The Add-On Menu

Just over a quarter of the sellers we track — 152 of 560 — run a peptide menu alongside their GLP-1 offering, and 127 of those also publish GLP-1 prices. Ranked by how often they appear, the menu is almost exactly the inverse of a ranking by evidence.

What is on the menu

Glutathione deserves a word, because “no evidence” would be wrong. It has a real randomized literature — in skin lightening and melasma, in Parkinson’s disease, in autistic children with disruptive behavior, in sepsis. What it does not have is trials for the reasons it appears on these menus. Evidence for one use is not evidence for another, and a seller citing “studies” is not necessarily citing studies of what you are buying it for.

The two items with the most human trial evidence — tesamorelin and bremelanotide, both of which became approved drugs — sit near the bottom of the menu. The two at the top have the least. We set out the trial counts in what has human trials and what does not.

Ranked by evidence, the list nearly reverses.

Why the inversion makes commercial sense

This is not a conspiracy and it does not need one. The items at the top of the menu share properties that have nothing to do with whether they work.

• They treat something everyone has. Energy, aging, recovery and general wellness have no diagnostic threshold, so nobody is excluded and nothing can fail.
• They have no approved indication, which means no label, no approved claim, and therefore no claim that can be contradicted by one.
• Nobody can tell whether they worked. Unlike a GLP-1, where the scale answers within weeks, an energy or longevity product is unfalsifiable at the individual level.
• They are cheap to add. The consultation, the prescriber relationship and the shipping already exist, so an extra product is close to pure margin.

The items further down the menu are the opposite: they treat specific conditions, in specific people, with specific measurable outcomes. That makes them harder to sell to everyone, which is exactly why they appear less often.

The shape of a typical menu

The median menu carries three items; the longest we found carries twenty. A short menu of two or three is usually the top of the list above — NAD, sermorelin, glutathione. Long menus tend to add the research-chemical end, where evidence thins to nothing and, in some cases, lawful compounding stops entirely: see what cannot legally be compounded.

What to do at the point of sale

1. Ask what it is approved for. For most of the top of that menu, the answer is nothing, anywhere.
2. Ask how you would know it worked. If there is no measurable endpoint, you are buying a subscription rather than a treatment.
3. Ask what it costs annually, not monthly. Add-ons are priced to look small next to the main product.
4. Notice when the offer arrives. Add-ons are usually presented after you have committed to the GLP-1, which is a sales sequence rather than a clinical one.

None of this means the sellers running these menus are bad. Many run them alongside a perfectly reasonable GLP-1 service. It means the menu is a commercial artifact and should be read as one — and that the ordering of it tells you about marketing rather than about medicine.