competition. Athletes subject to WADA testing should not be using these compounds.
The clinical signal for "anti-aging" or "longevity" indications is thin. Sermorelin can produce measurable increases in GH and IGF-1 levels — but whether that translates to functional, hard-outcome benefits in older adults without diagnosed GH deficiency is not established. The "more GH = more youthful" framing is a marketing simplification of a more complicated endocrinology picture.
These three compounds share a common pattern: interesting biology, limited Western RCT data, and most of the clinical signal coming from a single research program.
MOTS-c is a mitochondrial-derived peptide (encoded by mitochondrial DNA rather than nuclear DNA — a key biological distinction) discovered by Pinchas Cohen's group at USC in 2015. The mechanism story is unusually clean: MOTS-c increases in circulation during exercise [9], modulates metabolic regulation [10], and the broader literature on mitochondrial-derived peptides shows consistent association with exercise capacity and metabolic health [11][12]. The 2023 Frontiers in Endocrinology review covers the therapeutic-exploitation argument [13]. What is missing is a phase 3 trial of synthetic MOTS-c administration in humans for any indication. The compound is sold as a research-grade injectable through gray-market channels; we would not consider it appropriately characterized for clinical use as of mid-2026.
Epitalon (epithalon) is a four-amino-acid peptide (Ala-Glu-Asp-Gly) derived from pineal-gland extracts, developed at the Khavinson group's St. Petersburg Institute of Bioregulation and Gerontology. The proposed mechanism involves telomerase activation and circadian-rhythm modulation. A 2025 IJMS review summarized the bioactivity claims [14] — but the underlying literature is heavily weighted toward the originating research group, and independent Western replication is sparse. Marketed for telomere support, sleep regulation, and "biological age reduction." Used in the eastern-European medical tradition for several decades. We treat it as research-stage and not appropriately characterized for general clinical use.
Thymalin (тималин) is a thymic peptide preparation registered as a drug in Russia under the immune-restoration indication, with several decades of clinical use in the former Soviet medical system. The compound is also Khavinson-program-adjacent. It is not FDA-approved. It is occasionally available through compounding channels in the US for off-label immune support, but we have not identified rigorous Western peer-reviewed RCT data that would support a confident recommendation.
Three things a patient considering this category should keep in mind.
The "biological age reduction" claim is overpromised. Several supplement and telehealth brands sell longevity peptides with the framing that biological-age testing (DNA methylation, epigenetic clocks, telomere length) will improve in response to the intervention. Biological-age testing as a category is itself unstandardized — different commercial tests give different numbers from the same biological sample — and the interventional studies showing change scores on these tests are mostly small, short-duration, and not randomized. The science of measuring biological age is moving faster than the science of changing it.
The GH-axis compounds are WADA-prohibited. Sermorelin, CJC-1295, ipamorelin, and other GH secretagogues are on the WADA Prohibited List at all times [8]. A competitive athlete using these compounds is at material risk of an anti-doping violation. The 2026 Journal of Sports Medicine and Physical Fitness review documents the broader pattern [7].
Single-research-lineage compounds need more outside replication. Epitalon and thymalin are mechanistically interesting and have decades of clinical use in the Russian medical tradition. The fact that most of the peer-reviewed body of evidence is from one research program (the Khavinson group) means the broader scientific community has not yet stress-tested the claims through independent replication. That is a real caveat — not a dismissal, but a brake on confidence.
Of the telehealth providers PeptideWellness covers in our reviews, the two with the most relevant longevity-category programs are TeleZenMD (NAD+, glutathione, sermorelin, plus several adjacent programs) and Maximus (sermorelin and growth-hormone peptides as part of its men's-performance menu). NAD+ supplements through standard supplement channels (oral NR, oral NMN) are widely available without prescription; the manufacturers vary considerably in third-party quality testing.
For sermorelin specifically: the regulatory architecture means it is sold by compounding pharmacies under 503A, prescribed by a clinician. The questions to ask are the same as for any compounded peptide: which entity compounds the product, the pharmacy's state-board inspection history, and whether the prescribing relationship is appropriate for the intended off-label use.
There is no controlled head-to-head trial that establishes one route as superior on hard outcomes. The mechanism arguments for IV bypass of first-pass metabolism are plausible but the trial data behind IV NAD+ does not exceed the data behind oral precursors. The oral supplement category also has more standardized quality oversight than the IV-clinic compounded preparation route.
Not currently as a marketed drug. The original Geref approvals were for pediatric growth-hormone deficiency indications (diagnostic challenge initially, with subsequent therapeutic approval). The Serono group withdrew the product from the US market in the late 2000s. Current sermorelin available in the US is compounded under 503A for off-label adult use, not branded FDA-approved product.
The mechanistic claim (telomerase activation) is documented in vitro and in some animal studies, primarily from the Khavinson lab in St. Petersburg. Independent Western replication of the human telomere-length outcome is sparse. We would treat the claim as preclinical-suggestive, not human-clinically established.
The safety record over years to decades of off-label use is empirical rather than systematic. The mechanism (increased GH and IGF-1) has known associations — including theoretical cancer-risk concerns at the IGF-1 axis — but a controlled trial demonstrating either safety or harm at the durations and doses used in off-label adult practice has not been published. WADA prohibition applies regardless of safety question.
Variable. The active ingredient is real; the dosing protocols are not standardized; the source of the compounded NAD+ varies by clinic; and the clinical-outcome claims often outpace the trial evidence. The mechanism of restoring NAD+ levels is well-supported; the specific commercial protocols deserve case-by-case scrutiny.
Editorial note: Informational only — not medical advice. Decisions about longevity-adjacent therapies should be made with a clinician familiar with the relevant pharmacology. Last reviewed June 2026.