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Clinicians need to be aware of the growing grey market of injectable peptide-based substances being promoted online for weight loss.
Australian clinicians are increasingly encountering patients using or inquiring about unregulated injectable peptide-based substances. While several compounds are promoted via social media claiming benefits of ‘tissue repair’, ‘skin rejuvenation’ and ‘anti-aging’, we are particularly alarmed by the number of patients in our public multidisciplinary obesity clinic admitting to the use of unregulated products for weight loss, presumed to be pharmaceutical grade glucagon-like peptide-1 receptor agonists (GLP-1RA). This phenomenon demands clinical awareness and a non-judgemental approach to foster trust, openness, and engagement in clinical care.
From Silicon Valley to our clinics
While the precise origin of the peptide-based substance use trend is unclear, the widespread uptake among Silicon Valley entrepreneurs and wellness influencers, seeking performance optimisation beyond conventional medicine, has reverberated across social media platforms globally. US customs data reveals peptide-based substance imports from China nearly doubled from $164 million in early 2024 to $328 million in early 2025, reflecting surging demand. Social media influencers across platforms have likely amplified this trend, bringing unregulated peptide use into mainstream discussion, and now, to the clinic.
Within Australian clinical practice, people, particularly those aged in their 20s and 30s, are increasingly inquiring about or using these unregulated compounds. Drivers of uptake include cost barriers of approved GLP-1RA therapies, limited PBS eligibility criteria, and the perception that grey-market alternatives offer equivalent therapeutic benefit at lower cost or access to more effective novel agents unavailable in Australia. For instance, products purporting to contain retatrutide — a GLP-1/GIP/glucagon triple agonist which demonstrated 24.2% weight loss at 48 weeks in Phase 2 trials — have been increasing in popularity. Phase 3 trials are still in progress and full trial data are not yet published. Retatrutide is not approved from the Australian Therapeutic Goods Administration (TGA) nor any international regulatory body. Nevertheless, grey-market versions of uncertain composition are readily accessible online and “legitimised” through social media marketing. People purchasing these products face unverified risks relating to critical safety parameters including compound identity, concentration, and contamination.
The TGA issued warnings from late 2025 regarding the importation of unregistered GLP-1 products being promoted online for weight loss. These promotions can include misleading or false advertising through social media channels including Instagram and TikTok, with many targeting adolescents. Despite many overseas vendors attempting to circumvent regulations by labelling these products as ‘for research use only’, they often provide detailed dosing protocols and injection supplies to consumers. Additionally, there is a risk of some fitness and wellness social media influencers further amplifying this trend by demonstrating administration techniques and sharing positive testimonials. This is particularly concerning as the Australian Consumer and Competition Commission found up to four out of five Australian influencers promote products without clear paid-partnership disclosures.
Clinical approach
We suggest following a non-judgemental approach in response to peptide use disclosure or inquiry (Box 1).
| Domain | Suggested Approach |
| Documentation | Health practitioners shouldrecord product source, specific peptide, dosing regimen, duration, and adverse effects. This information contributes to emerging safety data. |
| Education | It is important toexplain that grey-market products differ fundamentally from pharmaceutical-grade compounds with independent testing by the TGA finding several counterfeit products did not contain the advertised substance at all. While many vendors supply certificates of analysis or purity certificates to add legitimacy, they are often misleading, incomplete or not entirely true. For patients with metabolic comorbidities (cardiovascular disease, hepatic steatosis, chronic kidney disease), introducing compounds of uncertain composition places an additional health hazard. |
| Suggest evidence-based alternatives | There are several TGA-approved alternative anti-obesity medications including semaglutide and tirzepatide. While there is no current PBS subsidy making the cost a major barrier, they do have quality control and clinical trial evidence to support their use. |
| Monitoring | For people choosing to continue use of peptides, acknowledging the absence of safety data guiding these protocols and maintaining open engagement in clinical care should be a priority. While there is no evidence to suggest routine monitoring, we suggest investigating and treating any symptoms that arise and using the opportunity for preventative health screening. |
| Adverse event reporting | Report suspected adverse events to the TGA to contribute to national safety databases. |
Systemic Strategies
Individual clinical encounters require complementary systemic responses.
Public and professional awareness: The Australian Medical Association, collaborating with professional bodies (such as RACGP and RACP), could develop targeted campaigns explaining regulatory approval processes and unregulated product risks, delivered through social media platforms where promotion occurs.
Enhanced regulation: Enhanced surveillance of online promotion and international supply chains is warranted given the volume of advertising outpacing current regulatory capacity. In addition to TGA safety notices, regulatory enforcement including fines is essential.
Access to approved therapies: Improving PBS access to TGA-approved obesity pharmacotherapy may reduce grey-market appeal by addressing underlying treatment access barriers.
The grey-market peptide trend represents a convergence of social media influence, patient demand for affordable and effective obesity treatments, and globalised unregulated commerce. Clinicians must maintain awareness of this evolving landscape, implement non-judgmental approach to patient encounters, and advocate for the regulatory and educational responses this public health challenge demands.
Dr Riashad Monjur is a General and Metabolic Medicine Advanced Trainee at Campbelltown & Camden Hospital.
Associate Professor Piya is an Academic Endocrinologist at the School of Medicine, Western Sydney University as well as Head of Department for the Macarthur Diabetes Endocrinology and Metabolism Service at Campbelltown and Camden Hospitals, South Western Sydney Local Health District, NSW. A/Prof Piya has received honoraria from Eli Lilly, Novo Nordisk, Boehringer Ingelheim and Johnson & Johnson.
Professor Phillipa Hay is an Academic Psychiatrist. She is Foundation Chair of Mental Health at Western Sydney University (WSU) and Director for Mental Health Research for the South Western Sydney Local Health District. Prof Hay has received sessional fees from the Australian Medical Council, Health Education and Training Institute (HETI, NSW), and royalties/honoraria from Hogrefe and Huber, McGraw Hill Education and BioMed Central. She has prepared a report under contract for Takeda (formerly Shire) Pharmaceuticals regarding binge eating disorder (July 2017), and was a consultant to Takeda Pharmaceuticals and is a consultant to Tryptamine Pharmaceuticals.
Dr Veena Jayadev is a Staff Specialist Endocrinologist and Head of Department for the Andrology Service at Concord Repatriation and General Hospital.
Dr Nic Kormas is a Senior Staff Specialist Endocrinologist and Head of Department for the Endocrinology Service at Concord Hospital. He has established 3 specialist multidisciplinary obesity services in public hospitals and an Aboriginal Medical Service, co-ordinates two publicly funded Bariatric Surgery Programs, is a Board Member of the Weight Issues Network (WIN) Charity and Treasurer of the National Association of Clinical Obesity Services (NACOS). Dr Kormas has received honoraria for presentations from Johnson & Johnson; and is a Board Member of the Weight Issues Network.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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