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Acknowledgements The authors acknowledge support from the Health Research Board (ILP-POR-2017-041), Ireland

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As peptide use continues to grow, Australia needs: coordinated surveillance to monitor emerging products and harms action on how these products are marketed and sold online: enforcing existing rules against advertising unapproved therapeutic goods and holding platforms accountable for referral-link selling better education for clinicians who are increasingly encountering peptide use in their clinical practice evidence-based information that reaches people through the same online platforms where these products are promoted research on the wider “enhancement” ecosystem, including how people move between products, where they source information and dosing protocols, what drives uptake, and how online communities influence norms around risk