Hey Doc,
Today is issue 100. It started the newsletter as a way for me to share the latest science, the technology, the market insights with a small group of physicians. The ecosystem got bigger as longevity became mainstream. Longevitydocs’ mission remains the same: democratize longevity medicine.
And we are getting there! Testing is cheaper. Care is more accessible. More physicians are moving into the space. More research is funded. More regulation and policy on the books. More health systems offering longevity services.
Longevity is becoming an industry beyond medicine. That is evolution, and it is also the reason the patient in front of you Monday arrives with more claims, more products, and fewer people qualified to sort them. Physicians will still play a role. Knowledge first, then care.
This is what I learned writing them (don’t expect copywriting tips)
-
Fringe becomes standard faster than you think. Plenty of what this newsletter covered as cutting-edge in 2024 is now used by millions of people, reimbursed, approved. Stay open.
-
Innovation impacts everything. Science, pricing, patient behavior, policy, regulation, and what gets taught in medical school. Keep building.
-
Longevity is a long-term game. Real science takes time. So does a real product. The companies that tried to skip that step are gone, and they took a lot of patient trust with them on the way out. Be patient.
-
Community creates impact. I do not agree with everyone in ours. That is the point. Same mission, same patients. Stay united.
-
It is about the patient. Every so often it is worth zooming out and asking why any of us are doing this. The answer has not changed in a hundred issues. Remember why.
The newsletter was always meant to be shared freely with our community. For 100, I am opening it up to trusted physicians from that community, in their own words, on the questions they actually get asked in clinic, the protocols they use, the work they do in the field.
Dr. Josh Starbuck goes first: peptides and the FDA.
Thank you for reading every Sunday. All hundred of them.
Dr. David Luu, Founder, longevitydocs.™
Each week, I try to explore one idea that could advance longevity medicine and hopefully support physicians in bringing it to life. This week, Dr. Joshua Starbuck shares his perspective from the FDA’s PCAC hearing on peptide compounding. For my full perspective read and subscribe to the weekly newsletter.
Featured Contributor: Joshua Starbuck MD, IFMCP - Makena Health
The FDA’s Pharmacy Compounding Advisory Committee recommended six peptides for inclusion on the FDA’s compounding list.
The question at hand was never whether these compounds should be FDA approved. It was whether a licensed 503A compounding pharmacy should be legally permitted to prepare them for an individual patient holding a valid prescription from a licensed clinician.
That distinction collapses fast in translation. The 503A Bulks List is the mechanism that allows this kind of compounding, and a substance only lands on it after a full sequence: nomination, a PCAC recommendation like this one, a comment period, then formal rulemaking through the Federal Register. Even in the fastest scenario, that takes roughly 90 days from here. The last time the list actually gained anything new was 2019, six substances, five of them topical, and those six remain the only ones ever added across fourteen meetings of this committee. Fourteen meetings, six substances. That’s a fair question to sit with on its own: whether the list was ever built to move at the pace patients actually need.
Separate from the Bulks List, and important not to confuse with it, sits FDA’s category system, an interim enforcement policy built because the rulemaking path is so slow. Category 1 means FDA doesn’t currently intend to act against compounding while it works through evaluation. Category 2 means the agency identified safety concerns. Category 3 means the nomination lacked sufficient data. A substance in Category 1 is not on the Bulks List, and can sit there for years without the rulemaking that would make it official ever finishing.
Patients have been asking about these compounds for years, evidence gaps and all, because the alternative was never no access, it was unregulated access.
The votes were close, not unanimous, and each went against FDA’s own scientific staff, who had recommended against inclusion. The evaluation framework runs on four factors regardless: characterization, safety, efficacy if known but not required, and history of use.
None of this is FDA approval. The 505 pathway demands an IND, full clinical trials, and often hundreds of millions to billions of dollars before a single indication is granted. This vote doesn’t touch that pathway, and these peptides remain unapproved drugs regardless of what the rulemaking eventually does. That gap between a recommendation and an actual legal listing is where the real work now sits.
That work took shape during the public hearing, the most human part of two otherwise procedural days. Dr. Elizabeth Yurth’s testimony on BPC-157 nearly brought me to tears, she named patients describing lives improved dramatically after years searching for a provider willing to try it. Reading the public docket alongside testimony like hers made the process feel less abstract, a decision with real suffering and real relief on the other side of it.
The hearing is also where the practical path forward took shape, as speakers spent less time arguing the science and more time proposing a safer bridge while rulemaking grinds forward. Dr. Jeffrey Egler and others laid out pieces of it: a verified-sourcing registry for API suppliers, something like a greens list; expanded state-level regulatory pathways; and a structured adverse-event reporting system, the same instinct behind VAERS. None of that needs a final rule, and none builds itself either. The next challenge isn’t waiting for these six to clear rulemaking, it’s building those guardrails now, so access arrives the right way instead of just faster.
Underneath all of it, the foundation this community already knows doesn’t change. Sleep, nutrition, hydration, movement, community, stress management, and recovery carry the weight. Peptides, if they arrive on the list at all, are the icing, not the cake. Physicians carry a real responsibility to model that hierarchy rather than let it invert, appropriate use, not overuse. A reason for use rooted in the patient in front of you, informed consent that’s honest, and monitoring that catches problems early.
Get that part right, and the rest follows. When patients win, we all win.
Dr. Joshua Starbuck, MD
For more key takeaways from our community, read on.
Sneak Peek: The Skin, Bone and Muscle Mastermind
October 24, 2026 • New York City
Why Skin, Bone and Muscle
It is the front door of longevity care. It is what the patient sees first, what brings them in, and what they use to judge whether any of this is working.
And it is a triad, not three separate problems. Bone and muscle fail together. Skin reports on what is happening in both. Manage them in isolation and you get exactly the results the field has been getting.
The medical community still underrates it. Cardiometabolic gets the seriousness, skin and musculoskeletal get filed under aesthetics, and the patient goes looking for answers somewhere other than a physician’s office.
That is the gap we are closing in one day.
Physician-led sessions. Every one sends you home with a protocol or a framework. Full program drops next week. Here is a sneak peek:
-
Skin, Bone and Muscle. The clinical triad of healthy longevity.
-
The Evidence. Where the science stands today, and where it is going.
-
New Diagnostics. The biomarkers, AI and devices you can use in practice now.
-
The GLP-1 Tax. Protecting skin, bone and muscle in patients already on the drug.
-
The Regenerative Menu. Stem cells, peptides and photons, with a risk-tiered framework for each.
-
Advanced Protocols. What to implement, and in whom.
-
The Debate. Where the money is versus where the data is. Choosing a service line you can defend in five years.
Front-row access to the physicians pioneering skin, bone and muscle longevity. One day in New York City. Breakfast, lunch and a VIP dinner. Clinical protocols and scientific breakthroughs you can put to work Monday.
For physicians only. Limited to 150.
Early access tickets are open now. Pricing goes up next week.
Frequently Asked Questions About longevitydocs.™ MEMBERSHIP
What is longevitydocs.™?
longevitydocs.™ is the world’s leading vetted physician network, offering physician-only access to evidence, peers, and practical growth. Our community is designed for physicians committed to advancing evidence-based longevity care. We unite the best specialties across functional medicine, cardiology, hormone health, and regenerative medicine, bringing together leaders from private practice, academia, and health systems. Our members come from institutions including Cleveland Clinic, Mayo Clinic, Kaiser Permanente, Mount Sinai, and Atria, alongside physicians from Next Health, SHA Wellness, Fountain Life, Harvard, and Stanford.
Who qualifies for longevitydocs.™ membership?
Licensed physicians from any field and those in longevity, preventive, integrative, or concierge practice.
What does longevitydocs.™ membership offer?
Outcomes that matter to busy physicians. Protocols you can defend: evidence-based approaches and case reviews you can apply in clinic. Peers you can trust: curated groups by specialty and market for honest consults and referrals. Time back: short, focused learning, an on-demand library, and vetted vendor shortlists. Practice growth: visibility at events, premium directory placement (Club), and partner access.
How does longevitydocs.™ membership work?
longevitydocs.™ membership offers two levels, Club and Explorer, with short, high-signal touchpoints that fit a physician’s schedule, plus deeper dives. Learn monthly, act weekly: live education webinars every month with replays you can watch on your time. Collaborate privately: ongoing, physician-only conversation on your mobile and curated cohort groups. Implement faster: frameworks, protocol packs, and vendor feedback you can use in clinic. Stay connected to the field: event invitations, chapter dinners, and small-group Masterminds.
What are the benefits of longevitydocs.™ membership?
Education & Library: monthly live webinars plus all-time access to the on-demand library (Club) of past Masterminds and webinars. Private Community: physician-only ongoing discussion, curated cohorts (Club), and protocol deep dives. Expert Access: monthly calls with experts (Club) for case reviews and Q&A. Events: invitations to key gatherings, with Club including 20% event access across the calendar (Masterminds, chapter dinners, and virtual). Marketplace: early access to vetted partners and due-diligence briefs (Club), with limited sponsor categories to protect quality. Credibility & Visibility: a standard directory listing (Free) and premium placement (Club), with opportunities for media and features tied to events.
Explorer - Free: dedicated mobile app, monthly free education webinar invitations, the newsletter, select event invitation, and eligibility to apply for cohorts and advanced offerings. Best for staying connected and evaluating fit.
Club - $5,000/year: everything in Explorer, plus 20% event access across the year, the exclusive content library, monthly expert calls, premium directory placement and referral pathways, and a discount on the Certified Longevitydocs CLD longevity medicine training course and longevity medicine Certification program. Best for physicians ready to implement faster and grow with a trusted peer network.
What is the Certified longevitydocs (CLD) program?
The Certified longevitydocs™ (CLD) program is the world’s first credential built exclusively for longevity medicine. It combines a physician-only curriculum, a peer community, and Hippo, an AI learning assistant, to help you launch, grow, and lead your longevity medicine practice.
How do I apply to join longevitydocs.™?
Physicians can apply for membership directly on the longevitydocs.™ website.
Longevitydocs.™ Skin, Bone, and Muscle Mastermind
NEWSLETTER• Issue 100
Skin, Bone & Muscle Mastermind
Issue 100 of the Weekly Longevity Medicine Intelligence newsletter: five lessons from 100 issues, the first physician contributor piece, from Dr. Joshua Starbuck on the FDA's peptide vote, and a preview of the Skin, Bone & Muscle Mastermind in New York.
Special contributor, Dr. Joshua Starbuck Last updated August 3, 2026 · 9 min read
Hey Doc,
Today is issue 100. It started the newsletter as a way for me to share the latest science, the technology, the market insights with a small group of physicians. The ecosystem got bigger as longevity became mainstream. Longevitydocs’ mission remains the same: democratize longevity medicine.
And we are getting there! Testing is cheaper. Care is more accessible. More physicians are moving into the space. More research is funded. More regulation and policy on the books. More health systems offering longevity services.
Longevity is becoming an industry beyond medicine. That is evolution, and it is also the reason the patient in front of you Monday arrives with more claims, more products, and fewer people qualified to sort them. Physicians will still play a role. Knowledge first, then care.
This is what I learned writing them (don’t expect copywriting tips)
Fringe becomes standard faster than you think. Plenty of what this newsletter covered as cutting-edge in 2024 is now used by millions of people, reimbursed, approved. Stay open.
Innovation impacts everything. Science, pricing, patient behavior, policy, regulation, and what gets taught in medical school. Keep building.
Longevity is a long-term game. Real science takes time. So does a real product. The companies that tried to skip that step are gone, and they took a lot of patient trust with them on the way out. Be patient.
Community creates impact. I do not agree with everyone in ours. That is the point. Same mission, same patients. Stay united.
It is about the patient. Every so often it is worth zooming out and asking why any of us are doing this. The answer has not changed in a hundred issues. Remember why.
The newsletter was always meant to be shared freely with our community. For 100, I am opening it up to trusted physicians from that community, in their own words, on the questions they actually get asked in clinic, the protocols they use, the work they do in the field.
Dr. Josh Starbuck goes first: peptides and the FDA.
Thank you for reading every Sunday. All hundred of them.
Dr. David Luu, Founder, longevitydocs.™
Each week, I try to explore one idea that could advance longevity medicine and hopefully support physicians in bringing it to life. This week, Dr. Joshua Starbuck shares his perspective from the FDA’s PCAC hearing on peptide compounding. For my full perspective read and subscribe to the weekly newsletter.
Featured Contributor: Joshua Starbuck MD, IFMCP - Makena Health
The FDA’s Pharmacy Compounding Advisory Committee recommended six peptides for inclusion on the FDA’s compounding list.
The question at hand was never whether these compounds should be FDA approved. It was whether a licensed 503A compounding pharmacy should be legally permitted to prepare them for an individual patient holding a valid prescription from a licensed clinician.
That distinction collapses fast in translation. The 503A Bulks List is the mechanism that allows this kind of compounding, and a substance only lands on it after a full sequence: nomination, a PCAC recommendation like this one, a comment period, then formal rulemaking through the Federal Register. Even in the fastest scenario, that takes roughly 90 days from here. The last time the list actually gained anything new was 2019, six substances, five of them topical, and those six remain the only ones ever added across fourteen meetings of this committee. Fourteen meetings, six substances. That’s a fair question to sit with on its own: whether the list was ever built to move at the pace patients actually need.
Separate from the Bulks List, and important not to confuse with it, sits FDA’s category system, an interim enforcement policy built because the rulemaking path is so slow. Category 1 means FDA doesn’t currently intend to act against compounding while it works through evaluation. Category 2 means the agency identified safety concerns. Category 3 means the nomination lacked sufficient data. A substance in Category 1 is not on the Bulks List, and can sit there for years without the rulemaking that would make it official ever finishing.
Patients have been asking about these compounds for years, evidence gaps and all, because the alternative was never no access, it was unregulated access.
The votes were close, not unanimous, and each went against FDA’s own scientific staff, who had recommended against inclusion. The evaluation framework runs on four factors regardless: characterization, safety, efficacy if known but not required, and history of use.
None of this is FDA approval. The 505 pathway demands an IND, full clinical trials, and often hundreds of millions to billions of dollars before a single indication is granted. This vote doesn’t touch that pathway, and these peptides remain unapproved drugs regardless of what the rulemaking eventually does. That gap between a recommendation and an actual legal listing is where the real work now sits.
That work took shape during the public hearing, the most human part of two otherwise procedural days. Dr. Elizabeth Yurth’s testimony on BPC-157 nearly brought me to tears, she named patients describing lives improved dramatically after years searching for a provider willing to try it. Reading the public docket alongside testimony like hers made the process feel less abstract, a decision with real suffering and real relief on the other side of it.
The hearing is also where the practical path forward took shape, as speakers spent less time arguing the science and more time proposing a safer bridge while rulemaking grinds forward. Dr. Jeffrey Egler and others laid out pieces of it: a verified-sourcing registry for API suppliers, something like a greens list; expanded state-level regulatory pathways; and a structured adverse-event reporting system, the same instinct behind VAERS. None of that needs a final rule, and none builds itself either. The next challenge isn’t waiting for these six to clear rulemaking, it’s building those guardrails now, so access arrives the right way instead of just faster.
Underneath all of it, the foundation this community already knows doesn’t change. Sleep, nutrition, hydration, movement, community, stress management, and recovery carry the weight. Peptides, if they arrive on the list at all, are the icing, not the cake. Physicians carry a real responsibility to model that hierarchy rather than let it invert, appropriate use, not overuse. A reason for use rooted in the patient in front of you, informed consent that’s honest, and monitoring that catches problems early.
Get that part right, and the rest follows. When patients win, we all win.
Dr. Joshua Starbuck, MD
For more key takeaways from our community, read on.
Sneak Peek: The Skin, Bone and Muscle Mastermind
October 24, 2026 • New York City
Why Skin, Bone and Muscle
It is the front door of longevity care. It is what the patient sees first, what brings them in, and what they use to judge whether any of this is working.
And it is a triad, not three separate problems. Bone and muscle fail together. Skin reports on what is happening in both. Manage them in isolation and you get exactly the results the field has been getting.
The medical community still underrates it. Cardiometabolic gets the seriousness, skin and musculoskeletal get filed under aesthetics, and the patient goes looking for answers somewhere other than a physician’s office.
That is the gap we are closing in one day.
Physician-led sessions. Every one sends you home with a protocol or a framework. Full program drops next week. Here is a sneak peek:
Skin, Bone and Muscle. The clinical triad of healthy longevity.
The Evidence. Where the science stands today, and where it is going.
New Diagnostics. The biomarkers, AI and devices you can use in practice now.
The GLP-1 Tax. Protecting skin, bone and muscle in patients already on the drug.
The Regenerative Menu. Stem cells, peptides and photons, with a risk-tiered framework for each.
Advanced Protocols. What to implement, and in whom.
The Debate. Where the money is versus where the data is. Choosing a service line you can defend in five years.
Front-row access to the physicians pioneering skin, bone and muscle longevity. One day in New York City. Breakfast, lunch and a VIP dinner. Clinical protocols and scientific breakthroughs you can put to work Monday.
For physicians only. Limited to 150.
Early access tickets are open now. Pricing goes up next week.
Frequently Asked Questions About longevitydocs.™ MEMBERSHIP
What is longevitydocs.™?
longevitydocs.™ is the world’s leading vetted physician network, offering physician-only access to evidence, peers, and practical growth. Our community is designed for physicians committed to advancing evidence-based longevity care. We unite the best specialties across functional medicine, cardiology, hormone health, and regenerative medicine, bringing together leaders from private practice, academia, and health systems. Our members come from institutions including Cleveland Clinic, Mayo Clinic, Kaiser Permanente, Mount Sinai, and Atria, alongside physicians from Next Health, SHA Wellness, Fountain Life, Harvard, and Stanford.
Who qualifies for longevitydocs.™ membership?
Licensed physicians from any field and those in longevity, preventive, integrative, or concierge practice.
What does longevitydocs.™ membership offer?
Outcomes that matter to busy physicians. Protocols you can defend: evidence-based approaches and case reviews you can apply in clinic. Peers you can trust: curated groups by specialty and market for honest consults and referrals. Time back: short, focused learning, an on-demand library, and vetted vendor shortlists. Practice growth: visibility at events, premium directory placement (Club), and partner access.
How does longevitydocs.™ membership work?
longevitydocs.™ membership offers two levels, Club and Explorer, with short, high-signal touchpoints that fit a physician’s schedule, plus deeper dives. Learn monthly, act weekly: live education webinars every month with replays you can watch on your time. Collaborate privately: ongoing, physician-only conversation on your mobile and curated cohort groups. Implement faster: frameworks, protocol packs, and vendor feedback you can use in clinic. Stay connected to the field: event invitations, chapter dinners, and small-group Masterminds.
What are the benefits of longevitydocs.™ membership?
Education & Library: monthly live webinars plus all-time access to the on-demand library (Club) of past Masterminds and webinars. Private Community: physician-only ongoing discussion, curated cohorts (Club), and protocol deep dives. Expert Access: monthly calls with experts (Club) for case reviews and Q&A. Events: invitations to key gatherings, with Club including 20% event access across the calendar (Masterminds, chapter dinners, and virtual). Marketplace: early access to vetted partners and due-diligence briefs (Club), with limited sponsor categories to protect quality. Credibility & Visibility: a standard directory listing (Free) and premium placement (Club), with opportunities for media and features tied to events.
Explorer - Free: dedicated mobile app, monthly free education webinar invitations, the newsletter, select event invitation, and eligibility to apply for cohorts and advanced offerings. Best for staying connected and evaluating fit.
Club - $5,000/year: everything in Explorer, plus 20% event access across the year, the exclusive content library, monthly expert calls, premium directory placement and referral pathways, and a discount on the Certified Longevitydocs CLD longevity medicine training course and longevity medicine Certification program. Best for physicians ready to implement faster and grow with a trusted peer network.
What is the Certified longevitydocs (CLD) program?
The Certified longevitydocs™ (CLD) program is the world’s first credential built exclusively for longevity medicine. It combines a physician-only curriculum, a peer community, and Hippo, an AI learning assistant, to help you launch, grow, and lead your longevity medicine practice.
How do I apply to join longevitydocs.™?
Physicians can apply for membership directly on the longevitydocs.™ website.
This newsletter is published exclusively for licensed physicians and qualified healthcare professionals. It is not intended for consumers or patients.
All content is for continuing medical education and professional information purposes only. It reflects emerging research, science, technology, and regulatory developments that may have implications for the practice of medicine. It does not constitute medical advice, clinical recommendations, or treatment guidance for any individual patient.
This article represents the personal clinical and professional opinions of Dr. Joshua Starbuck. It does not reflect the official position of the FDA, its Pharmacy Compounding Advisory Committee, or longevitydocs™, and has not been reviewed or endorsed by any regulatory, medical, or professional body.
References to specific therapies, compounds, or protocols are provided for educational context only. Some may be investigational, off-label, or not approved by the FDA or equivalent regulatory authorities in your jurisdiction. Physicians are responsible for independently evaluating all information in accordance with current evidence, applicable law, and the standards of their licensing board.
By reading this newsletter, you confirm that you are a licensed healthcare professional and that you will apply the information contained herein within the bounds of your clinical judgment, professional obligations, and applicable regulations.
If you are a patient or consumer reading this newsletter, please note that this content should not be used to make any health or medical decisions. Please consult your personal physician or a qualified healthcare provider for guidance specific to your situation.