Do peptides help with muscle wasting and sarcopenia?
6 peptides are graded for muscle wasting and sarcopenia on this page. The strongest grade is human RCT evidence, for MK-677 (ibutamoren), ACE-031 (ramatercept), SS-31 (elamipretide), and NAD+. Each one is weighed against the standard of care below, and the evidence table gives the grade and a note for every peptide.
What is the standard of care for muscle wasting and sarcopenia?
Screen with grip strength, chair stand, or gait speed and confirm low muscle mass; progressive resistance training; adequate protein and energy intake; treat underlying illness, malnutrition, and vitamin D deficiency; review medications that contribute to weakness or falls.
Any peptide below should be judged against this baseline, not against doing nothing. Talk to a licensed provider before replacing or adding to an established treatment.
Which peptides have been studied for muscle wasting and sarcopenia?
Ordered by strength of evidence for this use. Grades follow the methodology; each peptide page lists the individual studies.
| Peptide | Evidence for this use | Note |
|---|---|---|
| MK-677 (ibutamoren) | Evidence: Human RCT evidence | Added about 1.1 kg of fat free mass in older adults without a strength benefit and raised fasting glucose; a hip fracture trial stopped early over a heart failure safety signal; not a peptide and not approved. [2] [3] |
| ACE-031 (ramatercept) | Evidence: Human RCT evidence | Increased lean mass in healthy women and in boys with Duchenne muscular dystrophy, but the Duchenne trial was halted for nosebleeds and telangiectasia; development ended. [4] |
| SS-31 (elamipretide) | Evidence: Human RCT evidence | Elamipretide missed its walking and fatigue endpoints in MMPOWER-3 (n = 218) in primary mitochondrial myopathy. [5] [7] |
| NAD+ | Evidence: Human RCT evidence | A meta-analysis found oral NR and NMN did not increase muscle mass or physical function. [6] |
| Follistatin-344 | Evidence: Animal-only evidence | Follistatin gene therapy (not the injectable peptide) improved walking in a handful of patients with muscle disease; those results do not raise the grade for injectable follistatin-344. [8] |
| PEG-MGF | Evidence: Animal-only evidence | Muscle cell and rodent data only; WADA prohibited. [9] |
Head-to-head comparisons
Cost and access
Price ranges, lawful channels, and insurance notes for peptides graded here. State rules are in the legal guides by state.
Frequently asked questions
Which peptide has the strongest evidence for muscle wasting and sarcopenia?
MK-677 (ibutamoren), ACE-031 (ramatercept), SS-31 (elamipretide), and NAD+ have the strongest evidence among the peptides graded here, at human RCT evidence. MK-677 (ibutamoren): Added about 1.1 kg of fat free mass in older adults without a strength benefit and raised fasting glucose; a hip fracture trial stopped early over a heart failure safety signal; not a peptide and not approved. ACE-031 (ramatercept): Increased lean mass in healthy women and in boys with Duchenne muscular dystrophy, but the Duchenne trial was halted for nosebleeds and telangiectasia; development ended. SS-31 (elamipretide): Elamipretide missed its walking and fatigue endpoints in MMPOWER-3 (n = 218) in primary mitochondrial myopathy. NAD+: A meta-analysis found oral NR and NMN did not increase muscle mass or physical function. [2] [3] [4] [7]
Is any peptide FDA approved for muscle wasting and sarcopenia?
SS-31 (elamipretide) is an FDA approved drug, but an approval covers only the indications on that label, so check the label before assuming it applies to muscle wasting and sarcopenia. The other peptides graded here are not FDA approved. [5] [7] [10]
Has any peptide been tested in a randomized trial for muscle wasting and sarcopenia?
Yes, for MK-677 (ibutamoren), ACE-031 (ramatercept), SS-31 (elamipretide), and NAD+. Check each note for the population and endpoints: a randomized trial in a related group or on a surrogate marker is weaker than one on the outcome you care about. [2] [3] [4] [7]
From the blog
- Peptides for muscle growth, ranked by human evidence
MK-677, sermorelin, tesamorelin, CJC-1295, IGF-1 LR3, and more ranked by human evidence. None is approved for muscle growth, and all ten are banned in tested sport.
- Tesamorelin vs HGH: how they differ and which is approved
Tesamorelin (Egrifta) signals the pituitary to release growth hormone and is approved for HIV-associated belly fat; HGH (somatropin) is the hormone itself, approved for other conditions.
- Does tesamorelin build muscle? What the trials show
Tesamorelin raised lean body mass about 1.2 kg in HIV trials and slightly increased trunk muscle area, but no trial tested strength or muscle growth, and it is prohibited in sport.
Sources
- [1]Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019PubMed 30312372, 2019
- [2]Effects of an oral ghrelin mimetic on body composition and clinical outcomes in healthy older adults: a randomized trialPubMed 18981485, 2008
- [3]MK-0677 (ibutamoren mesylate) for the treatment of patients recovering from hip fracture: a multicenter, randomized, placebo-controlled phase IIb studyPubMed 21067829, 2011
- [4]Myostatin inhibitor ACE-031 treatment of ambulatory boys with Duchenne muscular dystrophy: results of a randomized, placebo-controlled clinical trialPubMed 27462804, 2017
- [5]Efficacy and safety of elamipretide in individuals with primary mitochondrial myopathy: the MMPOWER-3 randomized clinical trialPubMed 37268435, 2023
- [6]The effect of nicotinamide mononucleotide and riboside on skeletal muscle mass and function: a systematic review and meta-analysisPubMed 40275690, 2025
- [7]FDA prescribing information for Forzinity (elamipretide) injection, via DailyMedFDA, 2025
- [8]Regulation of myostatin activity and muscle growthPubMed 11459935, 2001
- [9]Different roles of the IGF-I Ec peptide (MGF) and mature IGF-I in myoblast proliferation and differentiationPubMed 12095637, 2002
- [10]Drugs@FDA: FDA-approved drugs databaseFDA