Medications & side effects

If something feels wrong

Signs of a severe allergic reaction such as a rash, hives, or swelling, difficulty breathing, severe abdominal pain, signs of pancreatitis, or any symptom that feels life-threatening. Don't wait for a portal reply for urgent symptoms.

Message your care team and tell us what you're experiencing, when it started, and whether you've been able to keep taking your medication. We'll coordinate with your provider on next steps, which can include a lower dose, a temporary pause, switching medications, or stopping treatment entirely.

The most common side effects are nausea, early fullness, constipation, mild stomach discomfort, and fatigue. These are usually mild and improve as your body adapts over several weeks.

Common side effects

Nausea: Eat small, slow meals. Choose bland foods when queasy and avoid greasy or spicy options. Ginger tea or peppermints can help. Stop eating at early fullness.

Constipation: Build fiber intake gradually to 25 to 35 g/day (oats, beans, chia, psyllium). Drink 2 to 3 liters of water daily. A 10 to 20 minute walk after meals helps. If needed, try magnesium at night or an osmotic laxative (PEG 3350) per label directions.

Reflux or heartburn: Eat earlier, lighter dinners and stop eating 2 to 3 hours before lying down. Sip fluids between meals rather than during them. Limit common triggers: chocolate, peppermint, coffee, carbonation, alcohol, and very greasy or spicy food. Ginger (not peppermint) can settle the stomach. A short walk after meals helps.

Diarrhea or loose stools: Choose binding, gentle foods for a few days: rice, bananas, applesauce, toast, oatmeal, and baked chicken. Keep fat lower, favor cooked over raw vegetables, and limit sugar alcohols (sorbitol, xylitol) and very high-FODMAP foods. Magnesium supplements can also cause loose stools. If you started one for constipation, that may be the cause.

Fatigue and GI discomfort: Stay hydrated, prioritize protein at each meal, and consider adding electrolytes on active or hot days.

Injection site redness: This is common and usually resolves on its own. Rotate your injection sites.

Side effects are rare and typically mild.

Common side effects

• Slight discomfort, redness, or tenderness at the injection site
• Mild nausea

GHK-Cu

A naturally occurring copper-binding peptide, prescribed for skin firmness, fine lines, wound support, and hair follicle health.

Common side effects

• Stinging or burning during and just after the injection. GHK-Cu is more acidic than the other peptides, and that is what causes it. It does not mean your vial is bad or that you are allergic. See "How do I store, handle, and inject GHK-Cu?" for the five things that help.
• Redness, itching, or a small lump where you injected. Common with any peptide. Rotating sites is the fix.

Less common

An allergic reaction, as with any peptide. This is rare.

Glutathione

Glutathione is generally very well tolerated. Most side effects are mild and happen at the injection site.

Common side effects

• Minor redness, swelling, or tenderness where you injected
• Occasional nausea or headaches, especially in the first few weeks

Side effects are usually mild and short-lived, and many ease as your body adjusts.

Common side effects

• A warm, flushing feeling during or shortly after the injection
• Nausea, especially if the dose is injected too quickly (injecting more slowly usually helps)
• Lightheadedness
• Tenderness at the injection site

Tesamorelin

A GHRH analog that stimulates your own pituitary gland to release growth hormone in its natural, pulsatile pattern, rather than supplying growth hormone directly.

Common side effects

• Injection site reactions
• Joint pain
• Mild swelling (peripheral edema)
• Muscle aches
• Tingling in the extremities
• A transient rise in blood glucose, which your care team monitors

Sermorelin

Most patients tolerate sermorelin very well. When side effects happen, they're typically mild and often fade as your body adjusts.

Common side effects

• Minor injection-site reactions such as redness or tenderness
• A brief headache or occasional flushing
• Temporary fatigue or mild dizziness early on

Less common

Elevated blood sugar and allergic reactions are rare risks. Your care team monitors you throughout treatment.

A peptide originally isolated from human gastric juice, studied for tissue repair, gut healing, and reduced inflammation, often prescribed alongside TB-500 for a broader recovery effect.

Common side effects

• Redness, itching, or a small firm lump where you injected. This is common with every peptide and is not specific to BPC-157. Rotating your injection sites is the fix, and icing the spot beforehand or applying hydrocortisone cream afterward can help.

Less common

BPC-157 has a long track record in animal studies and growing use in people, but there have been few human trials. That means there is no long list of published side effects to check yours against. The full range of possible side effects is not yet known (the same sentence you agreed to on your assessment). If you notice something that is not on the list above, tell us rather than assuming it is normal.

If your protocol pairs BPC-157 with TB-500 and you compete in a tested sport, talk to your provider first. TB-500 appears on some prohibited substance lists.

MOTS-c

A mitochondria-derived peptide studied for insulin sensitivity, fat metabolism, and exercise tolerance. It is meant to support and amplify physical activity, not replace it.

Common side effects

• Feeling anxious or jittery, a bit like too much coffee. A direct consequence of a higher metabolic rate. It usually settles.
• A faster heartbeat, or a fluttering feeling in your chest. Common on its own. Contact a provider if this feeling is associated with chest pain, lightheadedness, or lasts more than a few seconds at a time.
• Redness or irritation where you inject. Rotating sites is the fix.
• Disturbed sleep. This is usually a timing problem rather than a medication problem: a dose taken late in the day can keep you up. Move it to the morning.
• Feeling tired instead of energized. A minority of people react this way and we do not fully understand why. It is not dangerous on its own, but it is worth telling us. It is a reason to reassess rather than to push through.

Less common, and more serious

• Low blood sugar (hypoglycemia). MOTS-c makes you more sensitive to insulin, so your blood sugar can drop too low. More likely if you also take a GLP-1, or if you skip a meal or train hard. The signs and the rule of 15 are in "How do I store, handle, and inject MOTS-c?" Read that before your first injection.
• A serious allergic reaction. Any peptide can cause one, and this has happened rarely with MOTS-c.

Menopausal hormone therapy

Hormone therapy replaces the estrogen, progesterone and testosterone your body makes less of during perimenopause and menopause. Side effects are most common in the first 6 to 12 weeks, while your body adjusts and your provider fine-tunes your dose. Many of them are a sign that your dose needs adjusting, so tell us rather than stopping or changing your dose on your own.

Call 911 for signs of a blood clot or stroke: pain, warmth, or swelling in one leg; sudden shortness of breath or chest pain; sudden numbness or weakness on one side of the body, trouble speaking, vision changes, or a sudden severe headache. Message your care team the same day for a new breast lump, yellowing of your skin or eyes, or vaginal bleeding that is heavy, or that starts after you have gone a year without a period.

Testosterone injectable

Women are prescribed a much lower dose of testosterone than men, so most side effects are mild and dose-related.

Common side effects

• Redness, tenderness, or a small lump where you injected. Rotating sites is the fix.
• Oily skin or acne, usually on the face, chest, or back
• An increase in libido and energy. This is often the reason it's prescribed.

Signs your dose may be too high

• New or increased hair growth on your face, chest, or belly
• Thinning hair on your scalp
• Irritability or feeling more easily angered
• A deeper or hoarse voice, or enlargement of the clitoris. These changes can be permanent, so tell us as soon as you notice them.

Your care team checks your bloodwork during treatment, including your testosterone level and red blood cell count.

Testosterone cream

Testosterone cream can cause the same side effects as the injectable, listed above. A cream also brings a few of its own.

Common side effects

• Redness, dryness, or itching where you apply it. Rotating application sites helps.
• Hair growth on the patch of skin where you apply it. Rotate sites and avoid your face.

Protect the people around you

Testosterone can transfer to others through skin contact. Children and pregnant people are most at risk. Wash your hands right after applying, let the cream dry fully, and cover the area with clothing. Avoid skin-to-skin contact with that area for a few hours, or wash it first.

Estradiol injectable

Common side effects

• Breast tenderness or swelling
• Bloating or mild fluid retention
• Headache
• Nausea, especially early on
• Mood changes
• Spotting or light breakthrough bleeding in the first few months
• Redness or tenderness where you injected. Rotating sites is the fix.

Because each injection lasts several days, your estrogen level rises after a dose and falls before the next one. If side effects are strongest a day or two after injecting, or your menopause symptoms return before your next dose, tell us. Your provider can adjust your dose or schedule.

Biest cream

Biest is a compounded cream that combines two forms of estrogen, estriol and estradiol, and is absorbed through your skin.

Common side effects

• Breast tenderness
• Bloating
• Headache
• Spotting or light breakthrough bleeding in the first few months
• Redness or irritation where you apply it. Rotating application sites helps.

Apply it at the same time each day so your levels stay steady. Like testosterone cream, estrogen cream can transfer to others, so wash your hands after applying and let it dry before skin contact.

Vaginal estradiol cream

Vaginal estradiol works mostly where you apply it, and very little reaches the rest of your body. Side effects are usually mild and local.

Common side effects

• Mild burning, itching, or irritation in the first week or two. This usually settles as the tissue heals.
• More vaginal discharge or leakage, partly from the cream itself. Applying it at bedtime and wearing a panty liner help.
• Light spotting

Less common

Breast tenderness or headache. These are uncommon because so little estrogen is absorbed.

Don't use the cream as a lubricant or right before sex, because it can transfer to your partner.

Progesterone capsules

Progesterone is taken by mouth, usually at bedtime. If you have a uterus and use estrogen, it protects the lining of your uterus. Many people also find it helps with sleep.

Common side effects

• Drowsiness or dizziness. This is why it's taken at bedtime. Don't drive or do anything that needs you to be alert until you know how it affects you.
• Bloating
• Breast tenderness
• Headache
• Feeling low, moody, or irritable
• Spotting or irregular bleeding in the first few months

Some progesterone capsules sold elsewhere are made with peanut oil. The progesterone capsules Belle prescribes are peanut-free.

If you still have a uterus and use estrogen your provider has prescribed for your whole body (estradiol injectable or Biest cream), you will usually take progesterone capsules too. Progesterone protects the lining of your uterus, so take it exactly as prescribed, even if you feel fine without it.

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