Philosophy - Peptides/PEDs and Thinking About Risk

Overview

Unless you’ve been living under a rock, you’ve probably heard about peptides. They’re often marketed as being safer — and therefore a potential game changer — compared to traditional performance-enhancing drugs.

You might ask ❓, why would I write about this topic, given that I try to compete in bodybuilding naturally (not particularly well, I might add 😂)?

The answer

Like many people, I’ve heard about peptides but never really given them much thought. Recently, while chatting with a gym buddy, he mentioned that he had started experimenting with them and was seeing good results.

That got me thinking — perhaps it’s time to form a more structured opinion.

In my younger years, I read a bit about traditional performance-enhancing drugs, and like most people, I formed some opinions. But peptides seem to sit in a grey area — newer, less studied, often marketed aggressively, and discussed casually in gym circles.

Another question that came to mind was this:

What sort of heuristic or framework should we use when evidence is scarce, yet we still need to make decisions that ideally turn out to be correct more often than not?

Warning
I am not an expert in this field. These are simply my thoughts and reflections — take everything here with a bag of salt 🧂.
Note
I am fairly risk-averse and rely heavily on my understanding of the science. Everything I say here is filtered through that lens.

What are peptides?

Digestion of proteins begins in the stomach, where HCl and pepsin begin the process of breaking down proteins into their constituent amino acids. As the chyme enters the small intestine, it mixes with bicarbonate and digestive enzymes. The bicarbonate neutralizes the acidic HCl, and the digestive enzymes break down the proteins into smaller peptides and amino acids.

Peptides occur naturally in the body and are byproducts of protein digestion. In simple terms, they are short chains of amino acids — essentially smaller fragments of proteins.

Note

You might think 🤔, “It’s natural and already found in your body, so it must be safe.”

Hang on — testosterone is also natural and found in your body. Toxicity is often dose-dependent, meaning that higher concentrations can increase risk.

The term “natural” is also slippery. Many compounds are synthesized in a lab but chemically identical to what occurs in nature. That doesn’t automatically make them safe — or unsafe. What matters is dose, context, and evidence.

Well-Studied (Medical Use)

These are peptides that have undergone extensive human clinical trials, are prescribed by physicians, and have relatively well-documented efficacy and safety profiles.

As of 2023, over 80 peptide drugs have gained global approval, with more than 200 peptides in clinical development, focusing on infectious diseases, autoimmune diseases, metabolic disorders, and cancers [2].
Warning

I will link studies from reputable publications describing what these drugs are and how they were tested.

I am not qualified to dissect any of these studies for bias or methodological flaws, so I generally defer to the broader scientific consensus rather than trying to outthink specialists in their own field.

Semaglutide - Wegovy / Ozempic

Semaglutide, a GLP-1 receptor agonist, is FDA-approved for managing type 2 diabetes (T2D) and reducing cardiovascular risk. Its off-label use in weight management and other conditions has grown
meta-analysis of 13 randomized controlled trials involving 5838 patients demonstrated significant absolute weight reduction in the semaglutide group.

Semaglutide seems to be a good example of a peptide with strong human data behind it. It has been tested in large randomized controlled trials (generally considered the gold standard), approved by regulatory agencies, and prescribed under medical supervision.

Less Studied (Fitness / Experimental Use)

Again, I am not an expert — but based on conversations with gym buddies and some time spent reading online forums (yes, Reddit included), BPC-157 comes up time and time again.

BPC-157

Often marketed as a healing peptide, particularly for tendon, ligament, and gut repair.

BPC 157, known as the “Body Protection Compound”, is a pentadecapeptide isolated from human gastric juice that demonstrated its pleiotropic beneficial effects in various preclinical models mimicking medical conditions, such as tissue injury, inflammatory bowel disease, or even CNS disorders. Unlike many other drugs, BPC 157 has a desirable safety profile, since only a few side effects have been reported following its administration

Healing Properties

Much work has been expended to demonstrate the potent effect of BPC 157 on the healing process in various experimental models in vivo (i.e., alkali-burn wounds, alloxan-induced gastric lesions)

The review cites multiple preclinical studies showing healing effects in rodent models. That tells me there is probably something biologically active happening.

But the real question is: how well do rodent results translate to humans? Some systems translate well. Others, not so much.

Wound healing? Not so much. The following study goes into detail on how different it is between humans and rodents.

The major mechanisms of wound healing are different between rodents and humans due to differential skin organizational structure. Rodent models are not ideal because the major mechanism of wound healing in rodents is wound contraction, which is significantly different from that in humans.

Based on this, the effects of BPC-157 observed in rodents may not translate directly — or as strongly — to humans.

Now you might say — hang on 🤨. There are tons of people using this stuff who swear it works. Shoulders and knees suddenly feeling better. “Recovery miracles.”

What’s going on there?

One possibility is the placebo effect.

We did not find that placebo interventions have important clinical effects in general. However, in certain settings placebo interventions can influence patient-reported outcomes, especially pain and nausea, though it is difficult to distinguish patient-reported effects of placebo from biased reporting. The effect on pain varied, even among trials with low risk of bias, from negligible to clinically important

My interpretation of that conclusion is:

  1. Placebo will not generally cure serious medical conditions.
  2. It can meaningfully influence subjective outcomes — particularly pain.

That matters, because most BPC-157 claims revolve around pain, recovery, and “feeling better.”

I am not saying BPC-157 does nothing. I am saying it is difficult to distinguish between placebo, the compound itself, natural healing, training adjustments, or expectation effects when someone reports improvement.

Ultimately, we need well-designed human clinical trials. Until then, we’re mostly guessing.

Risks

Even though few side effects have been reported following administration, long-term human trials have not been performed. As a result, the true safety profile in humans remains uncertain.

The same review still emphasizes the need to better define potential side effects, warning that the compound’s complex biological activity could carry unintended risks — including processes such as angiogenesis.

With the increasing interest in the BPC 157 peptide and its application potential, the need to define the risk of probable side effects is also escalating. As already mentioned, the peptide exerts pleiotropic effects via different signaling pathways. Intriguingly, there is only insufficient information about its potential side effects, thus making the compound’s effects still unknown. However, as the mechanism associated with its biological activity appears to be regarded as being complex and diverse, this could pose a serious risk for BPC 157 unverified/untested but possible adverse reactions.

After revisiting the literature, I found another paper that pushes back on some of these concerns — particularly around angiogenesis. The authors argue that criticisms related to cancer risk and angiogenic stimulation are misplaced, and they report no observed toxicity across multiple organs at a wide range of doses.

Overall, from the perspectives of angiogenesis and the nitric oxide (NO) system, all criticisms of BPC 157 should be dismissed. This is because the review by Józwiak and colleagues [1] fails to acknowledge that BPC 157 therapy operates outside the framework of the negative aspects of Folkman’s classical angiogenesis model [7,8,9] (Folkman: angiogenic bioactivity of a given molecule→↑cornea neovascularization→↑carcinoma).

However, even if those criticisms are overstated, we are still left with limited long-term human data.

The absence of observed toxicity in certain models does not automatically translate to long-term safety in healthy individuals using the compound outside of controlled medical settings.

I’m not trying to win an argument — I’m trying to improve the quality of my own decisions.

Note

Even though BPC-157 and traditional performance-enhancing drugs are not marketed for the same purposes, there is some evidence that traditional anabolic agents can influence tissue repair.

Importantly, many traditional PEDs have well-established dose-response relationships. That allows risks to be monitored and partially mitigated through biomarker tracking.

With experimental peptides, that dose–risk relationship does not appear to be clearly defined.

Framework

Making decisions based on incomplete or limited information is something we all have to do — constantly.

Like many others, I’ve found myself in situations where the evidence is unclear but a decision still needs to be made. The following is my attempt at outlining a framework that, while imperfect, may help tilt decisions toward being correct more often than not.

1. Default to Being Unconvinced

The best starting position is neutral skepticism.

Being unconvinced does not mean automatically agreeing or disagreeing — it simply means withholding judgment until sufficient evidence is presented.

You need evidence to say “yes” — and you also need evidence to say “no.”

Note
Interestingly, this is one of the hardest positions for humans to maintain. Uncertainty is uncomfortable, so we often prefer a confident answer over an honest “I don’t know.”

2. Evaluate Only Specific Claims

Claims must be precise. Vague promises are impossible to evaluate.

If a claim cannot be clearly defined, it cannot be meaningfully tested — and the appropriate response is to remain unconvinced.

3. Look for High-Quality Evidence

To move from unconvinced to convinced, look for strong evidence. Prioritize:

  • Human clinical trials
  • Randomized controlled trials
  • Meta-analyses
  • Regulatory approval

Anecdotes are rarely sufficient. Personal experiences and feelings can be compelling, but they are also prone to bias and misinterpretation.

4. Adjust the Evidence Threshold to the Risk

The higher the potential downside, the stronger the evidence should be.

For low-risk decisions, weaker evidence may be acceptable. For high-risk decisions, the bar for evidence should be much higher.

5. Align with Scientific Consensus More Often Than Not

Yes, yes—I know. Everyone is an armchair expert on issues that affect their lives, and that absolutely includes me. However, I would wager that we (armchair experts—and even individual experts) get things wrong more often than the broader scientific consensus does.

Experts are human and therefore not infallible. Like anyone else, they can be influenced by financial incentives, institutional pressures, and personal biases.

However, broad consensus—built across many experts, institutions, and independent lines of evidence—is generally far more reliable than isolated studies, individual opinions, single experts, or confident internet takes.

Note

History shows this pretty clearly. Most scientific progress comes from improving and refining what we already know, not scrapping it entirely. Big revolutions—like germ theory, relativity, or plate tectonics are rare and only happen when the evidence is overwhelming and the new explanation works better.

Even then, the old ideas usually still work in everyday situations. Newton’s physics is still used all the time, despite Einstein giving us a deeper understanding. So while scientific consensus can be wrong, overturning well-established consensus is uncommon.

Note

Reading back over what I’ve written here, it becomes fairly clear that my philosophical stance leans toward Naturalism and Empiricism — the view that our best guide to truth is evidence grounded in observable reality.

I’m not an expert in philosophy, so this is my interpretation. It’s an area I’d like to explore in more depth over time.

Am I on PEDs yet?

If I were ever to consider using performance-enhancing drugs, my approach would be as follows:

  • Use well-documented, pharmaceutical-grade compounds (e.g., testosterone enanthate).
  • Use the lowest effective dose possible (remember: risk is often dose-dependent).
  • Consistently monitor biomarkers to detect and mitigate emerging risks.

However, point number two is the real constraint.

In most healthy individuals with normal testosterone levels, a “low” dose is unlikely to produce the kind of dramatic muscle mass seen in elite or enhanced bodybuilding circles. At best, it may result in modest improvements.

As discussed here: The Muscle and Strength Pyramid – Training 2, elite natural bodybuilders may only add around 0.5 kg of muscle per year. Even if we assume that a conservative dose meaningfully improves that rate — doubling or even tripling it — we are still talking about a few kilograms over multiple years.

Note
I am not implying that I am elite. I would consider myself intermediate, perhaps moving toward advanced at best.

That would certainly make a visible difference on stage. The real question is whether that improvement justifies the additional risk.

To significantly move beyond natural limits, higher doses are typically required — and as already discussed, higher doses generally increase risk.

That becomes a classic risk–reward trade-off. The balance is highly individualized. As mentioned earlier, I am naturally risk-averse — especially when the potential consequences involve long-term health.

Note

This type of asymmetric long-tail risk — where the potential benefits are modest but the downsides are low probability and severe — shows up in many domains: high-leverage margin trading, experimental drugs, and other forms of “small upside, large downside” decisions.

Perhaps I should spend more time studying how to reason about these types of risks properly and write about it in a future post — be on the lookout.

For me, the risk–reward equation simply does not justify the trade.

Closing thoughts

Some of the peptides currently being researched may well prove valuable in the future. Still, history suggests that many experimental compounds do not.

My view on exercise is centered around promoting healthspan, not merely lifespan. Healthspan refers to living well until death — maintaining the ability to move, think, and function independently. Lifespan alone is of little value if you cannot live normally or do the things you care about. As such, any potential downside to long-term health means the burden of proof should be high.

Risk tolerance is personal — but preserving health and functional independence into old age is something most people value deeply.