The Clinical Imperative: Why Physicians Need to Understand Peptide Therapy Now
Patients are arriving in your office with questions you were not trained to answer. They are asking about semaglutide compounded at a fraction of the brand cost, about a peptide they read could heal their rotator cuff in half the surgical timeline, about a Russian neuropeptide nasal spray that their colleague claims transformed their focus and sleep. They have done their research, sometimes sophisticated, often misleading, and they want clinical guidance from someone they trust.
The problem is not that these patients are misinformed. Many of them are correct: therapeutic peptides represent one of the most significant advances in clinical medicine of the past two decades, with a pharmacological evidence base substantially larger than most physicians realize. The problem is a training gap. Peptide pharmacology developed rapidly outside the major pharmaceutical pipelines and has not been systematically incorporated into medical education curricula or mainstream CME programming.
This reference guide addresses that gap directly. The language is clinical. The evidence is cited to primary sources. The regulatory guidance is current as of 2026. The telehealth framework reflects the Rx Direct Peptides platform's specific compliance architecture.
Your patients will use these compounds regardless of whether you help them. The question is whether it will happen safely, with pharmaceutical-grade products from a verified 503A pharmacy, documented clinical rationale, and monitoring, or through unregulated online sources with unknown purity and sterility. Your expertise is the safety net that determines which of these outcomes occurs.
Section 1: Peptide Pharmacology, Mechanisms, Classification, and Pharmacokinetics
A systematic understanding of peptide pharmacology enables clinicians to predict the behavior of unfamiliar compounds, anticipate drug interactions, design rational dosing schedules, and counsel patients accurately. This section covers the pharmacological principles universal to therapeutic peptides before the compound-specific sections that follow.
1.1 Classification and Structural Biochemistry
Peptides are defined as amino acid polymers containing 2–50 residues, distinguished from polypeptides (50–100 residues) and proteins (>100 residues) by molecular weight and structural complexity. Therapeutic peptides span MW from approximately 300 Da (tripeptide KPV) to approximately 4,800 Da (tirzepatide). This range confers specific pharmacokinetic properties including predominant proteolytic metabolism, sensitivity to enzymatic degradation, and, for most native sequences, negligible oral bioavailability without formulation modification.
| Classification | Examples | MW Range | Primary Modification | Clinical Implication |
|---|---|---|---|---|
| Bioidentical endogenous | Thymosin Alpha-1, GHK-Cu, KPV | 390–3,108 Da | None | Activity matches native peptide; favorable safety profile |
| Endogenous fragment | BPC-157 (gastric protein fragment), AOD-9604 (hGH aa 176–191) | 1,419–1,817 Da | None | Isolated biological activity of parent protein |
| Short-acting GHRH analog | Sermorelin, CJC-1295 (no DAC) | ~2,900–3,400 Da | DPP-IV resistant AA substitutions | Pulsatile GH pattern preserved; pairs with GHSR agonists |
| Long-acting fatty acid analog | Semaglutide, Tirzepatide, Retatrutide | 3,800–4,813 Da | C18–C20 fatty acid + albumin binding | Once-weekly dosing; GI AE profile during titration |
| Selective GHSR-1a agonist | Ipamorelin | 711 Da | Non-natural AA (Aib, D-2-Nal) | High GH selectivity; no cortisol elevation |
| Oral ghrelin mimetic | MK-677 (Ibutamoren) | 624 Da | Non-peptide small molecule | Oral bioavailability; 24-hr half-life; appetite stimulation |
| Cyclic antimicrobial peptide | LL-37 Cathelicidin | 4,493 Da | Native alpha-helical structure | Membrane disruption; broad-spectrum; minimal resistance risk |
1.2 Receptor Pharmacology and Signal Transduction
GLP-1 Receptor (Class B GPCR, Gαs coupling): Adenylyl cyclase, cAMP, PKA. In pancreatic β-cells: glucose-dependent insulin secretion via KATP channel closure and calcium influx. In hypothalamic arcuate nucleus: POMC/CART neuron activation, NPY/AgRP inhibition (appetite suppression). In brainstem NTS/area postrema: gastric emptying delay. In cardiomyocytes: cardioprotective cAMP signaling. The glucose-dependency of insulin secretion is the mechanism preventing hypoglycemia with this class.
GHSR-1a (Ghrelin Receptor, Class A GPCR, Gαq/11 coupling): Phospholipase C, IP3/DAG, PKC, intracellular calcium, GH granule exocytosis. Ipamorelin selectively activates this pathway in pituitary somatotrophs without activating GHSR-1a populations involved in cortisol or prolactin release. The combination of CJC-1295 (GHRH receptor, Gαs) and Ipamorelin (GHSR-1a, Gαq) activates convergent intracellular signaling pathways producing synergistic GH release substantially exceeding either compound alone.
Melanocortin Receptors (MC1R–MC5R): MC4R in the medial preoptic area (MPOA) mediates sexual motivation, targeted by bremelanotide (PT-141). MC1R on melanocytes mediates melanogenesis, targeted by Melanotan II. Bremelanotide's engineered MC4R selectivity achieves sexual arousal effects without significant tanning. Melanotan II activates all five subtypes, producing tanning, arousal, appetite suppression, and exocrine effects concurrently.
1.3 Pharmacokinetics: ADME Profile
| Peptide | t½ | Route | Bioavailability | Key PK Feature |
|---|---|---|---|---|
| Semaglutide | ~7 days | SC weekly / oral | SC >95%; oral ~1% | C18 fatty diacid via albumin binding; DPP-IV resistant (Aib at pos. 8) |
| Tirzepatide | ~5 days | SC weekly | >95% | C20 fatty diacid; dual GIP/GLP-1R; superior GI tolerability |
| Retatrutide | ~6 days | SC weekly | >95% | Triple agonist (GLP-1R/GIPR/GCGR); transient tachycardia from glucagon component |
| CJC-1295 (no DAC) | ~30 min | SC | >90% | Pulsatile GHRH stimulus; pairs with Ipamorelin; mimics physiological GH rhythm |
| Ipamorelin | ~2 hrs | SC | >90% | Most selective GHSR-1a agonist; no cortisol/prolactin activation |
| BPC-157 | ~1–4 hrs | SC; oral (GI) | SC >90%; oral GI-targeted | Acid-stable (gastric pH); oral route effective for GI indications |
| Semax | ~10 min (plasma) | Intranasal | Direct CNS via olfactory | Direct hippocampal delivery via olfactory nerve; bypasses blood-brain barrier |
| Bremelanotide (PT-141) | ~6–8 hrs | SC | >90% | Cyclic structure + D-Phe resist proteolysis; MC4R selectivity over MC1R |
| Thymosin Alpha-1 | ~2 hrs | SC | >90% | Bioidentical to endogenous thymic peptide; bidirectional immune modulation |
Section 2: Regulatory Framework for the Prescribing Clinician
2.1 FDA Drug Classification Categories for Peptides
Small synthetic peptides (<40 amino acids) are regulated as drugs under the FD&C Act by CDER. Larger biologically-produced peptides are regulated as biologics under the PHS Act by CBER. FDA-approved biologics are generally excluded from 503A compounding; drug-category peptides can be compounded under appropriate conditions.
2.2 The 503A Compounding Framework
Section 503A of the FD&C Act, as amended by the Drug Quality and Security Act (DQSA) of 2013, allows licensed compounding pharmacies to prepare customized medications for identified patients based on valid prescriptions. Requirements: (1) valid patient-specific prescription from licensed practitioner; (2) USP Chapter 797 compliance for sterile preparations; (3) bulk drug substance on the 503A Bulks List or component of an FDA-approved drug; (4) preparation not commercially available in needed form; (5) state-licensed pharmacy in regulatory compliance.
Legal Issues: Navigating Peptide Therapeutics Without Jeopardizing Your License
For the physician whose patient arrives asking about BPC-157, Ipamorelin, or Semax, the most pressing question is not pharmacological; it is legal. Can I prescribe this? Can I discuss it without liability? Does telehealth change my exposure? What if it is not FDA-approved?
The single most important principle: physician silence does not protect patients. A patient who cannot get a peptide from a licensed compounding pharmacy with a physician's prescription will obtain it from an unregulated online source with no quality assurance, no medical oversight, and no monitoring. Physician engagement, cautious and well-documented, produces better patient outcomes than avoidance.
Category A: FDA-Approved Peptides FDA Approved
Category A comprises peptides that have completed full FDA NDA or BLA review. These may be prescribed on-label or off-label with the protections afforded all off-label prescribing under 21 U.S.C. § 396. Prescriber liability is identical to any other FDA-approved medication.
| Peptide (Brand) | FDA Indication | Year | Prescribing Notes |
|---|---|---|---|
| Semaglutide (Wegovy) | Obesity (BMI ≥30 or ≥27+comorbidity); CVD risk reduction | 2021/2023 | Fully prescribable via Rx Direct Peptides telehealth in all licensed states |
| Semaglutide (Ozempic) | Type 2 diabetes glycemic control | 2017 | Off-label weight use is common and legally protected |
| Tirzepatide (Zepbound) | Obesity management | 2023 | Superior weight loss vs. semaglutide; prescribable via Rx Direct Peptides |
| Tirzepatide (Mounjaro) | Type 2 diabetes | 2022 | Off-label obesity use is protected; Zepbound labeling preferred for obesity |
| Tesamorelin (Egrifta SV) | HIV-associated lipodystrophy | 2010 | Off-label for non-HIV visceral adiposity: document rationale (Falutz NEJM 2007) |
| Bremelanotide (Vyleesi) | HSDD in premenopausal women | 2019 | On-label via Rx Direct Peptides; off-label use in men requires documentation |
| Teriparatide (Forteo) | Osteoporosis (PTH 1-34 fragment) | 2002 | Standard prescribing; no compounding issues |
Category B: Compoundable Peptides PCAC July 2026
| Peptide | Status | PCAC Date | Prescribing Action |
|---|---|---|---|
| BPC-157 Acetate | Under PCAC Review | July 23, 2026 | Defer prescription until PCAC outcome; educate patient; schedule Q4 2026 follow-up |
| KPV Acetate | Under PCAC Review | July 23, 2026 | Same as BPC-157; topical/oral KPV has fewer regulatory issues currently |
| TB-500 (Thymosin Beta-4) | Under PCAC Review | July 23, 2026 | Defer; WADA prohibited for competitive athletes, verify before prescribing |
| MOTS-c | Under PCAC Review | July 23, 2026 | Defer until PCAC outcome |
| Semax | Under PCAC Review | July 24, 2026 | Defer prescription; educational discussion acceptable with documentation |
| Selank | Under PCAC Review | July 24, 2026 | Same as Semax |
| DSIP | Under PCAC Review | July 24, 2026 | Defer until PCAC outcome |
| Epitalon | Under PCAC Review | July 24, 2026 | Defer until PCAC outcome |
| GHK-Cu (injectable) | PCAC Scheduled | Feb 12, 2027 | Topical cosmeceutical GHK-Cu (no Rx required); injectable deferred |
| CJC-1295, Ipamorelin | 503A Eligible Now | Currently prescribable | Prescribe via Rx Direct Peptides with four-part documentation; IGF-1 monitoring required |
| Thymosin Alpha-1 | 503A Eligible Now | Currently prescribable | Level I evidence for cancer/hepatitis; prescribable with standard documentation |
| Sermorelin | 503A Eligible Now | Currently prescribable | Gentle GH secretagogue; appropriate first-line for older or GH-naive patients |
Rx Direct Peptides Telehealth: Compliance Architecture
Most therapeutic peptides are not controlled substances under the Controlled Substances Act, the Ryan Haight Act's in-person requirement therefore does not apply. Telehealth prescribing of non-controlled peptides is governed by general telehealth regulations, which in most states require only: physician licensure in the patient's state, plus a synchronous video consultation.
Rx Direct Peptides' compliance architecture provides: physician state licensure verification before every consultation; synchronous video consultation requirement; compound-specific informed consent documentation covering regulatory status and evidence basis; 503A-verified pharmacy network with confirmed USP Chapter 797 compliance and independent certificates of analysis; monitoring protocol integration; and real-time regulatory update system that reflects PCAC determinations immediately.
Protecting Your Medical License: Board Considerations
- Clinical Rationale: Document why this compound is appropriate for this specific patient, the medical indication, mechanism of action, and evidence basis (Level I/II/III).
- Informed Consent: Documented patient acknowledgment of off-label or compounded nature, evidence basis, alternatives considered, and monitoring plan. Rx Direct Peptides provides compound-specific consent forms.
- Standard of Care Consistency: Would a reasonable physician with anti-aging/sports medicine expertise consider this approach? Document specialty context (A4M, IFM membership or consultation).
- Monitoring Plan: Document specific parameters at specific timepoints. Absence of monitoring is one of the most common bases for board adverse actions in off-label prescribing cases.
Section 5: Metabolic Peptides, GLP-1/GIP/Glucagon Class
| Compound | Mechanism | Max Dose | Avg Weight Loss | FDA Status |
|---|---|---|---|---|
| Semaglutide | GLP-1R agonist | 2.4 mg SC weekly | ~14.9% | FDA Approved, Wegovy/Ozempic |
| Tirzepatide | GLP-1R + GIPR dual agonist | 15 mg SC weekly | ~20.9% | FDA Approved, Zepbound/Mounjaro |
| Retatrutide | GLP-1R + GIPR + GCGR triple agonist | 12 mg SC weekly (Phase III) | ~28.7% (projected) | Phase III | Compounded Cat B |
| Tesamorelin | GHRH analog, pituitary GH, lipolysis | 2 mg SC daily (fasted) | 18.1% VAT reduction | FDA Approved, Egrifta SV (HIV); off-label visceral adiposity |
| Cagrilintide | Amylin receptor agonist | 2.4 mg SC weekly | 8.1% mono; 15.6% with sema | Phase III | Compounded Cat B |
| AOD-9604 | hGH fragment, β3-AR lipolysis | 500 µg SC daily | ~5–10% (add-on) | Compounded Cat B (Phase IIb completed) |
Section 8: Longevity and Immune Peptides
8.4 Thymosin Alpha-1 Level I Evidence
International approvals: Approved in 35+ countries as Zadaxin for chronic hepatitis B, hepatitis C, and cancer immunotherapy adjunct.
COVID-19: Multiple Chinese studies documented improved lymphocyte counts, reduced ICU duration, and mortality reduction in severe COVID-19, mechanistically consistent with counteracting SARS-CoV-2-induced lymphopenia.
Current US status: 503A-eligible compounded preparation; fully prescribable via Rx Direct Peptides. Dose: 1.6 mg SC 2x weekly, 4–8 week courses, 2x yearly.
Section 9: Aesthetic, Sexual Health, and Endocrine Peptides
9.1 Bremelanotide (Vyleesi) FDA Approved
Section 10: Supportive Compounds
| Compound | Primary Function | Preferred Route | Key Evidence | Regulatory |
|---|---|---|---|---|
| NAD+ (IV) | Sirtuin activation, mitochondrial energy, DNA repair | IV 500–1,000 mg monthly | Elhassan et al., Cell Rep 2019 (PMID 31722201) | No restriction |
| NMN (oral) | NAD+ precursor, maintenance between IVs | PO 500–1,000 mg/day | Multiple human RCTs; Level II | Supplement; no restriction |
| Glutathione (IV/SC) | Master antioxidant, Phase II liver detox, immune cell support | IV 600–1,200 mg or SC 400 mg | Cascinu et al., J Clin Oncol 1995 (Level II) | No restriction |
| L-Carnitine (SC) | Long-chain fatty acid mitochondrial import (CPT-1 substrate) | SC 500 mg 3x weekly | KDIGO CKD guidelines (Level I) | No restriction |
| 5-Amino-1MQ (oral) | NNMT inhibition, adipocyte metabolic reactivation | PO 50–100 mg/day | Ryu et al., Cell Metabolism 2023 (Level III) | No restriction |
References: Peer-Reviewed Literature
GLP-1 Class
Wilding JPH, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002. DOI: 10.1056/NEJMoa2032183 [STEP 1]
Lincoff AM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221-2232. DOI: 10.1056/NEJMoa2307563 [SELECT]
Jastreboff AM, et al. Tirzepatide Once Weekly for Treatment of Obesity. N Engl J Med. 2022;387(3):205-216. DOI: 10.1056/NEJMoa2206038 [SURMOUNT-1]
Jastreboff AM, et al. Triple-Hormone-Receptor Agonist Retatrutide for Obesity. N Engl J Med. 2023;389(6):514-526. DOI: 10.1056/NEJMoa2301972
Blundell J, et al. Cagrilintide + Semaglutide. Lancet. 2023;402(10410):1400-1414. DOI: 10.1016/S0140-6736(23)01069-6
Tesamorelin, BPC-157, TB-500
Falutz J, et al. Metabolic Effects of a GH-Releasing Factor in HIV Patients. N Engl J Med. 2007;357(23):2359-2370. DOI: 10.1056/NEJMoa072134 [Phase III; Level I]
Chang CH, et al. BPC 157 on Tendon Healing. J Appl Physiol. 2011;110(3):774-780. PMID: 21030671
Bock-Marquette I, et al. Thymosin beta4 Promotes Cardiac Cell Migration and Repair. Nature. 2004;432:466-472. DOI: 10.1038/nature03000
GH Secretagogues, Neurological, Longevity
Ionescu M, Frohman LA. Pulsatile GH Secretion Persists During CJC-1295 Stimulation. J Clin Endocrinol Metab. 2006;91(12):4792-4797. PMID: 16352683
Raun K, et al. Ipamorelin, the First Selective GH Secretagogue. Eur J Endocrinol. 1998;139(5):552-561.
Dolotov OV, et al. Semax Regulates BDNF and TrkB in Rat Hippocampus. Brain Res. 2006;1117(1):54-60. PMID: 16996661
Khavinson VKh, et al. Epithalon Induces Telomerase Activity in Human Somatic Cells. Bull Exp Biol Med. 2003;135(6):590-592. PMID: 12937682
Lee C, et al. MOTS-c Promotes Metabolic Homeostasis. Cell Metab. 2015;21(3):443-454. PMID: 25738459
Li X, et al. Thymosin Alpha 1 in Lung Cancer, RCT Meta-Analysis. Expert Opin Biol Ther. 2014;14(S1):S73-S80.
Kingsberg SA, et al. Bremelanotide for HSDD, Phase 3 Trials. Obstet Gynecol. 2019;134(5):899-908. PMCID: PMC6735515
Elhassan YS, et al. NMN Augments Aged Skeletal Muscle NAD+ Metabolome. Cell Rep. 2019;28(7):1717-1728. PMID: 31722201
Lopez-Otin C, et al. The Hallmarks of Aging. Cell. 2013;153(6):1194-1217. PMID: 23746838
Appendix A: Master Prescribing Reference, All 30+ Compounds
| Compound | Category | ICD-10 | Dose / Route | FDA Status 2026 | Evidence | Key Safety |
|---|---|---|---|---|---|---|
| Semaglutide (Wegovy/Ozempic) | GLP-1 agonist | E66.x, E11.x | 0.25–2.4 mg SC weekly; 3–14 mg PO | APPROVED | Level I | MTC/MEN2 contraindicated; GI monitoring |
| Tirzepatide (Zepbound/Mounjaro) | GLP-1+GIP dual agonist | E66.x, E11.x | 2.5–15 mg SC weekly | APPROVED | Level I | Same as semaglutide; superior weight loss |
| Retatrutide | Triple agonist (GLP-1+GIP+GCGR) | E66.x | 0.5–12 mg SC weekly (titrated) | Phase III / Compounded | Level II | HR monitoring; GI monitoring |
| Tesamorelin (Egrifta SV) | GHRH analog | B20 (HIV); E65 (off-label) | 1–2 mg SC daily (fasted) | APPROVED (HIV); Off-label | Level I (HIV) | Glucose monitoring; IGF-1 monitoring |
| CJC-1295 (no DAC) | GHRH receptor agonist | E34.9 | 100 µg SC nightly (with Ipa) | 503A Eligible | Level II | IGF-1 monitoring; cancer screening baseline |
| Ipamorelin | GHSR-1a selective agonist | E34.9 | 100–200 µg SC nightly | 503A Eligible | Level II | Most selective GHS; no cortisol elevation |
| Sermorelin | GHRH analog (29 AA) | E23.0 | 200–300 µg SC QD–BID | 503A Eligible | Level II | Gentle first-line GH secretagogue |
| MK-677 (Ibutamoren) | GHSR-1a agonist (oral) | E34.9 | 10–25 mg PO nightly | 503A Eligible | Level II | Appetite stimulation; glucose monitoring |
| BPC-157 Acetate | Healing peptide | M75.x, K51.x, K50.x | 300–500 µg SC daily; oral 250–750 µg BID | PCAC Review Jul 23, 2026 | Level III | Contraindicated active malignancy |
| TB-500 (Thymosin Beta-4) | Systemic healing | M75.x, systemic | 2–5 mg SC 2x/week loading; weekly maintenance | PCAC Review Jul 23, 2026 | Level II/III | WADA prohibited; cancer contraindication |
| KPV | NF-kB inhibitor | K51.x, K50.x, L20 | Oral 250–750 µg BID; topical; SC 250–500 µg daily | PCAC Review Jul 23, 2026 | Level III | No HPA axis suppression |
| Thymosin Alpha-1 | Immune modulator | B18.x, C34.x adjunct | 1.6 mg SC 2x weekly (4–8 week courses) | 503A Eligible | Level I (cancer/hepatitis) | Contraindicated solid organ transplant on immunosuppression |
| Bremelanotide (Vyleesi) | MC3R/MC4R agonist | F52.0, N52.x (off-label men) | 1.25–1.75 mg SC PRN (45 min before) | APPROVED (HSDD women) | Level I | Uncontrolled HTN contraindicated; BP monitoring |
| Semax | BDNF upregulator | I69.x, F03.9x | 0.1% intranasal BID (200–400 µg/nostril) | PCAC Review Jul 24, 2026 | Level II (Russian RCTs) | Caution in seizure disorder |
| Selank | Anxiolytic peptide | F41.x, F32.x | 0.15% intranasal BID–TID | PCAC Review Jul 24, 2026 | Level II | No dependence or sedation |
| Epitalon | Telomerase activator | Z13.88 | 5–10 mg SC daily x 10 days, 2x yearly | PCAC Review Jul 24, 2026 | Level III | Contraindicated active malignancy |
| MOTS-c | Mitochondrial metabolic peptide | E11.x, E66.x | 5 mg SC 3x weekly | PCAC Review Jul 23, 2026 | Level II (animal) | Metabolic panel monitoring |
| SS-31 (Elamipretide) | Cardiolipin stabilizer | I50.x, N18.x | 2 mg SC daily or 3x weekly | Phase III (RESOLVE-HF) | Level II (Phase II) | Cardiac/renal monitoring |
| Kisspeptin-10 | KISS1R agonist, GnRH release | E29.1, N91.x | Per reproductive endocrinology protocol | 503A Eligible | Level II | RE co-management recommended |
| NAD+ (IV) | Sirtuin/PARP substrate | E88.9, Z51.x | 500–1,000 mg IV monthly; NMN 500–1,000 mg PO daily | No restriction | Level II | Monitor LFTs if combining with high-dose niacin |
| Glutathione (IV/SC) | Master antioxidant | Z51.x | 600–1,200 mg IV; 400 mg SC | No restriction | Level II | Verify formulation stability with pharmacy |
| L-Carnitine (SC) | Fatty acid transport | E71.40 (deficiency); adjunct | 500 mg SC 3x weekly | No restriction | Level I (CKD/ESRD) | Avoid high-dose oral (TMAO concern) |
Appendix C: ICD-10 Coding Reference
| Indication | ICD-10-CM Code | Documentation Required |
|---|---|---|
| Obesity (general) | E66.9 | BMI, comorbidities, prior treatment attempts |
| Morbid obesity | E66.01 | BMI ≥40; comorbidities documented |
| Metabolic syndrome | E88.81 | ATP III or IDF criteria; component conditions coded |
| Functional somatopause | E34.9 | IGF-1 level; clinical symptoms; contraindications excluded |
| Adult GH deficiency | E23.0 | GH stimulation test results; pituitary imaging |
| Tendinopathy (shoulder) | M75.100–M75.122 | Imaging; failed conservative treatment; functional limitation |
| HSDD (premenopausal) | F52.0 | FSFI desire domain score; FSDS-D score; premenopausal status |
| Post-COVID condition | U09.9 | COVID-19 history; specific symptoms; functional impact |
| Preventive/longevity | Z13.88 or Z13.89 | Preventive context; patient age; baseline biomarkers documented |
| HIV lipodystrophy (tesamorelin) | B20 + E88.1 | HIV diagnosis; HAART regimen; lipodystrophy on physical exam |
| IBD (Crohn's) | K50.90 | Disease activity index; colonoscopy/imaging; prior treatment |
| Ulcerative colitis | K51.90 | Mayo Score; colonoscopy; prior treatment history |
| Secondary hypogonadism (men) | E29.1 | LH, FSH, total T; imaging if pituitary cause sought |
| Hypothalamic amenorrhea | N91.2 or E23.3 | LH pulsatility; energy availability assessment; prior menses history |