This is the format: you submit a question through the "Ask the Doctor" box on the homepage, and selected ones are answered here — anonymized, signed, and free of anything designed to sell you. Where the honest answer is "we don't know yet," that is the answer you'll get.
The FDA's Pharmacy Compounding Advisory Committee reviews several peptide categories on July 23–24, 2026. That is worth watching, but here is the part the headlines will blur: a committee vote is a recommendation, not a rule. Even a favorable vote would require the FDA to publish a proposed rule, run a second public comment period, and issue a final rule — a process that typically runs more than a year — before any peptide's durable status under the 503A framework actually changes.
What that means for you is simple. At Limitless we prescribe only what is lawfully compoundable under current FDA categorization, sourced through licensed 503A or 503B pharmacies with full documentation — never research-grade or gray-market product. Nothing on your protocol changes on the day of the vote. We publish a dated tracker of exactly where this stands on our PCAC Watch page, and a plain-language explainer of what the vote does and doesn't do.
The large randomized cardiovascular safety trial (TRAVERSE) did not show an increased rate of major adverse cardiac events in men treated for genuine hypogonadism compared with placebo. That is genuinely reassuring, and it retired a decade of fear built on weaker, older data.
It is not a blank check. The reassurance applies to men who actually have a deficiency, treated to a physiologic target, with monitoring. On every TRT protocol we track hematocrit, blood pressure, and your broader cardiovascular risk picture, and we adjust accordingly. Testosterone at Limitless is a therapy for a diagnosed condition — not a performance supplement dosed to a number you saw online. The full read is on the low-testosterone page and the hormone therapy overview.
Both things are true at once, and I'd rather you hear both. NAD+ is a central coenzyme in cellular energy metabolism, its availability declines with age, and it stays on my personal standing recommendation for nearly every adult patient. That is the case for it.
The case against the hype: the boldest marketing claims — reversing aging, curing this or that — run well ahead of the human clinical evidence, which is early and mixed. The honest position is that NAD+ is worth doing for the mechanistic rationale and the quality-of-life response many patients report, described accurately and not oversold. I wrote the long version, including what the 2026 news cycle actually showed, in the NAD+ clinical evidence brief.
Because the evidence and the law both point the same direction. Tesamorelin is the one growth-hormone-axis peptide with an FDA approval, a 26-week pivotal trial, a 2026 multi-RCT meta-analysis showing visceral-fat and lean-mass effects, and an NIH-funded cognitive endpoint trial. CJC-1295, by contrast, is not currently legal for 503A human compounding — clinics still advertising it are ahead of the law.
When one option has asymmetric evidence and a clean regulatory status and the other doesn't, the standing protocol should reflect that. We restructured the GH-axis menu around tesamorelin (with sermorelin as the alternative where indicated) and published the full reasoning in the GH-axis substitution brief.
Fair question, and the short answer is that erectile function is only one of five reasons it's there. Daily tadalafil 5 mg is on the standard adult-male Limitless protocol as a default — unless contraindicated — for its endothelial (blood-vessel) effects, its established benefit for lower-urinary-tract and prostate symptoms, a modest blood-pressure effect, and downstream circulatory benefits, in addition to sexual function.
"Default" does not mean "automatic for everyone." Whether it belongs on your protocol is a physician decision made against your labs, your blood pressure, and your medication list — nitrate use, for example, is an absolute contraindication. The five-system evidence is laid out in the tadalafil brief.
— Joshua Hare, DO, founding physician, Limitless Performance Medicine