I am not going to tell you not to do this.
Millions of Americans who clinically qualify for these medications cannot get them covered, cannot afford the list price, and are not going to accept that as an answer. Lecturing them about it has accomplished nothing in three years and it is not medicine, it is moralising.
What I can do is tell you what separates a defensible source from a dangerous one, because the marketing has been carefully constructed so that you cannot see the difference.
The three tiers, which get deliberately blurred
Tier one: a licensed 503A compounding pharmacy. State-licensed, requires a prescription for an individually identified patient, subject to state board of pharmacy oversight and USP compounding standards.
Tier two: a 503B outsourcing facility. Registered with the FDA, inspected against current good manufacturing practice, permitted to make larger batches. Higher regulatory bar.
Tier three: everything else. Websites selling vials of “research peptides,” labelled not for human consumption, shipped from anywhere, with no prescriber, no pharmacy licence, and no legal obligation to anyone. The disclaimer is not a formality — it is how they stay outside the framework that would otherwise apply to them.
Tier three is frequently designed to look like tier one. Clean website, white coat photography, a “medical team,” a checkout flow that resembles telehealth. The tell is almost always in what is absent rather than what is claimed.
“Not for human consumption” is not a technicality. It is the seller telling a regulator, in writing, that whatever happens to you is not their problem.
The eleven questions
Ask them in writing. A legitimate operation answers all eleven without difficulty. Anything that deflects, delays, or answers a different question has told you what you needed to know.
- What is the pharmacy’s name and state licence number? Then verify it independently with that state’s board of pharmacy. Do not accept a screenshot.
- Is it a 503A pharmacy or a 503B outsourcing facility?
- Who is the prescriber, and are they licensed in my state? A named individual, not “our medical team.”
- Is the active ingredient base semaglutide, or a salt form? Sodium and acetate salts are not the same active ingredient as what is in approved products, and the FDA has warned about them specifically.
- Where is the active pharmaceutical ingredient sourced, and is that facility FDA-registered?
- Can I see a certificate of analysis from an independent laboratory for my batch? Potency and sterility, from a lab that is not the seller.
- What exactly is in the vial besides the drug? Some compounded products add B12 or other substances. You should know why, and consent to it.
- What concentration is it, and is the dose fixed or do I calculate it? This is the safety question that matters most in practice.
- What is the beyond-use date, and how should it be stored?
- Who do I call at 2 a.m. with a reaction, and is there a licensed pharmacist on the line?
- What is the process if a batch is recalled, and how would I be contacted?
Red flags that should end the conversation
- No prescription required, or a “consultation” that is a form with no human reviewing it
- Prices that make no sense — a year of medication for the cost of a month
- Any variation of “research use only” or “not for human consumption”
- Sold as a powder you reconstitute yourself
- No named pharmacy, no licence number, no physical address
- Payment by cryptocurrency, wire transfer, or peer-to-peer app only
- Bulk discounts, subscription lock-ins, or affiliate codes from influencers
- Claims that it is “the same as Ozempic” — no compounded product is the same as an FDA-approved one, by definition
Tell your actual doctor
The thing I most want from anyone reading this: put it in your record.
I have had patients arrive with unexplained gastrointestinal symptoms, abnormal liver tests, or a hospital admission, and the compounded GLP-1 they had been taking for seven months came up on the third visit because they were embarrassed. That is a genuinely dangerous silence, and it is one created by clinicians who moralise rather than listen.
You will not be reported. You will not be dropped. The information changes the differential diagnosis, and withholding it is more dangerous to you than any pharmacy is.
Bring dates rather than impressions. Which pharmacy, which lot number if you have it, what concentration, what dose, and when each symptom began. That record is what makes an adverse event traceable at all, and it is the difference between a clinician who can help you and one who is guessing in front of you. Keep it wherever you will genuinely keep it — Zenday is designed for this and will hold a lot number alongside the dose, which paper does badly.
The thing underneath all of this
Every one of these eleven questions exists because the approved product costs more than a car payment and a large share of Americans who need it cannot get it covered.
The gray market is a symptom. Treating the symptom carefully is worth doing. It is not the same as treating the disease.