GLP-1/glucagon dual agonist approved in China in 2025 (Xinermei); grey-market 'ghetto reta' with tirzepatide.
Safety tier
Avoid
strict bar
Positive
55%
of 21 reports
Per month
≈ €36–140
estimate
Rank
#27
of 61 research peptides
At a glance
Onset
Appetite and sugar cravings drop within the first one or two doses for some users; trial weight loss accrues over months.
Lasts
Once-weekly injection; half-life about 10 days, so effects and side effects linger after stopping (the label asks women to stop 3 months before trying to conceive).
Access
Grey market
Strict case
Carries the GLP-1 class's serious-harm routes on its own label (pancreatitis, gallbladder disease, acute kidney injury, boxed warning for thyroid C-cell tumours in rodents) plus a glucagon-driven heart-rate rise; outside China it is bought as unregulated research vials and mostly stacked on tirzepatide, a combination no trial has tested.
Best effects
Weight loss of 14% at 48 weeks (6 mg) and 17% at 60 weeks (9 mg) in Chinese phase 3 trials · liver-fat, triglyceride, uric-acid and blood-pressure reductions beyond weight loss · appetite and sugar-craving suppression · users report more energy than on tirzepatide alone
Downsides
Vomiting, nausea and diarrhoea (53%, 47% and 39% at 9 mg in GLORY-2) · higher resting heart rate, mostly during dose escalation · insomnia · dizziness or fatigue as blood pressure falls · injection-site and allergic reactions (7-8% and 3-5% in GLORY-1)
Typical use
China label: 2 mg weekly for 4 weeks, then 4 mg, then 6 mg if needed after at least 4 more weeks; maintenance 4 or 6 mg once weekly (a 9 mg dose was filed in November 2025). Lilly's US phase 2 went up to 16 mg. Grey-market users: 1-2 mg start, 3-5 mg weekly beside 5-15 mg tirzepatide. Users report 340–710 mcg/day (median 570 mcg, n=7).
Stacked with
Stacked with
Tirzepatide: The 'ghetto reta' stack, adding glucagon agonism to GLP-1/GIP; the commonest use outside China, never trialled. · cagrilintide: Occasionally added for appetite, making a four-receptor stack. · retatrutide: Not combined; users switch between them, since retatrutide already includes glucagon agonism.
Safety
Watch
Acute pancreatitis and acute gallbladder disease (label warnings; obstructive pancreatitis and cholecystitis in GLORY-1) · Thyroid C-cell tumours in rodents at clinically relevant exposure (boxed warning); contraindicated with MTC or MEN 2 · Heart-rate increase from glucagon-receptor agonism (mean up to 4.6 bpm; sinus tachycardia 4.5% at 6 mg vs 2.9%) · Acute kidney injury from dehydration with severe GI effects (label); label says stop if resting heart rate stays raised · Label also warns of aspiration under anaesthesia and asks for monitoring of depression and suicidal thoughts (class precaution) · Stacking on tirzepatide doubles GLP-1 load in an untested combination; vials of unknown dose and purity
Tier by safety barStrict AvoidBalanced AvoidEvidence only Avoid
Seen harm2 of 3
Mechanism3 of 3
Data gap1 of 3
Silent harm3 of 3
Product3 of 3
Never if
Personal or family history of medullary thyroid carcinoma or MEN 2 (label) · Pregnancy, planned pregnancy within 3 months, or breastfeeding (label) · Known hypersensitivity to mazdutide or its excipients (label) · History of acute gallbladder disease or severe GI disease such as gastroparesis (not recommended on the label) · History of pancreatitis · Tachyarrhythmias, atrial fibrillation or other conditions where a higher resting heart rate is dangerous · History of suicidal thoughts or attempts (label advises avoiding it) · Under 18
Why each score
Seen harm 2/3
The Chinese label (2025) carries warnings for acute pancreatitis, acute gallbladder disease, severe GI reactions, acute kidney injury and sustained heart-rate rise, and the trials produced matching cases: one gallstone-induced obstructive pancreatitis and one acute cholecystitis on mazdutide in GLORY-1 (gallstones 2.0% vs 1.0%), severe GI reactions in 2.0%, and one acute cholecystitis at 16 mg in Lilly's US phase 2. No deaths reported. On Reddit, one user starting at double the label dose described palpitations with a resting rate near 130. Xinermei (mazdutide) Chinese prescribing information ↗Ji et al. 2025, GLORY-1 (NEJM) ↗NCT06124807 posted results (Lilly phase 2, serious adverse events) ↗
Mechanism 3/3
The molecule itself caused thyroid C-cell adenomas and carcinomas in a 2-year rat study at exposures below the human dose (boxed warning; human relevance unknown), and as a GLP-1 receptor agonist it shares the class's in-human pancreatitis and gallbladder harms. Glucagon-receptor agonism adds a heart-rate rise (mean up to 4.6 bpm in escalation, 2.6 bpm at 48 weeks; sinus tachycardia 4.5% at 6 mg vs 2.9%). Xinermei label: carcinogenicity and warnings ↗Ji et al. 2025, GLORY-1 full text (heart rate, sinus tachycardia) ↗
Data gap 1/3
Approved in China (NMPA, June and September 2025) on phase 3 trials with about 2,000 participants (GLORY-1, GLORY-2, DREAMS-1, DREAMS-2), plus Lilly's 179-person US phase 2. Not approved by a stringent regulator, post-marketing experience is about a year and almost all trial participants were young Chinese adults; no data on stacking it with tirzepatide, which is how grey-market users take it. Innovent: NMPA approval for chronic weight management (June 2025) ↗Gao et al. 2026, GLORY-2 (JAMA) ↗
Silent harm 3/3
The feared harm the mechanism points at includes thyroid C-cell tumours, which would be silent and delayed; under the rubric a theoretical tumour pathway scores 3. The other harms are mixed: pancreatitis and cholecystitis present acutely, while gallstones and a raised resting heart rate build up unnoticed without imaging or a monitor. Xinermei label: boxed warning, thyroid C-cell tumour risk ↗
Twenty-two first-hand reports, nearly all mazdutide added to tirzepatide (the 'ghetto reta' stack) by people stalled on a GLP-1. Twelve are good (a thirteenth, from a coach's account, is flagged as vendor-adjacent): stalls broken, 'powered through the last 25 lbs', more energy, and several prefer it to survodutide as gentler on the gut and heart rate. Two US trial participants describe food noise gone and better blood pressure and lipids. Complaints are nausea and sleepiness in week one, diarrhoea at 6 mg, insomnia, a higher resting heart rate, dizziness from falling blood pressure, one case of emotional numbness, and one person who started at 3 mg and had palpitations with a resting rate near 130. Reports are few and confounded by tirzepatide. Felt nothing: 1 of 22 reports felt nothing; one US trial participant lost only 23 lb in five months at 10 mg..
Everything I've read said Survo should deliver better results than Maz, but in my personal subjective experience, nothing has shed pounds more effectively than the stack of Tirz with Maz.
Positiveup to 3 mg/week with 10 mg tirzepatide · Injection
It also gave me such bad heart palpitations and my resting heart rate was like 130 that I thought i was going to need to go to the ER a few times.
Bad reactionstarted at 3 mg instead of 1.5 mg · Injection
grey-market vial after months on other GLP-1s
Studies
Evidence
Approved drug in China (NMPA, June 2025 for weight management, September 2025 for type 2 diabetes) on phase 3 GLORY and DREAMS trials in Chinese adults; Lilly's US phase 2 (n=179) has posted results; not FDA- or EMA-approved
Caveat
Almost all efficacy data come from young Chinese adults (mean age about 34) with modest baseline weight, and only the 9 mg trial ran past 48 weeks. The 2.6-4.6 bpm heart-rate rise eased during maintenance in trials, but users stacking it on tirzepatide report larger rises. Dose response is steep: 4 mg and 16 mg are very different drugs.
Shirley 2025: Mazdutide, first approval (Drugs)review · 2025 Summarises the June 2025 Chinese approval for chronic weight management and the development programme run by Innovent with Eli Lilly.
The peptide's chain of amino acids from its start (the N-terminus) to its end, one bead and one letter for each: A alanine, C cysteine, D aspartic acid, E glutamic acid, F phenylalanine, G glycine, H histidine, I isoleucine, K lysine, L leucine, M methionine, N asparagine, P proline, Q glutamine, R arginine, S serine, T threonine, V valine, W tryptophan, Y tyrosine. A modification such as an N-acetyl cap or a C-terminal amide changes how long it lasts in the body. Length tells related peptides apart, from a two-residue dipeptide like carnosine to a 43-residue protein like thymosin beta-4, and predicts neither effect nor safety.
Report grades
Every first-hand Reddit or X report is graded on its own, from glowing through positive, mixed, nothing and negative to bad reaction, and the bar shows how those grades split. Posts that look vendor-adjacent stay on the peptide's page but are left out of the counts.
GlowingPositiveMixedNothingNegativeBad reaction
% positive
The share of a peptide's graded Reddit and X reports that are glowing or positive, vendor-adjacent posts left out. A peptide with few reports is pulled toward the average of all reports, as if it had eight average ones besides its own, so two glowing posts cannot top the list. Peptides rank by this figure, those with no graded report yet after those with one, and Avoid ones after every other entry.
Researcher estimate
No first-hand report of this peptide has been graded yet, so the figure is the researchers' own rating out of 10 from what they read about it. It ranks after every peptide with graded reports until its own arrive.
Safety tier
Each peptide is tiered Clean, Caution or Avoid from its five risk axes under the chosen safety bar. An Avoid peptide carries a real risk of harm, a plausible route to serious harm rather than mere unpleasantness, so it stays listed with the reason but ranks behind every other entry, however good its reviews.
Safety bar
The safety bar sets how much risk it takes to rate a peptide Avoid. Strict: out on any serious mechanism with little human data, or any documented serious harm. Balanced: out on documented serious harm (unless it is obvious, reversible and from a regulated product), or a serious mechanism whose harm would be silent with no human data at all. Evidence only: out only on documented serious harm in humans that is lasting, delayed or from grey-market product.
Seen harm
Documented serious adverse events in humans, from 0 for none despite real exposure to 3 for deaths or several well-documented serious harms. Serious means a hospital or emergency visit or harm lasting weeks, so a headache or a bad night does not count.
Mechanism
A plausible biological route to serious harm at the doses people use, such as growth-factor signalling, hormone-axis suppression, heart or blood-pressure effects or immune activation. It runs from 0 when none is known to 3 when a dangerous pathway has been shown in living animals.
Data gap
How little human safety data exists for the molecule actually sold, from 0 for an approved drug with large trials and years of use to 3 for no human safety data at all. A modified analogue does not inherit its parent's trials.
Silent harm
Whether the feared harm would show quickly or stay hidden, from 0 when it is obvious and goes on stopping to 3 when it is silent and delayed, like tumour promotion or slow organ damage. User reports cannot reveal a harm that takes years to appear, so a high score here limits what good reviews can tell you.
Product
The risk of what people actually buy, from 0 for a regulated pharmacy or supplement product taken by mouth or on the skin to 3 for a grey-market injectable. In one dataset of 6,441 grey-market samples, 42–71% failed basic quality criteria and 15% carried endotoxin; taken by mouth or in the nose, a pack avoids the injection risks.
Evidence
The strongest kind of study behind the peptide's effects, from an approved drug through human controlled trials and small human studies to animal work or nothing of its own. Animal results often fail to carry over to people.
Access
How people get it: as an approved drug, a compounded prescription, an over-the-counter supplement or from the grey market, where nobody checks the vial. The channel decides both the legal position and the risk of a bad batch.
Price per month
Thirty days of the typical dose, from its low end to its high end, priced at the listing a careful buyer would choose: in stock, from a shop scoring 4 of 5 on trust (third-party tested where no score is set), failing that 3, a pure pack before a blend, a European shop first, then the cheapest per mg. The range is the dose's, not the shops'. A per-dose amount counts once a day unless the dose says otherwise. Prices are in euros at ECB rates of 2026-10-29, before shipping; the shop table keeps each listing's price per mg, per gram for bulk supplements. Where no listing can be priced the researchers' own estimate stands in, and says so.
Dose users report
The middle half of the daily doses stated in at least five first-hand reports, vendor posts left out. Where its middle sits more than twice above or below the declared dose, the month is priced at it as well, since what people take is what they pay for.
Shop trust
Each shop's trust on a 1–5 scale, read from its testing and its reputation: 1 for serious red flags (fabricated COAs, scam reports, impersonation, a closed shop), 2 for no public testing, a new shop or active complaints such as seized parcels, 3 for its own COAs or a short track record, 4 for verified third-party testing or a strong reputation, and 5 for third-party batch reports that name the shop, with years of good independent reputation. A shop without a score counts third-party batch testing as 4, its own COAs as 3 and no public tests as 2.
Best value
Within a category or a goal, a peptide that no other beats on both counts: none is rated more positively for the same or a lower monthly price, and none costs less for the same or a higher rating. The chart joins these into the best-value line; the cheapest of them and the best-rated of them both make it, so the line spans the trade-off from cheap to best. Avoid entries never count, and a peptide needs both a % positive and a price to be compared.
Testing
Whether the shop publishes lab results: third-party tested means an independent lab checks each batch, own COA means the shop's own certificate of analysis, and no public tests means neither. A certificate shows purity, not safety.
Added peptide
Some packs sold under one peptide's name hold a second one, such as 5 mg GHK-Cu in a nasal kit, stated only in the description. Sprayed in the nose or injected it reaches the blood like an injection, so it carries the risk of that route and is tiered as the injectable form, whatever its tier on the skin. A pack whose page gives no contents list may hold more than its name.