What would you be willing to put in your body?

This is Optimizer, a weekly newsletter sent from Verge senior reviewer Victoria Song that dissects and discusses the latest gizmos and potions that swear they’re going to change your life. Opt in for Optimizer here.At this time last week, I was getting ready to ask people what drugs they were on. I was waiting in a conference room at the Hilton Resorts World Las Vegas. In my hands was a sheet detailing the schedule of the roughly 40 elite athletes participating in the Enhanced Games — an athletic event where using legal performance-enhancing drugs was the name of the game. Soon enough, there would be a media scrum where the press could go up to each athlete, shove a microphone in their face, and ask, “Hey, what are you taking?”None of the athletes disclosed their unique, personalized cocktail of performance-enhancing substances. They just told us that they felt good, that training was easier, and that recovery was faster. Enhanced, the company behind the Games, only shared an aggregated, nonspecific list of what athletes were using, to prevent copycats from taking the same drugs without medical supervision.Much has already been said about the results of the inaugural Games. How three of the four unenhanced athletes beat their “enhanced” rivals in their races. How only one world record — arguably the main marketing draw of the event — was broken. How, in the end, it seemed the Games itself was a shady scheme aimed at convincing a susceptible public to buy supplements, hormone therapies, and (legal) peptides from Enhanced’s direct-to-consumer telehealth platform.I walked away from the Games with many questions. But from all my interviews and conversations, the biggest one was: How do we decide what’s safe to put into our bodies?James Magnussen had some choice words for press at a media scrum before the Enhanced Games.Both wellness influencers and athletes are obsessive about what goes into their bodies. It makes sense. Their bodies — how they look and perform — are their livelihood. This universal and human desire to optimize has led to a wellness industry worth $6.8 trillion, expected to hit $9.8 trillion by 2029. That desire is why you see incessant ads for telehealth apps that compound GLP-1 medications, influencers hawking ads for supplements, and dubious podcasters singing the praises of testosterone replacement therapies.But there’s one thing that’s always felt baffling: It’s so often the same people who decry vaccinations backed by a ton of scientific evidence who are perfectly happy to inject themselves with unproven substances that might make them stronger, thinner, or faster.“We all took an injection a couple years ago that it’s impossible to know what the long-term effects are. I’m not sure that that many people ask questions about that one,” James Magnussen, a retired swimmer and three-time Olympic medalist, said at the Enhanced Games media scrum. He was referring to the covid-19 vaccine, in response to a barrage of press questions regarding the potential health risks of doping. (Magnussen is incorrect here — researchers continue to study the long-term effects of the covid-19 vaccine, and the existing evidence shows serious complications are rare.)Still, the debate about what’s “safe” to put in our bodies versus the principle of bodily autonomy was a recurring theme as I talked to various athletes, health experts, and biotech executives for the article.“I would personally never tell anybody what to do for their body,” said Hunter Armstrong, another three-time Olympic medalist and Enhanced athlete. Unlike most of the athletes at the event, Armstrong competed without doping and won the men’s 50m backstroke. Asked whether his choice to remain unenhanced reflected his views on doping for others, Armstrong stated, “I definitely do not want to see any unsafe procedures or enhancements, especially at a young age.”Hunter Armstrong took home $375,000 from the Enhanced Games as one of four clean athletes.While Armstrong didn’t take home the $1 million prize, he did walk away with $375,000 for a first- and second-place finish in two races. He might’ve been unenhanced, but the optics of Enhanced incentivizing financially insecure athletes to dope so they can then sell various substances to the public are insidious. And after interviewing Dr. Guido Pieles, a sports cardiologist and chair of Enhanced’s independent medical commission, I found it curious that what was sold on Enhanced’s telehealth service was different from what the athletes used. For example, the telehealth service sells GHK-Cu and GLP-1s, but neither were on the approved list for athletes. Likewise, consumers can’t buy erythropoietin (either on Enhanced’s site or without a prescription), but 41 percent of Enhanced’s athletes were taking that. Colloquially known as EPO, the drug is often used illegally in cycling and marathons to boost oxygen in the blood and therefore endurance.But when I questioned that disconnect to Enhanced CEO and cofounder Maximilian Martin, he disagreed.“Look, GHK-Cu is a peptide that doesn’t necessarily help you become a quicker swimmer. I don’t think [our businesses] stand in controversy with each other. I think, especially because we’re so cut-and-dry on the research side, that’s exactly why we want to advertise so much,” he says, noting that Enhanced’s ultimate goal is to be a steward of the “right way” to use performance enhancers — both in the context of sports and for biohacking one’s own longevity. That means medical supervision and frequent follow-up testing.Martin questioned the way peptides are supposedly commonly consumed now. “The route saying, ‘I’m ordering peptides online from China that are untested, unregulated, unsupervised, and I’ll just inject myself because I want to take every peptide under the sun because the more the merrier’? That’s not what people should be doing!”Megan Romano told The Verge that the Enhanced Games was an opportunity to challenge herself again after 10 years of retirement.“We all agree it’s wrong when people follow influencers more than doctors,” says Christian Angermayer, a biotech investor and cofounder of Enhanced. Angermayer’s theory is that the current distrust in the medical establishment began with how governments handled the covid-19 pandemic. He also notes that the pharmaceutical industry has thus far ignored the strong desire among average people to improve themselves and live longer. Together, he says, those things have helped push people to take matters into their own hands. See: Magnussen’s comments on the vaccine and the fact that he was the first athlete to sign up for the Games.“A pure libertarian would say, ‘Everything goes! Why can’t people do whatever they want!’ Well, freedom without knowledge is not freedom. You might feel free, but you actually harm yourself,” says Angermayer.Martin and Angermayer have a point. A recent case study found that a 32-year-old man who obtained gray-market retatrutide — a currently unapproved GLP-1 agonist referred to online as “reta” — landed himself in the emergency room with “intractable diarrhea” after self-administering the wrong dosage. (By intractable, they mean the poor soul was having bowel movements every 20 to 30 minutes, up to 30 times per day.)In theory, Enhanced isn’t wrong in saying that people need to have safer, more reliable options. The harm reduction argument is one that Health Secretary RFK Jr. is also using to justify the Food and Drug Administration potentially recategorizing some popular experimental peptides to allow for compounding. But it’s also tricky. Proper harm reduction relies on people being able to trust the medical establishment.The jumbotron at the Games often displayed Enhanced’s talking points about medical supervision, transparency, and athlete welfare.I asked Enhanced what will happen if some of these experimental and unproven peptides are recategorized. In a nutshell, Angermayer said that they would review the individual ones and make a decision based on medical evidence about which ones they would sell. Martin had a slightly different answer.“I think ultimately, as a society, we need to have trust in our regulator that they will make the right decisions for society. If this reclassification from category 2 to category 1 happens, we’ll be able to offer those peptides as well — potentially not all of them, but certainly a subset,” he said. “I personally believe in bodily autonomy. If you have a substance that is approved by law, you should be able to make a decision on your health and what you want to do, or what you don’t want to do.”In an administration where the FDA was on solid footing, this would be a fair answer. However, the FDA under RFK Jr. and the MAHA movement has undergone a fair amount of turmoil. ProPublica has reported that former FDA officials have criticized RFK Jr. as mischaracterizing their work in initially banning certain experimental peptides from the compounding list. The same investigation noted that RFK Jr. has stated that the FDA’s role is to judge whether a substance is safe or not safe. He has incorrectly said that the FDA is not meant to make judgment calls on the efficacy of a given substance. (In fact, when the FDA grants approvals, it’s evaluating whether a pharmaceutical company has proven that a treatment is safe and that it provides health benefits that outweigh the known side effects.)So, again, in this new wellness wild west, how does the average person decide what’s safe to put in their body? How do they cut through the noise of flashy pro-doping sporting events, Hims & Hers ads, and misleading wellness narratives?“Do your own research” is the common refrain online, but that, too, is a farce. Scientific research is ever-evolving and requires constant updating. The cool thing about science is that it’s not static. The annoying thing about science is that it’s full of caveats and difficult to condense into pithy sound bites in short-form video reels. While researching peptides and performance-enhancing drugs, I admittedly gave myself several headaches trying to suss out the truth from marketing, what’s known versus what’s possible. Not all peer-reviewed studies or clinical research is equal. Learning how to tell a good study from a bad one isn’t easy for laypeople, especially when written in inaccessible jargon.But when it comes to health and performance “enhancement,” there are at least two bits of common sense advice the rest of us ought to keep in mind.Critics have said the Enhanced Games were thinly disguised marketing for the company’s telehealth platform.“Biohacking could be compared to trying to put a turbocharger on an engine. If you take a clapped-out car which is poorly maintained, you put a high-end turbocharger on it, it’ll rattle it apart. That engine needs to be well maintained in the first place and needs to be well built in the first place,” says Martin Chandler, a research fellow at the University of Birmingham’s School of Sport, Exercise and Rehabilitation Sciences. “And that is not something that you do with drugs.”“Magic medicines don’t exist because medicines are developed to treat medical conditions. They’re not designed, and they probably wouldn’t get ethical approval to test them in the first place through clinical trials, unless there is a stated need for them,” says Ian Boardley, a professor at University of Birmingham’s School of Sport, Exercise and Rehabilitation Sciences.Both are, of course, referring to the pesky fact that drugs and biohacking can only do so much to optimize health. Some things are predetermined by genetics. For example, drugs or treatments that are effective for one person may not be for another simply due to genes. In elite sports, there is such a thing as winning the genetic lottery. As far as things that can be controlled, the core fundamentals will always be sleep, exercise, and nutrition. In other words, there’s no silver bullet or shortcut for hard, and sometimes unpleasant, work.Everyone’s relationship to risk is different. Some people will be happy to jab a needle of something unproven if there’s a chance it addresses a want or need. Others will require a much, much higher bar of scientific rigor. But if there’s one thing I took away from the Enhanced Games, the ability to discern what’s marketing, what’s science-washing, and which experts you can trust — that’s going to be a hell of a lot more important in the days to come.Follow topics and authors from this story to see more like this in your personalized homepage feed and to receive email updates.Victoria Song