[2026 update] Evidence quality in the secretagogue literature: an honest assessment

Posting this under the heading it deserves: Evidence quality in the secretagogue literature: an honest assessment Everything below is what sits behind that.

I have spent a fortnight trying to pin Evidence quality down and I want to set out where I have got to, because I suspect the honest answer is duller than the thread this will produce.

What I have: a consistent observation across a small number of cases, collected the same way each time. What I do not have: any controlled comparison, or any reason to think my cases are representative.

The specific question is whether the pattern survives once the obvious confounder is removed. I cannot remove it with what I have.

I had written a reply contradicting the opening post and deleted it. Here is what survived.

The most useful single question to ask about any compound in this family is what the published human evidence actually consists of. In several cases the honest answer is a handful of small studies.

It reads as pedantry until the day it does not.

Adding the measurement that the opening post says would settle it.

The documentation on Evidence quality is better than this thread and I say that as someone who has posted in the thread.

Effects reported at the level of appetite are the most consistently described and the most mechanistically direct for the ghrelin-receptor compounds, which is not what most people are taking them for.

Second-hand, so weight it accordingly.

Tesamorelin is the compound in this family with the strongest regulatory evidence base, and it was studied in a specific population for a specific indication. That evidence does not generalise to the way it is usually discussed.

That is consistent with mine, for whatever one more account is worth.

Picking up post #4: that is the part I would want checked first.

My understanding of Evidence quality is a few years old and may have been superseded. If it has been, I would genuinely like to know rather than keep repeating it.

On post #7 — agreed on the reasoning, with one qualification.

Growth hormone secretagogues act on the ghrelin receptor or on the growth hormone releasing hormone receptor rather than supplying growth hormone, which is the distinction that matters for anyone reading the literature.

That is my reading. Someone else read the same page differently and was reasonable.

Post #8 answers the question as asked. The question underneath it is different.

Why this subcategory is stricter about sourcing than most: the evidence base is weaker and that is precisely why documentation quality matters more. A supplier page that clearly identifies the compound and the purity is more valuable for secretagogues than for incretin agonists where the evidence base is stronger.

That is all the detail I have. Someone else will have more.

Second-hand on Evidence quality, so weight it accordingly — someone whose method I trust told me this and I have not verified it myself.

Research-use-only secretagogues are not approved for human use. That statement is doing real work in this subcategory, where the published evidence base is thinner than the volume of confident discussion.

On balance I think that is right, and I would not bet much on it.

This follows post #9 rather than contradicting it.

I disagree with the framing of Evidence quality above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.

The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.

Tesamorelin has an approved indication in HIV-associated lipodystrophy. That is the only compound in this class with a registration-quality evidence base from a proper trial programme. Generalising from that narrow population to healthy adults is a substantial extrapolation.

I would rather be precise about what I do not know than vague about what I do.