When healthcare becomes an upsell

One of the joys of being a woman in midlife is discovering that apparently every normal inconvenience of aging now requires a subscription, a blood panel and something injectable.

Tired? Peptide. Not recovering like you used to? Peptide. Body composition changed? Peptide. Sleep rubbish? Hormones and peptides. Want to age well? Excellent. There is apparently a syringe for that too.

But this week I went down a slightly different rabbit hole. I stopped looking at what they are selling and started looking at how the businesses selling it are built.

I could start my own peptide business

Literally tomorrow, well within 48 hours.

There are health platforms currently marketing themselves directly to health coaches, fitness studios, wellness centers and medspas. The pitch is remarkably simple: you bring the clients, they provide the technology, clinical infrastructure, laboratories, pharmacies and access to licensed clinicians. Your business gets a branded online storefront selling prescription products, laboratory testing, hormone treatments, weight management drugs and peptides.

One platform currently advertises that businesses can be live in as little as 48 hours. You do not need to build a medical practice, run a pharmacy, or own a laboratory. You just slap your branding on the storefront and send your existing clients there.

Which is how "Sizzling Suzy's Sexy Peptide Biz" could theoretically be born.

Follow the money

The platform I looked at actively markets this model as a way for wellness businesses to increase revenue. Businesses can set their own prices, and its published terms allow the wellness partner to add its own service fee on top of the underlying cost of the products and services. The platform then processes the transaction and pays the relevant amount back to the wellness business.

Think about that for a minute.

The coach, trainer or wellness business that already has your trust can educate you about peptides, tell you about their potential benefits, direct you towards a branded clinical storefront and financially benefit when you purchase treatment.

That does not automatically mean the treatment is inappropriate. But it absolutely means the recommendation is not financially neutral. And when someone is simultaneously educating you about a problem and selling you the solution, I want you to ask more questions.

But there are board certified clinicians...

This is where the language sounds incredibly reassuring. Licensed clinicians. Board certified. Medical supervision. All sound reassuring. But what do they actually tell you?

A doctor being board certified does not automatically mean they have specialist expertise in your particular problem. If you are experiencing complicated menopause symptoms, knowing that a clinician is board certified tells you very little unless you also know what they are board certified in and what experience they have treating menopause.

And there is another layer. The platform I investigated states in its own legal terms that it is not a healthcare provider. The actual healthcare is provided by independent third party providers using its infrastructure.

So I would want to know: who exactly is writing my prescription? What are their qualifications? Will I see the same clinician next time? Who reviews my response to treatment? What happens if I experience side effects? What monitoring is mandatory? Who is ultimately responsible for my ongoing care?

Because access to a clinician is not the same thing as specialist, continuous medical care.

And then we get to the injectables

This is where my concern goes up considerably. I am not anti medication and I am certainly not anti injectables. There are injectable medicines with excellent evidence that can be completely appropriate when prescribed for the right person for the right reason.

The problem is treating injectable peptides as though they are an established category of wellness treatment. They are not. Some peptides being promoted in this space have limited human evidence. Some are investigational. Some have not been FDA approved for any indication.

The FDA has specifically identified limited safety information and potential concerns around several peptides that have appeared in the compounding market, including BPC 157, TB 500 and ipamorelin. That does not prove those compounds are dangerous in every circumstance. It means we do not have the level of human evidence required to confidently make many of the claims being made about them. And evidence specifically in perimenopausal and postmenopausal women is thinner still.

Mechanism is not outcome. Animal research is not a human clinical trial. A compound affecting a biological pathway does not mean injecting it will make you recover faster, lose fat, sleep better or age more slowly. Those jumps are where wellness marketing makes its money.

Compounded does not mean FDA approved

This matters because many products sold through these models are compounded. Compounding itself is legitimate medicine and can be extremely useful when a patient's clinical needs cannot be met by an FDA approved product. But a compounded drug is not FDA approved. The FDA does not review compounded medications for safety, effectiveness or manufacturing quality before they are marketed in the same way it reviews approved drugs.

And when something is injectable, quality becomes particularly important. The FDA warns that poor compounding practices can result in contamination, incorrect strength and problems with purity. Those failures have caused serious injuries and deaths.

The bit that really bothers me

It's the combination. A woman struggling with sleep, body composition, recovery, fatigue or just struggling with the menopause transition and suddenly having a body that doesn't behave as predictably as it did at 35. She follows someone she trusts. That individual explains why conventional approaches are not enough, then introduces an exciting treatment. There is medical language, clinicians, a prescription, a beautifully branded portal. Everything feels reassuringly healthcare adjacent.

And sitting underneath it is a business model where more treatment can mean more revenue. Something framed as helpful then becomes predatory, particularly when the target market is women who have spent years being told they need fixing.

Before you buy anything, ask these questions

• —Who is actually prescribing this?
• —What are they board certified in?
• —Do they have specialist experience in the problem I am being treated for?
• —What evidence supports this treatment in humans? Has it actually been studied in women like me?
• —Is this medication FDA approved for this indication?
• —If it is compounded, why is a compounded version clinically necessary?
• —Which pharmacy makes it? What quality testing has been performed?
• —Who monitors me after the prescription is written?
• —And perhaps most importantly, who makes money if I say yes?

And before you reach for the syringe...

Most of these products are being sold as solutions to problems that rarely have one.

• —Want to preserve muscle? Lift weights and eat enough protein.
• —Want better body composition? Look at energy intake, protein, activity, resistance training and sleep.
• —Want better recovery? Manage training load, eat properly and sleep.
• —Want stronger bones? Resistance training, adequate calcium and vitamin D where appropriate, and proper medical assessment if your fracture risk warrants it.
• —Want better cardiovascular health? Move, exercise, eat a decent diet, do not smoke and manage the risk factors we already know matter.

Not sexy. Not proprietary. Difficult to trademark. And unfortunately for the wellness industry, you cannot charge someone hundreds of dollars every month for them. The boring basics are still the things that have the best evidence behind them.

So yes, buyer beware. A slick platform, medical sounding language and access to a clinician do not automatically mean that the person selling you treatment has your long term health outcome at the center of the decision.

When healthcare feels like an upsell, follow the evidence, the care pathway and always follow the money.