Brigham Buhler says RFK Jr.s HHS finally gives peptides a real seat at the

Peptides Return to the Center of the Health Debate

Joe Rogan and Brigham Buhler open with a casual exchange about Austin allergies, cedar, and supplements like colostrum, but the conversation quickly moves into the policy fight Buhler says has dominated his work for “the last two and a half, three years”: getting peptides reclassified and normalized in American medicine. Buhler describes the previous FDA posture as hostile and opaque, saying he submitted “17 FOIA requests” asking why certain peptides had been classified as dangerous and “they have never once responded to a single FOIA request.” For him, the shift under Robert F. Kennedy Jr.’s HHS is not just political theater but a real structural opening. He says he is “the most optimistic” he has ever been because, for the first time, he feels there is “a seat at the table and a voice.”

The host frames one big reason for that optimism simply: Kennedy actually uses peptides, understands them, and is physically fit enough to judge their real-world effects. Rogan notes that this matters because “millions of people” are already taking peptides and reporting meaningful benefits. Buhler places himself in that group, saying he had once been “on the cusp of diabetes,” obese, and a believer in the conventional annual-checkup model, only to conclude that the system was not designed to build health.

That becomes the episode’s first major theme: a conflict between lived outcomes and institutional dogma. Buhler argues that regulators struggle because peptides do not fit the standard pharmaceutical template. They are often naturally occurring molecules, used in cash-pay, preventive, or optimization settings rather than in insurance-coded disease treatment. He credits Kennedy, adviser Stephanie Spear, and new FDA commissioner Marty Makary with being more willing to listen than prior officials. Makary’s openness matters, Buhler says, because he comes from a critique of medicine’s “dogma” and groupthink rather than blind loyalty to inherited assumptions.

The discussion establishes the lens for the rest of the episode. Rogan and Buhler are not treating peptides as a fringe curiosity. They present them as a test case for a larger question: whether American medicine can make room for preventive, personalized, cash-pay therapies that don’t fit the old insurance-pharma-regulator triangle. Buhler insists this is “so much bigger than peptides.” Still, peptides are where the battle is being fought now, and he suggests the outcome could determine whether much of the broader longevity and biologics movement survives in the US at all.

Testosterone, Prostate Cancer, and a Dogma Built on Three Patients

One of the conversation’s most concrete segments centers on testosterone replacement therapy and the long-standing fear that it causes prostate cancer. Rogan asks Buhler to revisit the issue because he often urges older friends to get their hormones checked, only to hear the same objection: “They get concerned with prostate cancer.” Buhler’s answer is direct and provocative. He says the fear traces back to a study from the 1930s involving just “three patients.” One dropped out, one remained normal, and one was “chemically castrated.” From that tiny sample, he argues, medicine built decades of caution and black-box fear.

Buhler explains the logic this way: if someone has essentially zero testosterone and is then raised from zero to a low-normal range, there may be a theoretical concern during that climb about stimulating pre-existing prostate disease. But, he says, once receptor sites are saturated and testosterone reaches an optimal level, the feared effect does not continue upward. He uses a simple metaphor: “You can only water a plant so much.” In his telling, the receptor sites become saturated, and higher physiologic testosterone does not keep “watering” the prostate indefinitely.

His key claim is sweeping: “There is not one single study that correlates testosterone therapy to prostate cancer.” He points to later research, especially work he attributes to urologist Dr. Abraham Morgentaler in the 1990s, that challenged the old assumption by treating men with prostate cancer using hormone therapy and finding no increased prevalence or worsening. Buhler then makes a population-level argument. If testosterone were truly causing prostate cancer, the modern boom in TRT would have produced a visible spike in incidence, and he says that has not happened.

Rogan is astonished that such a major belief could rest on such weak roots, and that doctors still repeat it confidently. Buhler’s answer is that this is how medical dogma works: a “misnomer can be adopted,” repeated in training, then hardened into orthodoxy. He says clinicians hear something in medical school, repeat it at conferences, and eventually it functions like “urban legend.” He ties this directly to Makary’s book Blind Spots, especially the idea that groupthink gets confused with scientific consensus.

This section matters because it gives the broader conversation a concrete example. Rather than speaking abstractly about corruption or incompetence, Buhler and Rogan use testosterone to show how a weak or outdated premise can dominate care for decades. For them, it is a warning that the same thing may now be happening with peptides, stem cells, and other tools of preventive medicine. If hormone fears were overstated for nearly a century, they argue, today’s regulators may be repeating the same institutional mistake in a new form.

Why Peptides Don’t Fit the Pharmaceutical Machine

After establishing medicine’s tendency toward dogma, Buhler widens the frame to explain why peptides create such regulatory friction. His argument is that the US drug-approval ecosystem was built around large pharmaceutical companies, patent protection, and insurance reimbursement—not around naturally occurring molecules sold directly to informed patients. He says bringing a drug to market is commonly described as costing “$1 billion to $3 billion,” though even by his conservative estimate it is “300 million to a billion dollars.” That cost structure, he argues, creates a moat around conventional drugs and makes it nearly impossible for low-cost, cash-pay, nature-derived therapies to enter through the same door.

Buhler emphasizes that peptide advocates are not asking for Medicare, Medicaid, employer insurance, or federal mandates. “We’re not asking for everything but the kitchen sink,” he says. Instead, they want patients to be able to pay out of pocket for preventive and personalized tools. That distinction is central to his worldview. Big pharma needs broad reimbursement because it must recover huge development costs; peptides, stem cells, and related therapies aim to be affordable enough that people can buy them directly. But regulators, trained inside a system where nearly every approved product is built for insurance billing, struggle to understand this model.

He claims the critique that peptides lack enough data is overstated. Buhler says his side recently provided the FDA with “over 800 different studies” covering “19 peptides” that were restricted under the Biden administration. He also says that in his own practice, Ways2Well has treated “over 90,000 patients nationwide” and did not see the kind of safety signal critics imply. The silence from prior regulators, in his view, reflected not evidence of danger but an inability—or unwillingness—to process therapies that fell outside the old framework.

Rogan adds a useful clarification: GLP-1 drugs are peptides too. That point matters because the word “peptide” often gets used as if it refers only to boutique anti-aging compounds, when in reality the hottest drug class in America belongs in the same category. Buhler uses that to challenge clinicians who say they “would never prescribe peptides” while simultaneously using medications off-label all the time. In his account, mainstream medicine already tolerates a huge amount of improvisation; it simply reserves legitimacy for products that passed through familiar institutional channels.

The takeaway is that peptides occupy a strange middle ground. They are not exactly supplements, not exactly standard drugs, and not easy to patent or reimburse. That “no man’s land,” as Buhler describes it, is why they are so vulnerable. For him, they have “been convicted of a crime they never committed.” The problem is not just safety or efficacy. It is that the existing system has no comfortable category for preventive, cash-pay medicine aimed at optimization rather than disease maintenance.

GLP-1s, Patent Politics, and the Pharma Lobby

The podcast’s most detailed policy discussion comes when the focus shifts from peptides in general to GLP-1 weight-loss drugs in particular. Buhler argues that the current backlash against compounding and peptides was driven largely by the explosion in demand for GLP-1s. He says lobbyists for companies like Eli Lilly and Novo Nordisk have pressed lawmakers with a simple story: they spent billions to innovate these medicines, and now compounders and independent pharmacies are infringing on their patents. Buhler concedes that this is compelling on the surface, especially for politicians who hear only that side.

But he insists the fuller picture is more complicated. First, he says many blockbuster drugs originate from NIH-funded research, which means taxpayer money helped create the underlying science before companies licensed and commercialized it. Rogan responds with disbelief—“How is that legal?”—and Buhler calls it “nuts.” Second, he argues that compounding during shortages was not some rogue theft operation but an established regulatory mechanism. The FDA itself signaled there was a shortage, effectively inviting compounders to help meet demand. Then, once compounders responded, pharma companies accused them of stealing the market.

Buhler goes hard at Lilly’s economics. He claims Eli Lilly “7xed the value of their company,” reached a valuation of roughly “$800 billion,” and that GLP-1s became “the biggest blockbuster molecule in the history of the world.” Against that scale, he says, the compounding industry’s temporary revenue—perhaps “$1.5 to $2 billion total” during the shortage—was an “accounting error.” He also highlights what he sees as hypocrisy: Lilly warns regulators that peptides sourced from China are dangerous while simultaneously signing a “$7 billion” deal to acquire a peptide company out of China.

The broader fear, he says, is precedent. If big pharma succeeds in pushing all of these products into biologic categories that extend exclusivity or shut down compounding, then the battle won’t stop at GLP-1s. “How long before they move to the next thing?” he asks. Rogan’s summary is blunt: they do not just want to win; “they want only them to win.”

For listeners, this section frames the peptide fight as less about science than about market control. Buhler repeatedly returns to lobbying, saying the industry spent “$31 million” on influence and that “dollars equal accessibility.” Regulators with limited time hear a polished fear-based case about Chinese ingredients, safety lapses, and billions in losses. Meanwhile, people like Buhler get “one minute” to rebut nine minutes of industry messaging. The result, he argues, is a policy environment shaped by financial leverage rather than public-health proportionality.

A Broken Sick-Care System Versus Preventive Medicine

From there, the conversation shifts into a broader indictment of American healthcare. Buhler lays out three models. The first is the conventional insurance-driven system, which he calls a “sick care system.” In his view, it is controlled by insurance companies, regulators, and pharmaceutical firms and is designed to treat symptoms of chronic disease, not prevent it. He cites staggering numbers: “1.7 to 1.9 million Americans” dying every year from chronic disease, a level he says exceeds deaths from all US wars combined, while the country remains both the most expensive and one of the sickest healthcare markets in the world.

Rogan pauses on those figures because they are so extreme, but Buhler uses them to justify why he is not interested in merely tweaking the old model. He argues that the average primary-care visit gives a doctor about six minutes with a patient and very limited diagnostic freedom. In that setting, a patient who is overweight, anxious, depressed, and inflamed gets routed into the standard tool kit: cholesterol drugs, GLP-1s, antidepressants, and quick follow-up. That may be efficient billing, but it is not root-cause care.

He contrasts that with a longevity-oriented clinic, where the patient gets a “battery of diagnostics” and a slower investigation into hormones, insulin resistance, inflammation, body composition, and lifestyle. He cites Jelly Roll as an example. In a standard clinic, he argues, the singer likely would have been put immediately on a weight-loss drug and “a battery of drugs.” At Ways2Well, the first focus was supposedly simpler: fix insulin, fix hormones, reduce estrogen imbalance and inflammation, then create “wins on the board.” The point is not one magic treatment but a layered approach.

Buhler says the average American is on “four or more prescription drugs,” which Rogan asks him to confirm because it sounds absurd. For Buhler, that number symbolizes a culture that is “prescription first.” He says the future should combine affordable concierge-style care, AI tools, wearables, body-composition tracking, and broad diagnostics—not just cash-pay blood work, which he dismisses as only “one marker in a sea of markers.”

This section crystallizes his mission. He says he does not want to “die on the peptide hill” because the real issue is much larger. Personalized, predictive, preventive care is the goal. The current system is good at emergencies—“wreck the car” care, as he puts it—but terrible at protecting long-term healthspan. Rogan’s role here is mostly to underline the absurdity of the status quo and emphasize that most large healthcare companies are structurally obligated to maximize profits, not maximize wellness.

Ways2Well, Cash Pay Care, and the Fight Over Incentives

Once the macro critique is established, the discussion becomes more personal and entrepreneurial. Rogan tells Buhler directly that he believes he is “an actual good dude” trying to help people rather than simply extract profit. That gives Buhler an opening to explain what he believes makes his model different from both legacy medicine and fast-scaling telehealth brands. He says Ways2Well’s internal rule from day one was simple: “If we always make this about people, if we make people our northern star, that is our secret sauce.”

That sounds idealistic, and Rogan calls it “hippie,” but he agrees with the core problem: public companies and large healthcare platforms have fiduciary obligations that make patient-first care fragile. Buhler contrasts his clinic with Hims and other venture-backed telemedicine firms, which he describes less as medical practices than as “multibillion dollar marketing” businesses. In his view, many of them are becoming pill mills for peptides and GLP-1s, prioritizing speed of conversion over quality of care.

He admits he once thought AI would be the fastest way to scale access, and he still believes AI matters. But he says he changed his view on one key point: “Everything always starts with people.” The best use of AI is not replacing clinicians but extending their reach. He criticizes platforms that pay clinicians hourly to jump between unrelated care categories—“on a Monday they’re pulling babies and on a Tuesday they’re a testosterone expert”—arguing that such flexibility may increase access but often lowers quality.

A major practical difference in his model, he says, is alignment. In cash-pay care, patients spend their own money and can leave if a treatment is not helping. “If you don’t put a win on the board, they’re going to fire your ass,” he says. That market discipline, in his telling, creates more integrity than the insurance model, where payers dictate which doctors and pharmacies a patient can use and where PBMs monetize prescriptions through rebates. He defends owning both clinics and pharmacy operations as a way to compete on price and quality, adding that patients remain free to take prescriptions elsewhere.

The section also underscores the operational challenge of scaling integrity. Buhler says rapid growth led to criticism because “you can’t onboard 20,000 people overnight” without friction. Still, he insists the answer is not to abandon quality but to use technology to support high-touch care at lower cost. This becomes a recurring theme: the ideal future is not elite concierge medicine for the richest 0.01%, nor mass-market drug vending. It is a middle path where advanced diagnostics and personalized treatment become affordable enough for ordinary people.

The Hims Controversy and How Bad Actors Shape Regulation

One of the podcast’s most pointed examples of market gamesmanship comes in Buhler’s criticism of Hims. He argues that some of the regulatory backlash against compounding was not an inevitable response to safety concerns but was strategically triggered by a major player that never intended to stay on the compounding side. His accusation is blunt: Hims ran a Super Bowl ad using the brand name of Novo Nordisk’s GLP-1 product in a way he says violated compounding rules, then shortly after signed a deal with Novo Nordisk to distribute the branded drug.

Buhler says that if a compounding pharmacy is marketing a compounded medication, it must use the generic compounded name rather than imply a direct branded equivalent. He likens it to saying, “We have Kleenex for cheaper than Kleenex.” According to him, Hims should have known better. He rejects the idea that this was an accident, calling it “the equivalent to somebody coming into your living room and taking a dump on your dining room table and you assuming that it was an accident.” In his reading, the move was designed to set off a regulatory explosion that would damage the compounding sector just before Hims pivoted into a pharma partnership.

The timeline matters to him. He says lawmakers and regulators across the spectrum reacted with outrage to what looked like open direct-to-consumer infringement, black-market style marketing, and a violation of compounding norms. Then, “within two weeks,” Hims had a source agreement with Novo. Its stock surged, and the rest of the compounding industry was left to deal with the consequences. He notes that a class action and antitrust lawsuit is now exploring what happened, though Rogan skeptically notes that even if the truth comes out, it will likely register only as “a blurb in the news.”

The strategic lesson is larger than Hims. Buhler argues that bad actors, whether deliberate or reckless, make it easier for regulators to lump together responsible compounders, gray-market peptide sellers, and aggressive marketers into one dangerous category. That is why he keeps stressing process, chain of custody, and lawful clinical involvement. The fear is that one flashy scandal gives opponents the excuse they need to shut down an entire category of care.

For Rogan, the whole episode illustrates greed at scale. For Buhler, it illustrates the fragility of emerging medical pathways. When one company lights a match for short-term advantage, regulators may respond with broad restrictions that hurt clinicians and patients who were trying to follow the rules. That is why he keeps returning to one principle: do not punish an entire industry for one actor that had already “rode off into the sunset.”

The Black Market Problem and the Case for Regulated Access

If there is one point where Buhler sounds most urgent, it is on the growth of the peptide black market. He says the cat is out of the bag: people know these compounds exist, they believe they work, and they are not going to stop seeking them. The result, he claims, is that “four out of five peptides being filled are being filled through gray or black market solutions.” That number is central to his argument because it reframes the policy question. The issue is no longer whether America can suppress peptide use; it is whether it can move use back into regulated channels.

Rogan brings up a common real-world example: people buying products online that may not even be what they claim. He mentions compounds like CJC/Ipamorelin that usually produce a noticeable physiological sensation; when users feel nothing, they suspect they received fake material. Buhler says some gray-market products are real and some are not, but even authentic ones can be badly dosed. He warns that a GLP-1 sold at twice the proper strength could cause “muscle wasting or all sorts of catastrophic events.”

He describes the loophole many sellers use: products labeled for “non-human use” while being openly promoted by influencers for human injection. He recounts warning one Ivy League-educated peptide CEO that if someone had a serious adverse event, the Department of Justice would subpoena the company and uncover the contradiction between labeling and marketing. He says that scenario is now happening, with the FBI reportedly showing up at several gray- and black-market peptide facilities.

For Buhler, the solution is straightforward: restore legal access through clinicians, pharmacists, and compounding pharmacies operating under inspection. He stresses that his own pharmacy buys active ingredients from FDA-recognized suppliers, undergoes constant state and federal inspections, and performs third-party verification on dosages. In contrast, black-market operations have no physician, no pharmacist, no reconstitution guidance, and no accountability. He calls the present moment “the wild west” and argues that banning legitimate channels only drives more people toward that chaos.

His pitch to regulators is therefore almost conservative: bring peptides back under professional supervision. Doing so would cut out much of the black market, satisfy some concerns from pharma, and restore a layer of law and order. Rogan summarizes the logic simply: regulate peptides and stem cells through compound pharmacies, and “everybody wins.” Buhler agrees—except, he notes, for pharmaceutical companies that want exclusive control. That conflict between public safety and market exclusivity sits at the heart of the episode.

Genes, Data, AI, and the Promise of Predictive Medicine

The conversation then pivots toward what Buhler sees as the next layer of health optimization: combining genetics, body-composition testing, wearables, blood work, and AI into a predictive system that tracks healthspan in real time. He argues that blood work alone, though useful, is just a “snapshot of you in time.” What matters more is integrating multiple streams: DEXA scans, VO2 max, body-fat distribution, bone density, sleep, biomarkers, and eventually full genetic sequencing.

Buhler says most people know the software version on their iPhone but not “what code our body’s running on.” He claims fewer than “one in 1,000” people have had their genome sequenced and that medicine is barely beginning to exploit this information. To make the idea concrete, he discusses Gordon Ryan. According to Buhler, Ryan’s sequencing revealed rare genes that help explain both his athletic gifts and his health problems. He says Ryan has a tendon-related gene that may make his connective tissue unusually resilient, a gene that raises bone mineral density, and other markers that help explain why he is so physically dominant. At the same time, Buhler says Ryan also has markers tied to immune vulnerability, recurring staph susceptibility, and a more acidic gut environment, which may help explain his chronic health struggles.

He extends the idea to other elite athletes, saying Devon Larratt also showed highly unusual combinations of tendon and bone-density genes. The larger claim is that once these patterns are understood across millions of people, medicine will become more individualized. He imagines using AI to detect that “every man with a gene marker” of a certain type responds especially well to a given intervention, or that someone with a particular cancer predisposition should alter lifestyle decades earlier.

The most speculative stretch of the conversation comes when Buhler discusses future gene editing and activation. Referencing his colleague Ryan Rosner, formerly of DARPA, he says science may eventually produce “real life X-Men.” He mentions experimental ideas like increasing bone density dramatically by switching on certain genes, and even points to animals like Greenland sharks and the so-called immortal jellyfish as examples of biological traits humans might one day study, mimic, or activate. Rogan is fascinated but repeatedly grounds the discussion with practical questions about side effects and physical trade-offs, like becoming too dense to swim easily.

The takeaway is not that such interventions are ready now, but that Buhler sees medicine moving from blunt chemical management toward software-level biology. In his framing, healthcare’s future lies in knowing each person’s genetic firmware, then using data and targeted interventions to guide them away from disease and toward optimal function long before symptoms appear.

Stem Cells, Muse Cells, Plasma Exchange, and a New Medical Frontier

The final stretch of the episode is devoted to the regenerative frontier, especially stem cells, Muse cells, and plasma exchange. Buhler becomes most animated when discussing Muse cells, which he says he first approached skeptically. After traveling to Japan with his chief science officer, Ian White, to meet researcher Mari Dezawa, he says he came away convinced these cells could be transformative. Muse stands for multilineage-differentiating stress-enduring cells, and Buhler presents them as a rare subset—less than 2%—of stem cells that can survive harsh conditions, evade damaging immune reactions, and actually differentiate into damaged tissue types.

He tells the discovery story almost like a scientific parable: Dezawa accidentally left cells out overnight after a dinner with sushi and sake, expected them to die, and instead found that this tiny subset survived. From there, the research reportedly showed that Muse cells can home in on damaged tissue, cross certain barriers more effectively than traditional mesenchymal stem cells, and adopt the phenotype of the damaged cell through phagocytosis. In Buhler’s simplified analogy, they act like “Pac-Man,” engulfing a broken cell and becoming a younger, healthier version of it. He stresses three properties repeatedly: safety, pluripotency, and superior “engraftment,” which he says may rise to “15 to 30%” versus “3 to 5%” for more conventional MSCs.

He also claims early studies suggest no tumor formation and even some tumor-shrinking behavior in animal settings, while also citing dramatic international anecdotes, including children with encephalitis reportedly regaining normal brain function when treated quickly and a comatose crash victim showing signs of recovery after Muse-cell treatment. Rogan is clearly captivated, especially by the possibility that these cells can cross into the midbrain and therefore may hold promise for Parkinson’s and other neurodegenerative conditions.

The last treatment discussed is plasmapheresis, or therapeutic plasma exchange, which Buhler says his clinic added recently. He describes it as an “oil change for your body”: blood is run through a machine, inflammatory material in plasma is removed, and the plasma is replaced with albumin and, in his protocol, additional regenerative components. He says a single exchange can remove around “70%” of unwanted plasma contents. He ties this to studies on endocrine disruptors and microplastics, then gives a striking anecdote about Philip DeFranco, whose testosterone was supposedly very low until testing revealed extreme microplastic burden. After interventions, Buhler claims DeFranco’s testosterone rose “to 1,200” without testosterone therapy.

The episode closes on a note of optimism. Rogan emphasizes how many people now know someone helped by stem cells or biologics, often after traveling to Panama, Tijuana, or Colombia. Buhler says states like Texas, Florida, Utah, and Arizona may move faster than Washington, creating “medical tourism” hubs in the US. His final message is that the country has a chance to build a regulated, affordable, cash-pay life raft alongside the old system—and that if this moment is handled correctly, it could mark the beginning of a “golden era of healthcare.”