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In September 2023 the FDA placed roughly 19 peptide substances into Category 2 of its interim 503A bulks list, meaning the agency had identified potential significant safety risks and compounding pharmacies could not use them

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(Its not clear if the peptides were responsible for the symptoms.) Considering the skin-darkening peptide melanotan II (sometimes called the Barbie peptide)

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Critical challenges included insufficient sample size reducing statistical power, reliance on self-reported exposure data introducing recall bias, and inadequate control for confounding factors such as smoking and alcohol consumption

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