Study: Peptide Access in Sexual Medicine Varies by State

Where you live may have a greater impact on your ability to access peptide-based sexual medicine therapies than whether those therapies are federally approved. That is one of the central findings of a peer-reviewed study published in Sexual Medicine in July 2026, which analyzed state-level policy environments across all 50 U.S. states and the District of Columbia. The study, led by Quesada SG, Ahmed Z, Nakamura HS, and colleagues, suggests that structural healthcare delivery factors — not peptide-specific regulations alone — may be shaping who can and cannot access these therapies.

What This Study Found

Researchers conducted a cross-sectional, state-level analysis to assess how three specific proxy variables influence clinical access to peptide-based sexual medicine therapies. Those variables were: (1) telehealth prescribing permissiveness, (2) nurse practitioner (NP) independent practice authority, and (3) the availability of FDA-registered 503B outsourcing facilities normalized by state population.

Each variable was coded on a standardized scale and combined to produce what the researchers termed a Peptide Access Environment Score (PAES). States were then categorized into high-, moderate-, and low-access tiers based on their composite scores.

The results revealed substantial interstate variability. PAES values ranged from a low of 0.33 to a high of 1.56 — a nearly fivefold difference across the country. High-access environments were found to cluster predominantly in the Northeast and West, while low-access states were most frequently observed in the South and parts of the Midwest. Regional differences in PAES values were statistically significant (p < .001).

Perhaps most notably, the study identified a meaningful discordance between telehealth permissiveness and compounding infrastructure. Multiple states were found to permit telehealth initiation of care but lacked in-state FDA-registered 503B compounding facilities. Conversely, some states possessed established compounding capacity but maintained restrictive telehealth regulations — a structural mismatch that may create gaps in the care pathway even when one piece of the puzzle is in place.

Clinical Significance

The implications for clinicians practicing in this space are considerable. The researchers suggest that the geographic disparities documented in this study are largely independent of any peptide-specific regulatory status at the federal level. In other words, the barriers patients face may have less to do with the legal standing of a particular compound and more to do with whether their state permits a nurse practitioner to prescribe it via telehealth, and whether a compliant 503B outsourcing facility exists to fulfill the prescription.

This framework — the PAES — was specifically designed to be clinically grounded and reproducible. The authors used publicly available data and a transparent methodology, with the stated goal of generating a framework useful to practicing clinicians for identifying geographic disparities in their patient populations.

For sexual medicine specialists, urologists, gynecologists, and integrative medicine practitioners, this study suggests that a patient's zip code may function as an unrecognized determinant of care. Clinicians in low-access states may face compounded obstacles: limited prescribing authority for mid-level providers, restrictive telehealth rules, and inadequate access to compliant compounding facilities — all simultaneously.

The authors acknowledge several limitations. The analysis relied on proxy measures rather than direct access data, excluded physician assistant autonomy as a variable, and could not assess within-state variation related to socioeconomic status or rural versus urban geography. The researchers note these as important areas for future investigation.

Current Access and Compliance Context

Understanding why these state-level disparities matter requires brief context about how peptide-based therapies enter clinical practice. Many peptides used in sexual medicine are not FDA-approved as finished drug products and are instead accessed through FDA-registered 503B outsourcing facilities — a regulatory category created under the Drug Quality and Security Act of 2013. These facilities operate under heightened federal oversight compared to traditional compounding pharmacies, producing sterile preparations at scale for office and clinical use without patient-specific prescriptions.

When a state lacks 503B infrastructure, patients and providers may face significantly narrowed options for obtaining compliant formulations. The study found that this infrastructure gap is not uniformly distributed — it clusters regionally in ways that may systematically disadvantage patients in certain parts of the country.

Telehealth regulations add another layer of complexity. While the post-pandemic regulatory environment expanded telehealth access in many states, those expansions have not been uniform. Some states have reinstated or maintained restrictions on telehealth prescribing of controlled or compounded therapies, further limiting the ability of patients to initiate care remotely — a particularly relevant concern in rural or underserved areas where in-person specialist access may already be limited.

Nurse practitioner scope of practice laws represent the third pillar of the PAES framework. In states where NPs operate under full practice authority, they can evaluate and prescribe independently, expanding the pool of qualified providers who can initiate peptide-based sexual medicine therapies. In states requiring physician supervision, access may be effectively constrained by specialist availability.

What Patients Should Know

If you are a patient exploring peptide-based therapies for sexual health concerns, this study suggests that your state of residence may play a meaningful role in shaping what options are realistically available to you — and how you can access them.

Patients in high-access states may be able to initiate care via telehealth, work with nurse practitioners as their primary prescribers, and receive formulations from nearby compliant 503B facilities. Patients in low-access states may encounter more friction at each of these steps.

This does not mean that access is impossible in lower-scoring states, but it does suggest that the pathway may require more navigation. Patients are encouraged to work with a qualified, knowledgeable clinician who understands both the regulatory landscape and the relevant clinical evidence.

It is also important for patients to understand that not all compounding pharmacies are equivalent. FDA-registered 503B outsourcing facilities are subject to current Good Manufacturing Practice (cGMP) standards and federal inspection. When seeking compounded peptide formulations, patients and their providers should verify the regulatory status of any dispensing facility.

Finally, the existence of geographic disparities should not be interpreted as an endorsement of any specific therapy. Clinical decisions about peptide-based sexual medicine treatments should always be made in consultation with a licensed healthcare provider who can evaluate individual health history, risk factors, and the available evidence base.

Connecting With a Qualified Provider

The findings of this study underscore the importance of working with clinicians who are not only knowledgeable about peptide-based sexual medicine but also fluent in the regulatory and infrastructure environment of their state. Geographic disparities are real, but informed, experienced providers can help patients navigate available pathways within their local care environment.

If you are looking for a qualified clinician with experience in peptide-based therapies, the Peptide Association maintains a directory of vetted providers across the United States. Visit peptideassociation.org/find-a-doctor to find a provider in your area who can evaluate your individual needs and discuss evidence-based options with you.

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Medical Disclaimer: This article is intended for educational purposes only and does not constitute medical advice, diagnosis, or treatment. The information presented here is based on a published research study and reflects the findings and limitations of that study as reported by its authors. Readers should not make clinical or personal health decisions based solely on this content. Always consult a licensed and qualified healthcare provider before initiating, modifying, or discontinuing any therapeutic regimen. The Peptide Association does not endorse any specific therapy, product, or compounding facility.

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Citation: Quesada SG, Ahmed Z, Nakamura HS, et al. Access without approval: state-level determinants of peptide availability in sexual medicine. Sexual Medicine. 2026;[volume](qfag050). doi:10.1093/sexmed/qfag050. PMID: 42394939.