Evidence & Research Status
A new JAMA Health Forum secret-shopper study is one of the first to systematically document what's inside the compounded GLP-1 products still sold at U.S. medical spas and weight-loss clinics — and…
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A new JAMA Health Forum secret-shopper study is one of the first to systematically document what’s inside the compounded GLP-1 products still sold at U.S. medical spas and weight-loss clinics — and GLP-1 additives turn out to be the norm, not the exception, even though the ingredients being added have little to no supporting clinical evidence at the doses used. Researchers observed that most surveyed businesses are still compounding well after the FDA-declared shortages of semaglutide and tirzepatide ended, often bundling in extra ingredients with consumer appeal but limited data behind them.
What the study actually did
Researchers from the University of Colorado Anschutz Medical Campus published the cross-sectional study in JAMA Health Forum (2026;7(7):e262207). Between August and October 2025, the team placed secret-shopper calls to 75 brick-and-mortar weight-loss clinics and medical spas across Oklahoma and West Virginia — two states selected for potentially high demand — to ask what these businesses were offering after the FDA lifted its shortage designations for semaglutide and tirzepatide.
Key findings researchers reported
Of the 75 businesses confirmed to offer compounded GLP-1 receptor agonists:
- 69 businesses (92.0%) reported offering compounded semaglutide
- 65 businesses (86.7%) reported offering compounded tirzepatide
- 7 businesses (9.3%) offered oral or sublingual formulations
- 44 businesses (58.7%) confirmed their products were compounded with an additive
- Among those, 42 businesses (56.0% of the full sample) reported B vitamins specifically, followed by levocarnitine (6.7%) and glycine (5.3%)
The study authors noted that this pattern — persistence of compounding activity paired with a shift toward additive-based formulations — suggests that FDA’s resumed enforcement against “copycat” compounding pushed the market toward product differentiation rather than toward the exit.
Who researchers found on the sourcing side
The study traced the 75 businesses back to 24 identified compounding pharmacy suppliers across at least six states. Of 21 facilities where sterile-compounding license status could be confirmed, 4 (19.0%) were not licensed to perform sterile compounding. One facility had received two FDA warning letters since 2023, both citing sterile-compounding violations, and 3 of 22 facilities with disciplinary records (13.6%) had faced state board of pharmacy action.
Most consultations in the study were conducted by nurse practitioners or physician assistants (56.0%) rather than physicians (40.0%), and about a third of businesses did not require an in-person consultation at all.
Why additive claims deserve scrutiny
The additives showing up most often — B vitamins, levocarnitine, glycine — are marketed on the theory that they might offset fatigue, support metabolism, or reduce injection discomfort. Researchers were clear that clinical evidence supporting these specific benefits, at the doses and delivery methods used in compounded GLP-1 products, remains unproven. Adding an ingredient to a formulation is a real chemical and regulatory change — it does not, on its own, indicate a clinically meaningful improvement over the base compound.
This matters for anyone evaluating a compounded product’s marketing claims: a formulation described as “enhanced” or “boosted” with an additive is making a claim about composition, not necessarily about outcome.
Comparing what “compounded” actually means
| Question | Why it matters |
|---|---|
| Is the supplying pharmacy licensed for sterile compounding? | 19.0% of facilities checked in this study were not, per the researchers’ findings |
| Does the formulation include an additive? | 58.7% did in this sample — ask what it is and why |
| Is there published human data for that additive at that dose? | Researchers found the evidence base thin across the additives studied |
| Has the supplying facility had FDA warning letters or state board actions? | Both were documented among the suppliers identified in this study |
Open questions for researchers
Several questions remain unresolved by this study and worth tracking as the compounding landscape keeps shifting. First, does additive inclusion correlate with supplier licensing status, or are they independent variables? Second, how do these findings generalize beyond Oklahoma and West Virginia — are additive rates similar in states with different compounding enforcement postures? Third, as FDA moves to tighten the 503B bulk-list pathway for semaglutide, tirzepatide, and liraglutide, will 503A patient-specific compounding absorb more of this demand, and does that change the additive picture? Researchers studying sourcing transparency in this space have more work ahead.
All compounds referenced in this article are available for research use only. This article is provided for informational and educational purposes. No therapeutic claims are made or implied.