Hey everyone, if you’ve been following my peptide adventures on this Substack, you know by day, I’m a startup founder building JustPaid.ai - automating B2B billing for complex contract based sales. By night, I’m deep in peptide rabbit holes, obsessed with biohacking tools and protocols, while chasing that elusive work-life balance (ha, as if!). Previously, I dove into my own experiments with MOTS-c, the mitochondrial powerhouse that’s given me access to this hidden energy stash, making long days feel less like a grind.
A few weeks ago, I was invited to a private event of longevity and biohacking enthusiasts in San Francisco, the kind of gathering where curious folks swap stories on health tweaks and optimization, and that is where I had the chance to meet and chat with Paul Abramson MD.
Let me tell you a bit more about Paul, because his background feels like the perfect mix! He founded My Doctor Medical Group, a concierge medicine practice in San Francisco that focuses on combining traditional medical approaches with technology and holistic strategies to help people optimize their health in the least invasive ways possible. With engineering degrees from Stanford under his belt before he pivoted to medicine, he brings this analytical, problem-solving mindset that clicks with founder types always iterating on ideas. He completed a fellowship in integrative medicine at the University of Arizona, and he comes from a family of doctors spanning generations, which gives him this deep-rooted perspective on patient care. Beyond that, he consults for health tech companies, shows up in media discussing everything from wearables to even Bitcoin-related documentaries, and specializes in areas like addiction medicine and longevity. What stands out to me is his contrarian style, he is not about chasing the latest hype, but emphasizing safety and real evidence, which is why I found our conversation so grounding.
At the event, our talk started with peptides, those tiny molecules I have been experimenting with myself for energy and recovery boosts, like MOTS-c to unlock that stored stamina or BPC-157+TB500 for quicker healing after workouts. Paul shared his view as someone who has seen a lot in practice, he appreciates the potential but leans hard on caution. We got into risk versus safety, and he humbled me by explaining how novelty can be exciting for folks like us founders always testing new tools, but most people, including his patients, prioritize proven paths over unknowns. He mentioned how clinical trials often start strong but fizzle out, at high cost, and urged owning the risks if you are diving in, like I do with lab-testing everything. It made me reflect on my own stack, but aligning it carefully with my family plans to avoid anything messing with fertility. Coming from Amsterdam, where nobody really knows about peptides and doesn’t have a need to optimize their health as Silicon Valley entrepreneurs do - San Francisco scene always energizes me!
We split into groups chatting hormones, GLP-1 tweaks, and peptides that really move the needle. I shared my personal research, but Paul’s grounded view reminded me this is all still exploratory. As founders juggling high-stakes days, we love quick wins, but health experiments deserve that same iterative mindset we bring to product builds. Paul is not against the innovation, he’s philosophically open, but he’s big on owning the risks, especially for high-achievers like us. We geeked out on BPC-157, solid for joint repair, with Reddit crowds vouching and no major red flags yet, but for stuff like FOXO4-DRI? That’s the senescent cell clearer I’ve been eyeing, and was developed by researchers affiliated with institutions in both Amsterdam and the Netherlands, such as the Netherlands Cancer Institute, wild potential for zapping damaged cells, sounds futuristic, right? Paul shared how so many phase trials flame out, with hundreds of millions (or more) of dollars poured in.
It made me reflect: my MOTS-c cycles have me feeling unstoppable, but as a founder eyeing family plans, I need to be extra cautious, skipping anything ghrelin-messing for fertility alignment.
We then discussed TRT and hormones, a frequent topic among founders seeking an edge. Dr. Abramson emphasized the significant commitment and recommended addressing foundational issues like sleep and stress first. Drawing on his engineering background, he weighs hormonal innovations against simpler, lifestyle fixes, noting that unmonitored use has led to serious, even tragic, outcomes. He suggested TRT is only warranted for busy professionals if levels are genuinely low and symptomatic, as it otherwise becomes a major ongoing management hassle. This tempered my curiosity, making peptides feel like a lower-commit, but still “basics-first” option. Dr. Abramson detailed the downsides he has witnessed: side effects like polycythemia (thick blood/increased blood viscosity) requiring management, infertility concerns, and potential prostate issues (elevated PSA values leading to unnecessary biopsies), adding that quitting is difficult and HCG may not always restart natural production
What really lingered? Paul’s late-night puzzle isn’t diagnostics, AI speeds those sometimes, it’s linking our behaviors to results and actually shifting them. As founders, we track KPIs religiously, yet do we also do in health? We might party like it’s launch day, then peptide-patch the fallout. For us over-40 grinders, it’s about sustainable edges amid the chaos. Paul’s contrarian humility inspired me, bro-science has merit, but real wins are behavioral.
That chat left me with more questions than answers, so I followed up with Paul post event.
Paul it was such a pleasure to connect, as I was digging more I have a few questions for you:
1. Paul, your practice blends conventional and integrative medicine for optimization, which seems ideal for self-experimenters like me, what draws you to caution around peptides, and are there any you have seen shine in practice or raise red flags?
The honest answer is that my caution around peptides comes from the same place as my caution around any intervention: the gap between plausible mechanism and proven benefit in humans. Most peptides that excite the biohacking community, such as BPC-157, TB-500, and GHK-Cu, have genuinely interesting preclinical data. Rats heal faster. Cell cultures show impressive effects. The mechanisms make biological sense. But we have essentially zero rigorous human trial data for most of these compounds, and the FDA classified several as Category 2 substances in 2023 specifically because they present safety risks that can’t be adequately assessed.
What shines? Tesamorelin actually has robust Phase 3 data, with 816 patients, 15-18% visceral fat reduction, but only for HIV lipodystrophy and at the price of a substantial increase in diabetes risk. That’s a far cry from general metabolic optimization. The GLP-1 agonists like semaglutide and tirzepatide aren’t peptides in the biohacker sense, but they represent what properly studied peptide therapeutics look like: years of trials, clear safety profiles, FDA oversight.
What raises red flags? The combination protocols. When I see someone stacking four or five peptides simultaneously, each promoting growth factor signaling, angiogenesis, or tissue proliferation through different pathways, I worry about cumulative effects no one has studied. We know elevated IGF-1 correlates with increased cancer risk in large epidemiological studies. We know chronic angiogenesis stimulation is how tumors acquire blood supply. Combining tesamorelin (which raises IGF-1 by 80-90%) with BPC-157 and TB-500 (both pro-angiogenic) represents a biological experiment with completely unknown long-term consequences.
The sourcing issue is equally concerning. Independent testing consistently finds 30-70% of gray market peptides are mislabeled, underdosed, or contaminated, often with bacterial endotoxins. Even Andrew Huberman, who’s done more than anyone to popularize these compounds, has publicly warned about lipopolysaccharide contamination in gray market sources. The (maybe) loudest advocate is also telling people to be careful about quality.
2. On TRT, you highlighted risks like polycythemia and the long-term commitment, with your Stanford engineering background, how do you balance hormone therapy innovations against lifestyle changes, and when might it fit for over-40 pros juggling work?
My engineering background actually makes me more conservative here, not less. Engineers understand that complex systems fail in unexpected ways, that optimization for one variable often degrades others, and that the most elegant solution is usually the simplest one that works. Hormone replacement is a legitimate medical intervention for genuine deficiency, but it’s become conflated with optimization in ways that concern me.
The risks are real and often minimized: polycythemia requiring regular phlebotomy, testicular atrophy requiring HCG if fertility matters, potential cardiovascular effects that remain debated, and the commitment issue: once you’ve been on exogenous testosterone for years, your hypothalamic-pituitary axis may not recover normally. You’re potentially committing to lifelong therapy based on a decision made at 42.
For over-40 professionals, I start with a question: have we actually addressed the modifiable factors that affect testosterone? Sleep deprivation alone can drop testosterone 10-15%. Chronic stress elevates cortisol, which suppresses the HPG axis. Visceral adiposity increases aromatase activity, converting testosterone to estrogen. Alcohol has direct testicular toxicity. Many men in demanding careers have testosterone levels reflecting their lifestyle, not their biology.
When does TRT fit? When someone has genuinely optimized sleep, exercise, stress, and body composition, still has symptomatic hypogonadism with confirmed low levels on multiple morning draws, and is willing to engage in an ongoing regular monitoring of blood tests while adjusting dose to safe levels and responding appropriately to side effects that may be discovered. And who has already had a full medical workup and had unusual causes hypogonadism ruled out, along with the full informed consent discussion. That’s a different conversation than treating a number on a lab report in someone sleeping five hours a night and having four drinks a day.
The innovation I’m actually excited about? Better understanding of the lifestyle factors. The data on resistance training and testosterone is compelling. The sleep research is solid. These interventions have purely positive side effects and address root causes rather than downstream numbers.
3. We touched on how trials can promise big but often fail, as a founder taking calculated risks myself, how do you guide patients through emerging therapies and any tips for balancing curiosity without veering off track?
The founder mindset serves you well in recognizing that breakthrough returns require accepting some uncertainty, but it can mislead in medicine because the asymmetry runs the wrong direction. In venture, you can lose your investment but the upside is theoretically unlimited. In health experimentation, the upside is usually modest (feeling somewhat better) while the downside includes irreversible harm. The expected value calculation is fundamentally different.
I guide patients through emerging therapies by asking three questions. First: what’s the quality of evidence? Animal studies and mechanistic plausibility are hypothesis-generating, not hypothesis-confirming. Phase 1 trials tell you about safety at specific doses in small populations. Phase 2 gives preliminary efficacy signals. Phase 3 is where most promising interventions fail, and we don’t have Phase 3 for most peptides.
Second: what’s the risk-benefit ratio given your specific situation? An experimental intervention makes more sense for someone with serious disease and limited options than for someone optimizing from a healthy baseline. The potential benefit is greater and the opportunity cost of conservative management is higher.
Third: what’s the quality control? Pharmaceutical-grade compounds from regulated sources are fundamentally different from gray market products labeled “for research use only.” The entrepreneurial parallel isn’t funding a scrappy startup. It’s wiring money to an unregistered offshore entity based on a pitch deck. While testing individual lots might seem to mitigate this risk, there are many potential pitfalls in that process too.
The tip I’d offer: apply the same due diligence you’d apply to an investment. You wouldn’t fund a company based on a subreddit thread and a podcast appearance. You’d want audited financials, customer references, regulatory status. Demand the same rigor for what you put in your body.
4. Your point on linking habits to outcomes really resonated, how do you help high-achievers like CEOs grasp that behavior-health tie, and from your addiction medicine side, what simple steps could help founders build routines amid the grind?
The most effective reframe I’ve found is speaking the language of performance and returns. High achievers understand compounding. They understand that small advantages accumulate over time. When I explain that consistent sleep optimization likely provides more cognitive benefit than any nootropic stack, and that the effect compounds daily for decades, that resonates.
The challenge is that behavior change feels pedestrian compared to the appeal of novel interventions. Taking a peptide feels like doing something sophisticated. Going to bed at the same time every night feels ordinary. But the evidence base isn’t close: sleep, exercise, nutrition, and stress management have robust outcome data across millions of subjects. Most biohacking interventions have anecdotes and mechanisms.
From my addiction medicine work, I’d emphasize two principles that transfer directly to habit formation in high-performers.
First, environmental design beats willpower. The same principle that makes it important for a person struggling with alcohol use to remove alcohol from their home applies to sleep hygiene, food environment, and exercise. Don’t rely on making good decisions when depleted at 10 PM. Structure your environment so the default behavior is the healthy one.
Second, identity precedes behavior. In recovery, sustained change happens when someone internalizes “I am a person who doesn’t drink” rather than “I am trying not to drink.” Similarly, “I am someone who prioritizes sleep” produces different behavior than “I should try to sleep more.” The founders I see succeed at health behavior are those who’ve made it part of their identity, not a checklist item.
Simple steps? Protect the first hour and last hour of your day. Morning sunlight exposure, no screens before bed. Make exercise appointments non-negotiable. Track and improve sleep schedule consistency and sleep quality. These aren’t exciting interventions, but they’re the foundation that makes everything else work.
5. With your integrative fellowship and multi-generational doc roots shaping a least-invasive approach at My Doctor Medical Group, how does that philosophy help entrepreneurs like me align longevity with startup life and family goals, without adding complexity?
My family has practiced medicine across three generations, and the through-line is a healthy skepticism of overtreatment. My grandfather saw patients harmed by interventions that seemed reasonable at the time. I’ve seen the same. The history of medicine is littered with treatments that made mechanistic sense, had enthusiastic adopters, and ultimately caused net harm: DES to prevent miscarriage, aggressive cardiac stenting, routine episiotomy, to name a few. Humility about what we don’t know should inform how aggressively we intervene.
For entrepreneurs specifically, the least-invasive philosophy addresses a real problem: complexity has costs. Every additional intervention is something to source, store, schedule, track, and troubleshoot. A six-peptide protocol with precise timing windows, reconstitution requirements, and injection sites adds cognitive load and potential failure points. That complexity competes with your finite bandwidth for building companies and being present with family.
The longevity interventions with the strongest evidence, namely cardiovascular exercise, resistance training, Mediterranean-style nutrition, sleep optimization, stress management, and maintaining social connection, require minimal external inputs and integrate with rather than compete against a full life. You can maintain an exercise routine while traveling. You can eat well at business dinners. You can prioritize sleep without complex protocols.
My concern with the optimization culture is that it sometimes creates an illusion of control through complexity, the feeling that you’re doing everything possible, even when the evidence base for many interventions is thin. The entrepreneurs I see thriving long-term are usually those who’ve mastered the fundamentals rather than those chasing the cutting edge. They sleep consistently, exercise regularly, maintain relationships, and get appropriate preventive care. It’s not exciting content for a podcast, but it’s what actually works.
The question Paul poses back to the longevity-seekers:
What would it mean for your longevity goals if the answer were simpler than you expected? What if the 80/20 were truly the fundamentals, and the elaborate protocols were mostly sophisticated distraction?
If the real 80/20 truly is the fundamentals, I’d feel two things at once.
First, a huge wave of relief and validation. My Eight Sleep is consistently 7.5–8 hrs, Hevy lifting app logs show 4 heavy lifting days a week with weekly PRs, one solid cardio session, one yoga flow, and my supplement cabinet is boringly dialed in. The only fundamental I still need to lose is startup stress (when JustPaid.ai is on fire, cortisol wins). So knowing I’ve already nailed most of the big levers would feel like a quiet win.
But second (and this is the part I have to be honest about), I’d also feel a tiny bit of… protective defensiveness? Because I genuinely enjoy the remaining 20 %. Hunting down the next marginal gain with peptides, cycling BPC-157 for recovery, or geeking out on some research scratches the same itch that makes me a good founder: curiosity, experimentation, and the thrill of finding a 1–5 % edge that most people miss.
So if the data eventually says “Anelya, you’re already at 92 % of what’s possible with basics alone,” I wouldn’t abandon the peptides entirely. I’d just reframe them from “necessity” to “hobby I can afford because the foundation is rock-solid.” I’d keep the protocols that clearly move the needle for me (recovery speed, metabolic flexibility) and drop the ones that are mostly intellectual entertainment.
In short: I’d sleep even better knowing the house is already built, and I get to keep tinkering in the garage for fun.
Thanks for the nudge. It’s exactly the kind of mirror I needed.
Wrapping this over my virtual SF coffee, the chat was a humble nudge to experiment smartly. Peptides have been my quiet ally for energy and recovery, but Paul’s insights keep me grounded. If you’re a founder navigating this, you’re in good company here, drop your thoughts below, or guest-post if you’ve got stories, DM me. Always chat with a doctors like Paul first through his practice at
https://mydoctorsf.com/
Let’s keep learning together. 🚀
Disclaimer
This is not medical advice. The content on this Substack is for informational and educational purposes only and is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider before making any decisions regarding your health or the use of peptides.
My experiences with peptides are personal and may not be typical. Individual results can vary widely based on personal health conditions, lifestyle, and other factors. Do not rely on my experiences as a guarantee of similar outcomes.
The information provided here does not constitute an endorsement or recommendation by any regulatory authority, including the FDA or other health organizations. Some peptides may be experimental or not approved for general use.
I am not liable for any losses, injuries, or damages arising from the use or misuse of information shared on this Substack. Readers are solely responsible for their own actions and any decisions made based on this content.
The peptides discussed are for research purposes and may not be intended for human use. Please ensure compliance with all local laws and regulations regarding the purchase, possession, and use of peptides.
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