“Doc, can you prescribe me some BPC-157 with sermorelin, and maybe semaglutide too?”

He didn’t come in asking about his sleep.

He didn’t mention that his last meal the night before was at 11:30 p.m., eaten in front of a laptop glowing with unanswered emails.

He didn’t bring up the statin he’d been taking for years, the creeping fatigue he’d started to normalize, or the way his waistline had slowly expanded as his energy quietly shrank.

He came in with a shopping list. Not of groceries, but of peptides.

In that moment, I wasn’t just looking at a 45-year-old man chasing “optimization.” I was looking at a mirror held up to our entire longevity culture, one that promises transformation through compounds and protocols while often skipping the most basic, human questions: What are you eating? When are you eating? How are you sleeping? What’s really happening in your life?

When “optimization” forgets the human

I didn’t say no to his request. Instead, I said, “Before we talk about prescriptions, can you walk me through a day in your life?”

As he spoke, a pattern emerged that had nothing to do with peptide deficiency:

• Caffeine till noon, then a late first meal.
• Chaotic workdays with no real downtime.
• Late-night snacking to “unwind.”
• Fragmented sleep, falling asleep exhausted, waking up wired at 3 a.m.
• A supplement drawer full of pills he couldn’t quite explain.

On paper, he wanted BPC-157 for joint pain, sermorelin for growth hormone support, and semaglutide for weight loss. Underneath, he was asking for something much deeper: relief from a life out of rhythm with his own biology.

This is the quiet paradox of the longevity boom. We have more tools than ever, such as peptides, continuous glucose monitors, and advanced biomarker panels, yet many patients are sicker, more anxious, and more disconnected from their bodies than before.

The longevity industry didn’t invent this

The way his request was framed, “Doc, can you prescribe me X, Y, and Z?”, wasn’t unusual. It’s how our system trained both patients and doctors to think: Identify the problem, match it with a product, and move on. The longevity industry simply upgraded the catalog.

But the heart of good medicine has never been a product. It’s a process.

Long before “optimization” became a buzzword, thoughtful clinicians were:

• Reviewing diet before adjusting medications.
• Looking at lipid panels alongside A1c, not in isolation.
• Asking about sleep, stress, bowel habits, and relationships.
• Considering how one prescription interacts with 10 others.
• Wondering whether a patient’s chronic inflammation might be as much about grief and burnout as about diet and genetics.

The modern wellness world has rebranded this as something novel. In reality, it’s what happens when medicine has enough time and curiosity to be whole.

The questions that change everything

With my peptide-seeking patient, we did eventually talk about semaglutide, BPC-157, and other options. But not before we explored the terrain those molecules would be walking into.

Instead of starting with “Which peptide?”, we started with:

• What are you eating? Not just macros, but patterns. The late-night meals, the mindless snacking, the skipped breakfasts.
• When are you eating? How his meal timing was fighting his circadian rhythm, spiking insulin at midnight, and confusing his metabolism.
• How’s your sleep quality? Not just hours in bed, but sleep architecture, the 3 a.m. awakenings, the unrefreshed mornings.
• What do your labs actually say in context? Lipids, A1c, inflammatory markers, cortisol rhythm, thyroid function, nutrient status.
• What medications might be quietly draining you? The statin depleting CoQ10, the resulting muscle fatigue he thought was “just getting older.”
• What’s your stress story? The promotions that came with invisible costs: chronic activation of his stress response, emotional eating, emotional numbing.

By the time we circled back to peptides, the conversation had changed. It was no longer, “Can you give me these three things?” but “What does my body actually need, and how do we sequence this so it truly helps?”

Circadian health is not a luxury

One of the most overlooked parts of his story, and of so many others, is timing. Not just what he did, but when he did it.

He exercised late at night because it was the only time available. He ate his largest meal under artificial light. He answered work emails from bed, bathing his nervous system in blue light and stress at the very moment his brain was trying to downshift.

We talk about peptides as if they’re magic keys, but they still operate inside a larger rhythm. Growth hormone, insulin sensitivity, mitochondrial repair, these are profoundly circadian processes. When we live against our internal clock, we create friction that no injection can fully erase.

Sometimes the most radical “biohack” is not another compound, but aligning meals, light exposure, and sleep with how the body is already wired to heal.

Data without a story is just noise

Another layer: He’d been tracking his health with apps and wearables: HRV, steps, heart rate, calories burned. He showed me graphs with pride and frustration. “Look, my numbers are sometimes better, sometimes worse. I don’t know what to do with it.”

This is the other shadow of our optimization culture: oceans of data with very little meaning.

Biomarkers are incredibly valuable: A1c, hs-CRP, fasting insulin, lipid subfractions, cortisol curves, and more can show whether an intervention is helping or just expensive guessing. But numbers alone do not heal. They must be woven into a story: your story.

• Why did HRV crash the week your father went into the hospital?
• Why did your glucose spike during “healthy” evening smoothies?
• Why did your sleep score plummet after you changed jobs?

Without context, even the most advanced biomarker panel becomes another source of anxiety, one more thing to “fix” rather than understand.

The real miracle is attention

What changed the trajectory for this patient was not the eventual decision about peptides. It was the experience of being fully seen.

Of having someone ask:
“How does your body feel when you wake up?”
“What do your evenings look like emotionally, not just metabolically?”
“What are you afraid might happen if you don’t get these medications?”

Underneath his request for BPC-157 and semaglutide was a quiet fear: That he was running out of time. That his body was a project falling behind schedule. That aging was a failure he could outsmart if he found the right combination.

We didn’t take that fear away with a single visit. But we did something more important: We turned it into a conversation instead of a transaction.

Returning to medicine that remembers

The more I work at the intersection of internal medicine, functional medicine, and what the world now calls “longevity,” the clearer it becomes: The most healing thing in the room is not the molecule. It’s the relationship.

Yes, the compounding details matter: sterility, stability, dosing calculations. Yes, medications like semaglutide can be transformative when used wisely. But the essence of good care is older and simpler:

Ask better questions.
Listen longer than is comfortable.
Look at patterns, not just points.
Treat the human, not the protocol.

The longevity industry did not invent this. It simply monetized what attentive clinicians have always done when given the space: practice contextual, comprehensive, deeply human medicine.

My patient didn’t walk out with the exact peptide cocktail he had in mind. He walked out with something far more subversive in our quick-fix culture: a plan that started with his story, his rhythms, his life.

In the end, that’s the medicine I believe we’re all secretly searching for, not just longer life, but a life that finally makes sense from the inside out.

Shiv K. Goel is a board-certified internal medicine and functional medicine physician based in San Antonio, Texas, focused on integrative and root-cause approaches to health and longevity. He is the founder of Prime Vitality, a holistic wellness clinic, and TimeVitality.ai, an AI-driven platform for advanced health analysis. His clinical and educational work is also shared at drshivgoel.com.

Dr. Goel completed his internal medicine residency at Mount Sinai School of Medicine in New York and previously served as an assistant professor at Texas Tech University Health Science Center and as medical director at Methodist Specialty and Transplant Hospital and Metropolitan Methodist Hospital in San Antonio. He has served as a principal investigator at Mount Sinai Queens Hospital Medical Center and at V.M.M.C. and Safdarjung Hospital in New Delhi, with publications in the Canadian Journal of Cardiology and presentations at the American Thoracic Society International Conference.

He regularly publishes thought leadership on LinkedIn, Medium, and Substack, and hosts the Vitality Matrix with Dr. Goel channel on YouTube. He is currently writing Healing the Split Reconnecting Body Mind and Spirit in Modern Medicine.