The evidence & access framework
The evidence, graded
Every agent the curriculum teaches, graded per indication on two independent axes. Free to read. These are the same grades a learner meets in Module 1.6, published because a framework you can check is worth more than one you are asked to trust.
Source: the published curriculum, Version 1.0 · August 2026.
Grades change when the evidence or the law changes. Verify the regulatory status of any agent on the day you prescribe — the curriculum’s own instruction.
What the grades mean
Evidence
- E1
- Approved indication, randomized evidence
- E2
- Meaningful human evidence — off-label, other population, or foreign approval
- E3
- Early or unreplicated human data
- E4
- Preclinical or mechanistic only
Access
- A1
- Approved and commercially available for this use
- A2
- Approved product, off-label use
- A3
- Lawful compounding pathway exists
- A4
- No lawful US pathway today
A chip turns green only when both gates clear — evidence E1–E2 and access A1–A3. The color is computed from the grades; nobody chooses it. Everything else renders in the appraisal color, which means exactly what it says: appraise before anything else.
Graded as clearing both gates (30)
Rows the curriculum grades E1–E2 for evidence and A1–A3 for access.
| Agent | Graded for | Grade | Verified |
|---|---|---|---|
| Abaloparatide | postmenopausal osteoporosis | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Bremelanotide | premenopausal HSDD | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Dulaglutide | type 2 diabetes, CV risk | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Elamipretide | Barth syndrome | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Exenatide | type 2 diabetes | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Liraglutide | obesity | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Liraglutide | adolescents 12–17 | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Octreotide | acromegaly | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Oral semaglutide | type 2 diabetes, CV risk | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Oral semaglutide | weight management | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Orforglipron | obesity | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Semaglutide | obesity | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Semaglutide | CV risk reduction, established CVD | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Semaglutide | MASH, F2–F3 non-cirrhotic | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Semaglutide | adolescents ≥12 | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Semaglutide 1.0 mg | T2D with chronic kidney disease | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Teduglutide | short bowel syndrome | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Teriparatide | postmenopausal osteoporosis | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Tesamorelin | HIV-associated lipodystrophy | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Tirzepatide | obesity | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Tirzepatide | obstructive sleep apnoea with obesity | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Tirzepatide | type 2 diabetes | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Vaginal DHEA | dyspareunia of GSM | Evidence tier 1, access tier 1 — graded as clearing both gates | August 2026 |
| Semaglutide | HFpEF with obesity | Evidence tier 1, access tier 2 — graded as clearing both gates | August 2026 |
| Tirzepatide | HFpEF with obesity | Evidence tier 1, access tier 2 — graded as clearing both gates | August 2026 |
| Bremelanotide | postmenopausal HSDD | Evidence tier 2, access tier 2 — graded as clearing both gates | August 2026 |
| Liraglutide | children 6–11 | Evidence tier 2, access tier 2 — graded as clearing both gates | August 2026 |
| Semaglutide | CV primary prevention | Evidence tier 2, access tier 2 — graded as clearing both gates | August 2026 |
| Tesamorelin | body composition, non-HIV | Evidence tier 2, access tier 2 — graded as clearing both gates | August 2026 |
| Testosterone in women | postmenopausal HSDD | Evidence tier 2, access tier 2 — graded as clearing both gates | August 2026 |
Graded as not clearing both gates (30)
Failing either gate is enough. The curriculum grades some of these as good evidence with no lawful route, some as a lawful route with no evidence, and some as neither.
| Agent | Graded for | Grade | Verified |
|---|---|---|---|
| Compounded semaglutide | general weight loss | Evidence tier 1, access tier 4 — graded as not clearing both gates | August 2026 |
| Compounded tirzepatide | general weight loss | Evidence tier 1, access tier 4 — graded as not clearing both gates | August 2026 |
| CagriSema | obesity | Evidence tier 2, access tier 4 — graded as not clearing both gates | August 2026 |
| Kisspeptin | hypoactive sexual desire | Evidence tier 2, access tier 4 — graded as not clearing both gates | August 2026 |
| Retatrutide | obesity | Evidence tier 2, access tier 4 — graded as not clearing both gates | August 2026 |
| Sermorelin | GH axis (previously approved, withdrawn) | Evidence tier 2, access tier 4 — graded as not clearing both gates | August 2026 |
| Survodutide | obesity | Evidence tier 2, access tier 4 — graded as not clearing both gates | August 2026 |
| Thymosin alpha-1 | chronic hepatitis B | Evidence tier 2, access tier 4 — graded as not clearing both gates | August 2026 |
| Topical GHK-Cu | photoaging (cosmetic) | Evidence tier 3, access tier 1 — graded as not clearing both gates | August 2026 |
| Bimagrumab | muscle preservation with a GLP-1 | Evidence tier 3, access tier 4 — graded as not clearing both gates | August 2026 |
| Cerebrolysin | stroke, vascular dementia | Evidence tier 3, access tier 4 — graded as not clearing both gates | August 2026 |
| Elamipretide | longevity or wellness use | Evidence tier 3, access tier 4 — graded as not clearing both gates | August 2026 |
| LL-37 | wound healing | Evidence tier 3, access tier 4 — graded as not clearing both gates | August 2026 |
| MK-677 (ibutamoren) | body composition | Evidence tier 3, access tier 4 — graded as not clearing both gates | August 2026 |
| Selank | anxiety | Evidence tier 3, access tier 4 — graded as not clearing both gates | August 2026 |
| Semax | cognition, stroke | Evidence tier 3, access tier 4 — graded as not clearing both gates | August 2026 |
| TB-500 / thymosin β4 | ophthalmic and ulcer programs | Evidence tier 3, access tier 4 — graded as not clearing both gates | August 2026 |
| Trevogrumab | muscle preservation with a GLP-1 | Evidence tier 3, access tier 4 — graded as not clearing both gates | August 2026 |
| Lixisenatide | CV risk reduction | Evidence tier 4, access tier 1 — graded as not clearing both gates | August 2026 |
| BPC-157 | tissue repair | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| CJC-1295 | GH secretagogue | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| Dihexa | cognition | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| Epitalon | longevity | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| Humanin | longevity | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| Injectable GHK-Cu | tissue repair | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| Ipamorelin | GH secretagogue | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| KPV | inflammation | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| Melanotan II | tanning, libido | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| MOTS-c | metabolic, longevity | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
| Semaglutide sodium / acetate | any use | Evidence tier 4, access tier 4 — graded as not clearing both gates | August 2026 |
The curriculum behind this table teaches how each grade was derived, what changes it, and what to do at each one — including how to decline well, which is most of Tier 2. The programs →