Every peptide ranked S-tier through D-tier by published evidence quality, risk profile, and the bloodwork you must track if you run it. The honest 2026 list.
# Peptide Tier List 2026: Ranked by Evidence, Risk, and Bloodwork Burden Most peptide tier lists rank by hype. This one ranks by **published evidence quality + risk profile + bloodwork you must track to run it safely**. The bloodwork column is the part the other lists skip — and it's the part that determines whether a "good" peptide on paper is actually a good peptide for your situation. This is updated for the post-RFK 2026 reclassification. Many of these now require a prescription and licensed compounding pharmacy — that's noted per row.
These have human RCTs, FDA-approved indications somewhere in the world, and well-understood biomarker patterns.
Tesamorelin — FDA-approved (Egrifta) for HIV-related visceral fat reduction. Strong IGF-1 response in published trials. Off-label use for body composition + IGF-1 optimization is the most evidence-based GH-axis intervention available. *Bloodwork burden: medium* — IGF-1 at 6 weeks, IGFBP-3, fasting glucose, HbA1c quarterly.
Semaglutide — FDA-approved (Ozempic / Wegovy). The most clinically studied GLP-1, with landmark STEP trials documenting 15%+ body weight reduction over 68 weeks. *Bloodwork burden: medium* — HbA1c, fasting glucose, ApoB, LFTs, amylase/lipase, total/free testosterone (sarcopenia risk). [Read the full lab guide →](/blog/semaglutide-blood-work-guide)
Tirzepatide — FDA-approved (Mounjaro / Zepbound). Dual GIP/GLP-1 agonist showing superior weight loss vs semaglutide in head-to-head data. Same monitoring profile as semaglutide. *Bloodwork burden: medium*.
Thymosin Alpha-1 — FDA-approved internationally as Zadaxin. Strong immune-modulation evidence, especially post-viral and integrative oncology. *Bloodwork burden: medium-high* — CD4/CD8, NK cell activity, CBC with differential, cytokine panel.
These have meaningful published research and clear bloodwork mapping, but the protocol design matters more than for S-tier.
BPC-157 — Extensive animal evidence for tendon, ligament, and gut healing. Limited human RCTs but a strong case-series base. Post-2026 reclassification: prescription required. *Bloodwork burden: low-medium* — IGF-1, hs-CRP, CBC, iron panel.
TB-500 (Thymosin Beta-4) — Synergistic with BPC-157 (the "Wolverine Stack"). Animal and observational human data for tissue repair and angiogenesis. *Bloodwork burden: low-medium* — hs-CRP, CBC, serum copper.
Ipamorelin + CJC-1295 (no DAC) — The gold-standard GH secretagogue stack. Pulsatile GH release with minimal cortisol/prolactin elevation. Predictable IGF-1 response curve. *Bloodwork burden: medium* — IGF-1, IGFBP-3, fasting glucose, HbA1c. [Read DAC vs no-DAC comparison →](/blog/cjc-1295-dac-vs-no-dac)
Sermorelin — FDA-approved for pediatric GH deficiency, off-label use as gentler GH secretagogue. Lower IGF-1 response than CJC-1295, smaller side-effect profile — good for first-time GH-axis users. *Bloodwork burden: medium*.
PT-141 (Bremelanotide) — FDA-approved (Vyleesi) for hypoactive sexual desire disorder in women. Used off-label in men. *Bloodwork burden: low* — but requires blood pressure monitoring (transient elevation common).
Real research base, but human data is thinner. Higher uncertainty — track more carefully.
MOTS-c — Mitochondrial peptide with growing metabolic-optimization research. *Bloodwork burden: medium-high* — fasting glucose, HbA1c, fasting insulin, ApoB, lactate.
GHK-Cu — Strong cosmetic / wound-healing evidence; metabolic effects less established. Watch serum copper. *Bloodwork burden: medium* — serum copper, ceruloplasmin, P1NP.
Retatrutide — Triple GLP-1/GIP/glucagon agonist. Phase 2 data shows ~24% mean weight loss at 48 weeks (largest of any GLP-1-class compound). Not FDA-approved yet. *Bloodwork burden: high* — HbA1c, fasting glucose, ApoB, triglycerides, LFTs, weight, heart rate. [Read the Phase 2 breakdown →](/blog/retatrutide-lilly-triple-agonist-2026)
Epithalon — Russian-origin tetrapeptide studied for telomere elongation and pineal melatonin regulation. Compelling but early. *Bloodwork burden: medium* — telomere length (specialized), melatonin, IGF-1.
KPV — Anti-inflammatory tripeptide derived from alpha-MSH, particularly for gut inflammation. *Bloodwork burden: medium* — hs-CRP, calprotectin (gut), cytokine panel.
These have niche use cases or require very careful monitoring.
Orforglipron — Lilly's first oral GLP-1, Phase 3 in 2026. *Bloodwork burden: medium* — same as semaglutide once available.
HGH (Somatropin) — FDA-approved for GH deficiency. Effective but expensive and requires the heaviest bloodwork load. *Bloodwork burden: very high* — IGF-1, IGFBP-3, fasting glucose, fasting insulin, HbA1c, ApoB, thyroid panel.
IGF-1 LR3 — Modified IGF-1 with extended half-life. Standard IGF-1 lab assay does NOT detect LR3 — you can't track it the way you'd track natural IGF-1 elevation. *Bloodwork burden: high but partially blind* — fasting glucose monitoring is critical (hypoglycemia risk).
MK-677 (Ibutamoren) — Oral GH secretagogue. Documented to impair glucose tolerance and increase fasting insulin. Water retention common. *Bloodwork burden: high* — IGF-1, IGFBP-3, fasting glucose, fasting insulin, HbA1c, prolactin.
Selank / Semax — Russian cognitive peptides. Real research base in the Russian literature, less Western validation. *Bloodwork burden: low* — but useful to track cortisol AM, BDNF (specialized).
Not "bad" peptides — but the safety/protocol complexity is high enough that solo experimentation isn't appropriate.
Dihexa — Synthetic angiotensin IV analog. Very limited human safety data. Not water-soluble. Researcher-grade only.
ARA-290 (Cibinetide) — EPO-derived but no RBC stimulation. Phase 2 trials for diabetic neuropathy. Specialized use case.
Kisspeptin-10 — Acts upstream of GnRH. Powerful HPG-axis modulator. Should be run under clinician supervision alongside other testosterone optimization protocols.
Oxytocin — FDA-approved IV (Pitocin) for labor. Off-label intranasal/sublingual use studied for social bonding and gut motility. Effects subtle and short-duration; harder to verify than to claim.
A peptide's tier rating is only as useful as your willingness to track the bloodwork it requires. An S-tier compound run blind (no labs, no monitoring) becomes a C-tier protocol in practice. A B-tier compound tracked carefully against the right markers can become a personally-S-tier protocol because *you actually know what's happening*.
This is why MyProtocolStack exists. Tier lists tell you what compounds have research behind them. Bloodwork tracking tells you what's actually happening to your body when you run them. Both matter; only one of them is in your control.
[Start tracking your protocol + bloodwork together →](/auth)
---
*This article is for informational and educational purposes only. It does not recommend any specific peptide for any individual. Tier ratings reflect published evidence quality and risk profile, not therapeutic recommendation. Many of these compounds require a prescription and licensed compounding pharmacy. Always consult a qualified healthcare provider before starting any peptide protocol. MyProtocolStack is a tracking and education platform — it does not diagnose, treat, or prescribe.*
Enter your blood work in MyProtocolStack, run StackAI analysis, and get personalized insights based on your actual numbers — not generic charts.
Start Free →