Four topics come up often when adults over 40 talk with clinicians: hormone changes (low testosterone and perimenopause), joint pain, low energy, and weight and metabolic health, including GLP-1 medicines. For each, an evaluation by a licensed clinician comes first, and whether labs or imaging are needed depends on the question. Several newer options you may read about online are still being studied or are not FDA-approved for these uses. This guide explains what is known, what is not, and what to ask. It is educational, not medical advice, and the right answers depend on the individual.
What Counts as Low Testosterone, and How Is It Diagnosed?
Fatigue, low sexual desire, fewer morning erections, low mood, and loss of muscle mass are commonly linked with low testosterone, but none is specific to it. Many other conditions and medications cause the same symptoms, so symptoms alone are not enough.
The American Urological Association (AUA) guideline says the diagnosis should rest on compatible symptoms or signs plus low total testosterone on two separate early-morning blood tests, and it names a total below 300 ng/dL as a reasonable cutoff (see the original 2018 publication). Ranges differ across guidelines and laboratories, so interpretation belongs with a clinician who knows your history.
Testosterone products are FDA-approved for men with low testosterone caused by specific medical conditions that affect the testicles, pituitary gland, or brain. FDA labeling has stated that the benefits and safety of these products have not been established for low testosterone due only to aging, and it carries warnings, including about blood pressure. In June 2026, FDA requested labeling updates, including removing that age-related limitation, so ask your clinician to check the current label. Compounded testosterone is not FDA-approved.
How Is Perimenopause Diagnosed, and What Does "Bioidentical" Mean?
Perimenopause is the transition leading up to menopause. It is generally recognized from age, symptoms such as hot flashes, night sweats, sleep disruption, and mood changes, and changes in menstrual cycles. Hormone levels swing widely during this stage, so a single blood test often cannot confirm or rule it out. The UK's NICE guidance, for example, says that in otherwise healthy people aged 45 or over, perimenopause and menopause can be diagnosed from symptoms alone, without confirmatory laboratory tests.
"Bioidentical" usually means hormones that are chemically identical to those the body makes, such as estradiol and progesterone. It is not an FDA-recognized category, and it is applied to two different kinds of products:
ACOG's clinical consensus advises against routinely prescribing compounded bioidentical hormones when FDA-approved options are available.
What Does the Evidence Say About Stem Cell and Exosome Injections for Joint Pain?
Research is ongoing, results are mixed, and no stem cell or exosome product is FDA-approved for joint conditions. Conventional care comes first: exercise and physical therapy, weight management, bracing, medications, and, for advanced damage, procedures including joint replacement.
What the Research Shows
A 2025 systematic review and meta-analysis of placebo-controlled trials of mesenchymal stem cell injections for knee osteoarthritis found that the majority of the improvement people reported was attributable to contextual (placebo) effects, with only a modest added benefit beyond placebo. The authors rated the certainty of the evidence as low. The American College of Rheumatology's 2026 osteoarthritis guideline update strongly recommends against both stem cell injections and platelet-rich plasma for knee and hip osteoarthritis.
What These Therapies Are
Cell-based products can come from a patient's own tissue or from donated tissue, such as umbilical cord Wharton's Jelly. The main proposed mechanism is signaling that may influence inflammation, rather than cells simply replacing damaged tissue. Exosomes are tiny vesicles that cells release to communicate, and human evidence for joint use is very limited. Read more about Wharton's Jelly and exosomes.
Regulation: What "Not FDA-Approved" Means
The FDA has not approved exosome products or any stem cell product for joint conditions, and its consumer page on regenerative medicine therapies lists Wharton's jelly and exosomes among unapproved products. The FDA has approved some cell-based products for specific serious conditions, such as cord-blood-derived blood-forming (hematopoietic) progenitor cell products for certain blood disorders and, in 2024, a bone-marrow-derived mesenchymal stromal cell product for steroid-refractory acute graft-versus-host disease in children. Neither product is approved for joint conditions. Any injection carries risks such as pain, swelling, bleeding, and infection, and the FDA has received reports of patients harmed by unapproved stem cell and exosome products, so ask about donor screening and sterility testing. Use for joint conditions is considered investigational, so informed consent matters and claims of guaranteed outcomes deserve caution. The ISSCR's Guide to Stem Cell Treatments offers more independent background. Some people are not candidates, and individual results vary.
What Does the Evidence Say About NAD+ and Peptides for Energy?
Fatigue has many possible causes, including sleep problems, thyroid conditions, anemia, mood, and medications, so evaluation usually starts with a history and basic labs.
NAD+ is a molecule involved in cellular energy metabolism. Some studies report that NAD+ levels fall with age, though a review of the published data found the evidence limited and often restricted to a single tissue or cell type, particularly in humans. Much human research has examined oral NAD+ precursors rather than injections or infusions. A 2023 review found that these oral precursors appeared well tolerated and raised NAD+ and related metabolites in several tissues, but that the clinical evidence they improve physiological function is unclear because studies are small and vary widely in dose and duration. Those findings do not establish the safety or benefit of NAD+ injections or infusions, which are not FDA-approved products.
Peptides are short chains of amino acids, and some, such as insulin and semaglutide, are FDA-approved medicines. Peptides discussed in wellness settings for sleep, recovery, growth hormone signaling, and body composition are different: evidence varies widely by peptide and is limited for many, and the compounded peptide preparations offered for these purposes are not FDA-approved. Ask where a product comes from and who dispenses it. Our peptides and NAD+ pages explain the telehealth programs we offer.
How Do GLP-1 Medicines Fit Into a Metabolic Health Plan?
GLP-1 medicines such as semaglutide, along with tirzepatide, which also acts on the GIP receptor, have been studied for weight management. In large randomized trials such as STEP 1, adults with overweight or obesity who took semaglutide alongside lifestyle support lost more weight on average than those given placebo. Individual responses vary, and gastrointestinal side effects such as nausea and diarrhea are common. FDA labeling also describes more serious risks, including a boxed warning about thyroid C-cell tumors and warnings about pancreatitis and gallbladder problems. These medicines are not appropriate for everyone, so a prescriber should review your history before you start.
The FDA has approved semaglutide (Wegovy) and tirzepatide (Zepbound) for chronic weight management in certain people, labeled for use with a reduced-calorie diet and increased physical activity (see the Wegovy and Zepbound labels). Compounded versions are not FDA-approved, and the FDA has expressed concerns about unapproved GLP-1 drugs used for weight loss. Ask any prescriber which version you would receive and where it is made.
Weight loss from any method can include loss of lean mass as well as fat, so many clinicians discuss protein intake and strength training alongside these medicines.
What Should You Look for in a Care Team?
Primary care physicians, specialists, concierge practices, and telehealth clinics can all provide good care. Because these questions often cross specialties, ask how care is coordinated. Useful questions include:
Regenerative Revival, founded in 2018, is a concierge regenerative medicine company with a network of 100+ licensed clinicians and physician oversight through Arora Health Group. Hormones, peptides, and NAD+ are offered by telehealth in all 50 states. Compounded hormone, peptide, and NAD+ preparations are not FDA-approved. They are prescribed after a clinical review and dispensed by accredited pharmacy partners, and your clinician can explain FDA-approved alternatives where they exist. In-home regenerative care is offered where available, and availability varies by location. Biological materials come from AATB-accredited tissue banks. Learn more about our concierge care model and hormone therapy.
Next Steps
If you are sorting through these questions, a conversation with a licensed clinician can help you understand your options and whether a given approach fits your situation. Take the 2-minute consult quiz or contact the team with questions. Individual results vary, and no outcome is guaranteed.
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