Sermorelin Tablets vs Injections vs Nasal Spray: What the Evidence Actually Shows

Table of Contents

When people compare sermorelin tablets, injections, and nasal spray, the real question is not “which one is most convenient?” Instead, it’s “which one actually gets enough active drug to the pituitary gland to matter?”

Telehealth marketing has moved quickly toward needle-free options. Many product pages treat sublingual troches and nasal sprays as equal to injections. The published evidence does not necessarily reflect that.

Sermorelin is a synthetic 29-amino-acid growth hormone-releasing hormone (GHRH) analog, designed to prompt the pituitary gland to release growth hormone.¹ Every formulation sold in the United States today is compounded, meaning a pharmacy prepares it, rather than a manufacturer making and selling it as a finished, FDA-approved drug.²

The route you take matters because it decides how much of the drug survives to reach the pituitary. Peptides are fragile, and the path each form takes through the body decides how much breaks down before it can work.^3-5

This article compares injections, sublingual troches, and nasal sprays on three things: how much gets absorbed, how strong the evidence is, and what each one is like to use day to day.

Medical Disclaimer: This article is informational and not medical advice. Sermorelin is prescription-only and requires evaluation by a licensed clinician. All currently available sermorelin is compounded and has not been individually reviewed by the FDA for safety, efficacy, or quality.

At A Glance

Injection is the only route with primary FDA absorption data, drawn from the original Geref product.
The widely repeated claim of 90 to 95 percent absorption conflicts with FDA prescribing information, which reports about 6 percent after a shot under the skin.
No published human study has shown nasal sermorelin to equal an injection.
Sublingual troches are generally expected to absorb better than swallowed tablets, though there is little human data on sermorelin specifically.
All sermorelin available now is compounded and not individually FDA-reviewed.
Adult use for anti-aging and wellness is not FDA-approved.
Sermorelin is banned under WADA rules at all times.

How Sermorelin Delivery Methods Differ (Pharmacology Foundation)

The FDA-approved Geref label reports that about 6 percent of a subcutaneous dose (a shot under the skin) reaches the bloodstream in active form.⁶ This is contrary to higher figures repeated across many commercial blogs. That fraction is called bioavailability: the share of a dose that makes it into the bloodstream where it can act.^3-5 Even the subcutaneous form (the gold standard here) delivers only a small share of the dose, which reframes how other routes should be judged.

Sermorelin is a synthetic 29-amino-acid peptide and a GHRH analog, which means it binds receptors in the pituitary to trigger pulsatile growth hormone release.¹ It is a small molecule, about 3,358 daltons, and it clears the body fast, with a half-life of roughly 11 to 12 minutes after a shot.⁶ That short window matters for every route, because the drug has to reach its receptors quickly before the body breaks it down.^3-5

Many peptides break down when you swallow them.^4,7 Stomach acid and digestive enzymes start taking the peptide apart, and the liver clears out much of what is left before it ever reaches the bloodstream. This is called first-pass metabolism: the liver processes a drug soon after it is absorbed from the gut.^5,8

A peptide’s size works against it too, since larger molecules pass through the gut wall poorly.^4,9,10 This is why other routes are explored. Sublingual and nasal delivery skip the stomach and avoid part of that liver processing, and injection avoids these obstacles most directly.¹¹

Sermorelin Injections

Geref was the brand name for an FDA-approved version of sermorelin. The manufacturer, EMD Serono, chose to stop making it for business reasons, not because of any safety or effectiveness problem, and asked the FDA to withdraw its approval. The FDA later confirmed that Geref was not pulled for safety or effectiveness reasons.^12,13 Because the original product no longer exists, every form of sermorelin sold today is compounded.¹³

Subcutaneous injection is the only form of sermorelin with data that was submitted to and approved by the FDA.^6,12,13 This is why it is the standard other routes are measured against. The study behind that data used a 2 mg dose under the skin. It found the drug peaked in the blood 5 to 20 minutes after the shot, and that about 6 percent of the dose reached the bloodstream in active form.⁶

Don’t confuse the discontinued Geref with current compounded versions of sermorelin. Geref was originally FDA-approved for children with growth hormone deficiency and dosed accordingly.^6,13 Compounded forms of sermorelin today are made and dosed for anti-aging and wellness, but these products and indications have not been approved by the FDA.¹⁴

Side effects reported for sermorelin include reactions at the injection site, such as redness or swelling. Other common side effects includes with flushing, headache, or dizziness.^14-16

The day-to-day demands are real. Injectable sermorelin usually has to be kept cold and may need to be mixed from a powder right before use.^6,16 Although storage and handling requirements may vary according to each compounded formulation, studies have found that sermorelin quickly degrades at temperatures above 39 degrees Fahrenheit.¹⁷ Peptides structures are often damaged at very high and very low temperatures.¹⁸ Injections also require proper needle handling and disposal.⁶ For someone who dislikes shots, that is a real hurdle.

At the time of writing, injectable sermorelin is usually dispensed legally by:

503A compounding pharmacies, which prepare it for one patient-specific prescription at a time, under state regulations ^2,19-26
503B outsourcing facilities, which can make larger batches under tighter federal rules and oversight ^{2,19-22,27-30}

Where Evidence Ends and Marketing Begins

Beware of claims made on private commercial websites that have no real sources behind them. For example, many telehealth pages attach inflated figures for subcutaneous injections of sermorelin that are many times greater than the 6 percent figure listed in the originally FDA-approved labeling for Geref.⁶ As another example, many adult anti-aging clinics make claims that lean on small studies or stretch the findings well past what they actually showed.

Check for exact citations behind each scientific statement. Make sure that you can actually access the sources listed in the references section. You might end up encountering several dead-end hyperlinks. Many of the publications may turn out to be non-existent or not actually support what was said. Some of the linked references could simply make a series of bold claims without providing any supporting evidence themselves.

Sermorelin Tablets and Sublingual Troches

No published human study shows that any oral form of sermorelin matches an injection. Also, different formulations grouped as “oral” are not considered equal ^4,31:

Swallowed tablets and capsules go through the stomach and liver where acid and enzymes break peptides down before they can be absorbed.
Troches (lozenges that dissolve under the tongue) and buccal tablets (which dissolves against the inside of the cheek) are made to absorb through the lining of the mouth instead, skipping the digestive tract.

Sublingual sermorelin has no dedicated human data of its own. You may see various figures touted on commercial websites, but they do not come from controlled studies of sermorelin. When you try to follow their sources, they often lead to:

Dead hyperlinks that do not load.
Citations of made-up studies that do not exist.
Published journal articles that don’t actually mention the proclaimed findings.
General scientific statements from which theoretical conclusions were reached.
Standalone sites that only make bold statements without any supporting evidence.
Extrapolated figures that were questionably overstretched from scientific studies that:
- Had small samples.
- Used animal test subjects.
- Examined drugs other than sermorelin.

Where Evidence Ends and Marketing Begins

There is no published human research showing sublingual sermorelin works as well as injection. Troches might seem to be a more believable idea than swallowed pills, but the evidence is non-existent. Many products sold as oral sermorelin pills are just swallowed capsules. Very little of an intact peptide is expected to survive the stomach or liver and reach the bloodstream.^4,7

Sermorelin Nasal Spray

No published human study has shown nasal sermorelin to work as well as an injection. This is the most important thing to know before considering a nasal product as a needle-free alternative.

Nasal absorption depends on the peptide crossing the lining of the nose and getting into the bloodstream. Bigger molecules cross less easily, and sprays may deliver slightly different amounts each time, which adds inconsistency. How much gets through depends on^32-36:

The size of the molecule.
What else is in the formula.
The additives meant to boost absorption.
Whether the nose is congested.

While there is scientific evidence to support intranasal sermorelin, many of the studies are non-controlled, small, and dated. Additionally, the findings were limiting and modest compared to the injected form of sermorelin.

Borkenstein et al published a small and short study in 1986. It was conducted on 5 healthy children with short stature. After the children were given intranasal sermorelin, their blood samples were collected and they were observed at regular intervals for up to 2 hours afterwards.³⁷

The researchers found that intranasal sermorelin triggered a rise in growth hormone blood levels. The only side effects observed were burning sensations in the nasal passages in one patient. The authors identified intransal sermorelin as a possible treatment for children with growth hormone deficiency due to defects at the pituitary level and above.³⁷

Wilton et al. published a sermorelin study in 1993. It had a slightly larger sample size and duration. Study comparing intravenous and intranasal sermorelin in 30 healthy adult men. The study was also notably double-blind and randomized with a six-treatment, six-period crossover. The timeline ranged from 3 hours to 2 days (from baseline to post-treatment observation), depending on the study arm.³⁸

Intranasal administration was found to stimulate release of growth hormone. The authors suggested that the work of this short study should be explored further in larger and longer trials. Of particular interest were the findings that absorption of sermorelin through nasal mucosa was low, and bioavailability was only 3-5%.³⁸

Hümmelink et al. also published a study on sermorelin in 1993. It was a six-month, non-controlled pilot study of 8 children using intranasal sermorelin. The results showed that growth hormone levels and height were stimulated but declined over 6 weeks to 6 months.³⁹

Some patients developed antibodies against sermorelin. Many patients had side effects like sneezing, runny nose, and mucosal irritation. The authors concluded that the intranasal sermorelin formulation was not suitable to treat children due to decreasing absorption, antibody development, and nasal irritation.³⁹

This selection was reflective of the studies performed on intranasal sermorelin. They found that the sermorelin could be administered intranasally to yield some measurable effects on growth hormone levels. However, the findings of these modest, decades-old studies were not built upon with larger and longer trials using clinical endpoints to demonstrate successful treatment of a particular condition.^37-39

The Wilton study noted that sermorelin required an intranasal dose about 30 to 50 times higher than an intravenous dose to produce the same growth hormone release.³⁸ Similarly, the Borkenstein study found that intranasal sermorelin required about 50 to 100 times higher doses to produce growth hormone responses similar to intravenous sermorelin.³⁷ So although many researchers were interested in the potential advantages of intranasal sermorelin (like easier administration), none of them found that it worked better than the injectable routes.

Where Evidence Ends and Marketing Begins

Nasal sermorelin is biologically plausible but not clinically proven through robust trials. Small studies noted tolerability issues due to nasal irritation.^37-39 Online marketing that treats intranasal sermorelin as equal to injection is stretching the findings of limited data.

How to Compare Sermorelin Delivery Methods at a Glance

The table below compares the three routes on the factors that matter most when choosing one. The absorption estimates are current as of the writing of this article. Only the injection figure comes from data that was submitted and approved by the FDA.⁶ The sublingual and nasal entries reflect the lack of dedicated human studies on sermorelin, as covered above.^4,7,37-39

Factor	Subcutaneous injection	Sublingual troche	Nasal spray
Strength of evidence	Backed by primary FDA data	Limited; no dedicated human studies	Limited human studies; no published robust trials showing it equals injection
Estimated absorption	~6% (FDA label)	Not established; only borrowed estimates	3-5%
Legal status	Compounded; off-label for adults	Compounded; off-label for adults	Compounded; off-label for adults
Convenience	Lower (needles, mixing)	Higher (needle-free)	Higher (needle-free)
Dosing consistency	Most consistent	Can vary with saliva and technique	Can vary with spray and congestion
Main drawbacks	Refrigeration, sterile preparation, sharps	No standard recipe, base varies	Nasal irritation, affected by congestion

In plain terms: most of the available clinical data involves the injectable route, whereas the sublingual and nasal forms haven’t been studied to the same extent.

What to Consider Before Choosing a Sermorelin Format

Choosing a route should weigh several things together, not just convenience: how good the evidence is, how well the product is made, how reliable the dosing is, how it fits your life, what it costs, and where it stands legally.

How much evidence supports each route

Injectable sermorelin is backed by primary FDA data.⁶ Sublingual sermorelin has no dedicated human data of its own, and the absorption figures quoted for commercial sales are usually borrowed from other drugs. Nasal sermorelin has limited human studies with laboratory measurements but no robust trials demonstrating clinical efficacy.^37-39 If published evidence matters to you, the three routes are not on equal footing.

Compounding pharmacy quality

Because sermorelin is compounded, quality can vary from pharmacy to pharmacy even for the same prescription.⁴⁰

Here are some things you can ask or look into when deciding on a compounding pharmacy^41-43:

Are they a 503A state-licensed compounding pharmacy?
- If so, you can look up their license on the state board’s website⁴⁴
Or are they a 503B FDA-registered outsourcing facility?
- If so, you can look them up on the FDA’s list of registered outsourcing facilities⁴⁵
Are they accredited with a professional organization like Pharmacy Compounding Accreditation Board (PCAB)?⁴⁶
- If so, you can look them up on the Accreditation Commission for Health Care (ACHC) website.⁴⁷
Ask about their quality standards.
- Do they only use ingredients sourced from FDA-registered manufacturers?
- Do they use third party laboratories to test their products?

These signs do not guarantee good outcomes, but their absence can raise concerns.

How reliable the dosing is

When absorption is unpredictable, the dose is too. Sermorelin injections give the most consistent result of the three routes discussed.⁶ Sublingual sermorelin lacks any dedicated, reliable study data. Nasal absorption of sermorelin may vary with the spray and congestion.^33,34 The less predictable the absorption, the harder it can be to tie a given dose to a given effect.

Fit with your life

Whether you can tolerate needles is a fair thing to consider. Injection means mixing the dose, keeping it cold, and handling sharps,^6,16 which some people might not keep up with over time. Needle-free routes may be easier for those people, but going with a less-proven route does not necessarily mean better results. The trade-off is convenience against evidence.

Cost and ongoing access

Because all sermorelin is compounded and not FDA-approved, insurance may not cover it and you might have to pay out of pocket.^40,48-49 Prices can vary widely between pharmacies for the very same prescription. Budget separately for the labs before and during treatment and for the consultation, which aren’t usually part of the medication price.

Legal and regulatory standing

Compounded sermorelin is not reviewed by the FDA, and adult use for anti-aging, wellness, or weight loss is not approved by the FDA either.¹⁴ For athletes, The World Anti-Doping Agency (WADA) prohibits growth hormone secretagogues, including sermorelin, both in and out of competition.⁵⁰

What happens after you contact a provider

A responsible process usually starts with an intake questionnaire, then baseline labs and a clinician’s review of your history and results before any prescription is written. Getting a prescription should depend on that review, not on making a purchase. Warning signs may include a guaranteed prescription, a skipped evaluation, and no review of your lab work before the medication is dispensed.^14,51

Conclusion

Of the three routes of administration for sermorelin, injection has the strongest evidence, backed by FDA-approved data. The actual study figures are rather modest, compared to the wildly inflated figures common in online marketing. Nasal sprays may offer needle-free convenience. While some human studies have provided useful information, the research on sermorelin nasal sprays is limited, especially compared with injectable sermorelin.

Intranasal sermorelin, remains clinically underestablished. Sublingual troches for sermorelin have no dedicated human studies, and many claims seem to be theoretical extrapolations based on literature.^6,37-39

The right route depends on how much you weigh published evidence, how you feel about needles, how likely you are to stay consistent, and the quality of the compounding pharmacy involved.

Every form of sermorelin is prescription-only and needs clinician oversight.^6,14 Be cautious of any provider offering a guaranteed prescription, a skipped evaluation, or no review of your lab work.^14,51 Talk through your own risks and goals with a qualified clinician before starting or switching any sermorelin therapy.

Frequently Asked Questions

No published human study has shown nasal sermorelin to match the injection formulations. However, there were multiple small studies that demonstrated measurable changes in blood tests after the administration of intranasal sermorelin in human patients.^6,37-39

It should be noted that the intranasal studies were limited in comparison to the more robust clinical trials for the original brand name Geref.^6,37-39 On top of that, how well a nasal spray works can vary depending on factors like delivery device and patient congestion.^32-36

Not in the form sold today. The FDA-approved product, Geref, was discontinued and its approval formally withdrawn in 2009 for business reasons (not safety or effectiveness concerns). Everything available now is compounded, which means a pharmacy can legally prepare it, but the FDA has not reviewed these preparations for safety, effectiveness, or quality.^6,12-14

You may not feel the effects of sermorelin immediately after a dose. The changes a clinician actually tracks (usually through IGF-1 lab values and a review of your symptoms) show up over weeks to months, not days. The timeline varies with factors like age, lifestyle, and consistency.¹⁴

Swallowed pills are not a promising option, because stomach acid and digestive enzymes break the peptide down before it can be absorbed. Many products labeled as oral sermorelin are just capsules that are meant to be swallowed, but very little is expected to get through. Troches that dissolve under the tongue are designed to skip the stomach, but they still lack dedicated human data showing they match an injection.^4,7,31

Because insurance often does not cover compounded sermorelin, costs may require out-of-pocket payments. Monthly prices can vary widely between pharmacies for the same prescription.^40,48,49 Budget separately for the consultation and for the labs (before and during treatment), which are not usually part of the medication price. Ask each pharmacy for an itemized quote.

The most commonly reported effects from the approved product were reactions at the injection site, flushing, and headache.^14-16 Needle-free routes like intranasal sprays avoid the injection-site reactions but bring their own issues, such as mucosal irritation or uneven dosing.^33,34,37-39 Report any unexpected symptoms to the clinician who prescribed it.

Yes. Sermorelin is banned at all times under the Prohibited List of The World Anti-Doping Agency (WADA). The U.S. Anti-Doping Agency (USADA) holds tested athletes to the same standard. Using it in the off-season does not change anything, since the ban applies both in and out of competition.^50,52

You can switch, but it is not a straight swap, because absorption can differ by route and a dose that works for one form may not deliver the same amount through another. As an example, limited studies found that intranasal sermorelin required about 30 to 100 times higher doses to produce growth hormone responses similar to intravenous sermorelin.^37,38 Make any switch with your clinician, who can adjust the dose and recheck your labs rather than assuming the results will carry over.

References

National Center for Biotechnology Information. PubChem Compound Summary for CID 16132413, Sermorelin. Accessed July 13, 2026. https://pubchem.ncbi.nlm.nih.gov/compound/sermorelin
US Food and Drug Administration. Compounding and the FDA: Questions and answers. Updated September 16, 2025. Accessed July 13, 2026. https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers
Price G, Patel DA. Drug Bioavailability. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 30, 2023. Accessed July 13, 2026. https://www.ncbi.nlm.nih.gov/books/NBK557852/
Le J. Drug absorption. Merck Manual Professional Version. Updated November 2024. Accessed July 13, 2026. https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-absorption
Le J. Drug bioavailability. Merck Manual Professional Version. Updated November 2024. Accessed July 13, 2026. https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-bioavailability
Sermorelin acetate. RxList. Updated October 24, 2022. Accessed July 13, 2026. https://www.rxlist.com/sermorelin-acetate-drug.htm
Weinstock MT, Francis JN, Redman JS, Kay MS. Protease-resistant peptide design-empowering nature’s fragile warriors against HIV. Biopolymers. 2012;98(5):431-442. doi:10.1002/bip.22073 https://pmc.ncbi.nlm.nih.gov/articles/PMC3548907/
Herman TF, Santos C. First-Pass Effect. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 3, 2023. Accessed July 13, 2026. https://www.ncbi.nlm.nih.gov/books/NBK551679/
New R. Oral Delivery of Biologics via the Intestine. Pharmaceutics. 2020;13(1):18. Published 2020 Dec 24. doi:10.3390/pharmaceutics13010018 https://pmc.ncbi.nlm.nih.gov/articles/PMC7824380/
Varilie N. The Influence of Molecular Size on Drug Absorption: A Comprehensive Overview. Ann Clin Trials Vaccines Res. 2024;14(3):242-243. Published 2024 Jun 28. doi:10.37532/ACTVR.2024.14(3).242-243 https://www.openaccessjournals.com/articles/the-influence-of-molecular-size-on-drug-absorption-a-comprehensive-overview-17761.html
Debe MS, Khan SA, Ahmed IS, Hussain Z, Uddin MN, Rawas-Qalaji M. Nasal versus sublingual routes for emergency drug administration. J Pharm Sci. 2025;114(9):103903. doi:10.1016/j.xphs.2025.103903 https://www.sciencedirect.com/science/article/abs/pii/S0022354925003557
University of Maryland, Baltimore. Sermorelin Acetate: Summary Report. UMB Digital Archive; 2020. Accessed July 13, 2026. https://archive.hshsl.umaryland.edu/entities/publication/fc0d2c27-77e7-4ada-ad12-32162c4d614b
Food and Drug Administration. Determination that GEREF (sermorelin acetate) injection, 0.5 milligrams base/vial and 1.0 milligrams base/vial, and GEREF (sermorelin acetate) injection, 0.05 milligrams base/amp, were not withdrawn from sale for reasons of safety or effectiveness. Federal Register. 2013;78(42):14095-14096. Accessed July 13, 2026. https://www.federalregister.gov/documents/2013/03/04/2013-04827/determination-that-geref-sermorelin-acetate-injection-05-milligrams-basevial-and-10-milligrams
Testing.com. Sermorelin treatment overview. Updated June 1, 2026. Accessed July 13, 2026. https://www.testing.com/treatments/sermorelin/
US Anti-Doping Agency. What should athletes know about sermorelin? Spirit of Sport. Published June 30, 2025. Accessed July 13, 2026. https://www.usada.org/spirit-of-sport/athletes-know-sermorelin/
Mayo Clinic. Drugs and supplements database: Sermorelin (injection route) – side effects & dosage. Updated February 1, 2026. Accessed July 13, 2026. https://www.mayoclinic.org/drugs-supplements/sermorelin-injection-route/description/drg-20065923
Coppieters G, Deventer K, Polet M, Van Eenoo P, Judák P. An antibody-free, ultrafiltration-based assay for the detection of growth hormone-releasing hormones in urine at low pg/mL concentrations using nanoLC-HRMS/MS. J Pharm Biomed Anal. 2022;214:114726. doi:10.1016/j.jpba.2022.114726 https://pubmed.ncbi.nlm.nih.gov/35298973/
Shi M, McHugh KJ. Strategies for overcoming protein and peptide instability in biodegradable drug delivery systems. Adv Drug Deliv Rev. 2023;199:114904. doi:10.1016/j.addr.2023.114904 https://pmc.ncbi.nlm.nih.gov/articles/PMC10526705/
US Food and Drug Administration. Human drug compounding laws. Updated December 17, 2024. Accessed July 13, 2026. https://www.fda.gov/drugs/human-drug-compounding/human-drug-compounding-laws
Food and Drug Administration. Definition of the Term “Biological Product.” Federal Register. 2020;85(35):10057-10063. Published February 21, 2020. Accessed July 13, 2026. https://www.federalregister.gov/documents/2020/02/21/2020-03505/definition-of-the-term-biological-product
Food and Drug Administration. Definition of the term “biological product”: Docket No. FDA-2018-N-2732: Preliminary regulatory impact analysis, initial regulatory flexibility analysis, unfunded mandates reform act analysis. Economics Staff, Office of Planning, Office of Policy, Planning, Legislation and Analysis, Office of the Commissioner; 2018. Accessed July 13, 2026 https://www.fda.gov/media/122985/download
Food and Drug Administration. ANDAs for certain highly purified synthetic peptide drug products that refer to listed drugs of rDNA origin: Guidance for industry. Center for Drug Evaluation and Research; May 2021. Accessed July 13, 2026. https://www.fda.gov/media/107622/download
Food and Drug Administration. Bulk drug substances used in compounding. Updated March 26, 2026. Accessed July 13, 2026. https://www.fda.gov/drugs/human-drug-compounding/bulk-drug-substances-used-compounding
Food and Drug Administration. Compounded drug products that are essentially copies of a commercially available drug product under Section 503A of the Federal Food, Drug, and Cosmetic Act: Guidance for industry. Center for Drug Evaluation and Research, Office of Compliance/OUDLC; January 2018. Accessed July 13, 2026. https://www.fda.gov/media/98973/download
Alliance for Pharmacy Compounding. Compounding peptides: It’s complicated: A briefing for physicians and other prescribers. Published August 2022. Accessed July 14, 2026. https://join.a4pc.org/hubfs/PDFs/2022-08-Prescriber-Briefing-Peptides_4-Aug-2022.pdf
Asebey EJ, Faviero GF. Peptide regulation in 2026: What you need to know to remain compliant. Dispense Times. January-February 2026:20-24. Accessed July 13, 2026. https://www.frierlevitt.com/wp-content/uploads/2026/01/FL-Peptides-.pdf
Food and Drug Administration. Bulk drug substances nominated for use in compounding under Section 503B of the Federal Food, Drug, and Cosmetic Act. Updated March 21, 2025. Accessed July 13, 2026. https://www.fda.gov/media/94164/download
Food and Drug Administration. Interim policy on compounding using bulk drug substances under Section 503B of the Federal Food, Drug, and Cosmetic Act: Guidance for industry. Center for Drug Evaluation and Research; January 2025. Accessed July 13, 2026. https://www.fda.gov/media/94402/download
Food and Drug Administration. Compounded drug products that are essentially copies of approved drug products under Section 503B of the Federal Food, Drug, and Cosmetic Act: Guidance for industry. Center for Drug Evaluation and Research, Office of Compliance/OUDLC; January 2018. Accessed July 13, 2026. https://www.fda.gov/media/98964/download
Trujillo SB, Sullivan T. FDA releases draft interim guidance on bulk drug substances in compounding under Sections 503A and 503B of FDCA. Quarles & Brady LLP. January 10, 2024. Accessed July 13, 2026. https://www.quarles.com/newsroom/publications/fda-releases-draft-interim-guidance-on-bulk-drug-substances-in-compounding-under-sections-503a-and-503b-of-fdca
Kim J, De Jesus O. Medication Routes of Administration. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 23, 2023. https://www.ncbi.nlm.nih.gov/books/NBK568677/
Valdesolo F. People aren’t just injecting peptides—they’re snorting them, too. Vogue. January 14, 2026. Accessed July 13, 2026. https://www.vogue.com/article/nasal-peptides
Ozsoy Y, Gungor S, Cevher E. Nasal delivery of high molecular weight drugs. Molecules. 2009;14(9):3754-3779. Published 2009 Sep 23. doi:10.3390/molecules14093754. https://pmc.ncbi.nlm.nih.gov/articles/PMC6254717/
Luo D, Ni X, Yang H, Feng L, Chen Z, Bai L. A comprehensive review of advanced nasal delivery: Specially insulin and calcitonin. Eur J Pharm Sci. 2024;192:106630. doi:10.1016/j.ejps.2023.106630 https://www.sciencedirect.com/science/article/pii/S0928098723002609
Food and Drug Administration. Nasal spray and inhalation solution, suspension, and spray drug products: Chemistry, manufacturing, and controls documentation: Guidance for industry. Center for Drug Evaluation and Research; July 2002. Accessed July 13, 2026. https://www.fda.gov/media/70857/download
Trows S, Wuchner K, Spycher R, Steckel H. Analytical challenges and regulatory requirements for nasal drug products in Europe and the U.S. Pharmaceutics. 2014;6(2):195-219. Published 2014 Apr 11. doi:10.3390/pharmaceutics6020195 https://pmc.ncbi.nlm.nih.gov/articles/PMC4085595/
Borkenstein M. The effects of intranasal insufflation of growth hormone releasing factor analogue GRF 1-29 NH2 on growth hormone secretion in children with short stature. Acta Endocrinol Suppl (Copenh). 1986;279:135-138. doi:10.1530/acta.0.112s135 https://pubmed.ncbi.nlm.nih.gov/2877535/
Wilton P, Chardet Y, Danielson K, Widlund L, Gunnarsson R. Pharmacokinetics of growth hormone-releasing hormone(1-29)-NH2 and stimulation of growth hormone secretion in healthy subjects after intravenous or intranasal administration. Acta Paediatr Suppl. 1993;388:10-15. doi:10.1111/j.1651-2227.1993.tb12827.x https://pubmed.ncbi.nlm.nih.gov/8329825/
Hümmelink R, Sippell WG, Benoit KG, Danielson K, Faijerson Y. Intranasal administration of growth hormone-releasing hormone(1-29)-NH2 in children with growth hormone deficiency: effects on growth hormone secretion and growth. Acta Paediatr Suppl. 1993;388:23-27. doi:10.1111/j.1651-2227.1993.tb12830.x https://pubmed.ncbi.nlm.nih.gov/8329828/
National Council on Aging. Compounded medications: Are they legal, FDA-approved, and covered by insurance? Updated September 6, 2024. Accessed July 13, 2026. https://www.ncoa.org/article/what-are-compounded-medications/
Levine H. Thinking of using a compounding pharmacy? What you need to know. Harvard Health Publishing. September 26, 2024. Accessed July 13, 2026. https://www.health.harvard.edu/healthy-aging-and-longevity/thinking-of-using-a-compounding-pharmacy-what-you-need-to-know
Bieber AM. Compounding pharmacies: the real story. Cedars-Sinai. Published May 22, 2025. Accessed July 13, 2026. https://www.cedars-sinai.org/stories-and-insights/healthy-living/compounding-pharmacies-the-real-story
Alliance for Pharmacy Compounding. Find a compounding pharmacy. Accessed July 13, 2026. https://a4pc.org/find-a-compounder
National Association of Boards of Pharmacy. Boards of pharmacy. Accessed July 13, 2026. https://nabp.pharmacy/about/boards-of-pharmacy/
US Food and Drug Administration. Registered outsourcing facilities. Updated July 13, 2026. Accessed July 13, 2026. https://www.fda.gov/drugs/human-drug-compounding/registered-outsourcing-facilities
Accreditation Commission for Health Care. PCAB accreditation for modern compounding pharmacies. Accessed July 13, 2026. https://achc.org/pcab-compounding-pharmacy/
Accreditation Commission for Health Care. Search for ACHC-accredited organizations. Accessed July 13, 2026. https://organization.achc.org/
Dunkin MA. Frequently asked questions about compounded medications. Mayo Clinic Press. Published August 18, 2025. Accessed July 13, 2026. https://mcpress.mayoclinic.org/living-well/frequently-asked-questions-about-compounded-medications/
US Government Accountability Office. Compounded drugs: payment practices vary across public programs and private insurers, and Medicare Part B policy should be clarified. Report No. GAO-15-85. October 10, 2014.Accessed July 13, 2026. https://www.gao.gov/products/gao-15-85
World Anti-Doping Agency. Prohibited list. Published January 1, 2026. Accessed July 8, 2026. https://www.wada-ama.org/en/prohibited-list
Faget KY. Telehealth practice standards with emphasis on the United States: what telerehabilitation providers need to know. Telerehabilitation. 2022;405-415. Accessed July 8, 2026. doi:10.1016/B978-0-323-82486-6.00028-9 https://pmc.ncbi.nlm.nih.gov/articles/PMC8763330/
US Anti-Doping Agency. World Anti-Doping Agency (WADA) prohibited list. Published January 1, 2026. Accessed July 13, 2026. U.S. Anti-Doping Agency. Prohibited Substances and Methods. https://www.usada.org/athletes/substances/prohibited-list/