Maximus CEO makes the case for performance medicine: FDA-approved hormones and peptides as founder stack

Summary

Cameron Sepah, founder and CEO of Maximus, argues that performance medicine—using FDA-approved hormones and peptides to enhance health rather than treat disease—is moving from niche practice into mainstream adoption among founders and venture investors.

Sepah's background matters. He is a licensed clinical psychologist and former assistant clinical professor of psychiatry at UCSF School of Medicine. He was on the founding team of Omada Health, a unicorn that went public and has helped a million people lose weight while cutting diabetes and heart disease risk in half. Maximus operates as a cash-pay private practice across all 50 states.

Sepah organizes performance enhancement around five foundational health behaviors: diet, exercise, sleep, stress management, and intimacy. He maps conventional supplements against prescription-grade alternatives that deliver measurable gains.

Supplement-to-drug progression

For muscle building, creatine offers mild gains. Testosterone is described as "literally a cheat code." A landmark study showed men on testosterone without exercise built far more muscle than men who trained five days a week without it. For appetite control, fiber delivers 1–2% body fat loss, while GLP-1 agonists like semaglutide and tirzepatide show 14.7% and 22% weight loss in clinical trials. For sleep, melatonin works mildly, while growth hormone peptides like sermorelin and tesamorelin restore sleep toward seven to nine hours by enhancing recovery. For stress, magnesium is mild, whereas oxytocin—which Maximus has formulated as a topical nasal or skin application—reduces cortisol and increases connection far more effectively. For intimacy, zinc is baseline, while tadalafil and sildenafil increase erectile function, blood flow to muscles and brain, and show associational links to reduced Alzheimer's and dementia risk.

Sepah predicts that within five years, top founders and VCs will be taking at least three of these five drugs: testosterone for muscle, tirzepatide for fat loss, tesamorelin for growth hormone and recovery, tadalafil for blood flow, and oxytocin for stress.

Insurance and the cash-pay model

Traditional insurance won't pay for performance enhancement because insurers optimize for three-year retention, not long-term health. If you change jobs every few years, the insurer that pays for your preventive care doesn't reap the benefit. Sepah uses testosterone as an example: insurance deems you untreatable unless your levels fall below the 2.5th percentile. The other 97.5% of Americans, especially those in the lower half of normal range, could feel better in energy, motivation, drive, and sexual function, but insurance won't fund it.

Maximus operates as a direct-to-consumer practice, betting that patients and doctors should decide cost-benefit tradeoffs, not insurers.

Fertility and patent protection

Injectable testosterone, the gold standard, shuts down testicular function and fertility in younger men, making TRT risky for anyone under 50 who wants children. Maximus has patented a solution combining oral and topical testosterone with enclomiphene, a selective estrogen receptor modulator that blocks suppression in the hypothalamus and pituitary. Men as young as 18 can take testosterone without suppressing fertility markers. Sepah describes this as allowing them to maintain natural testosterone production while supplementing it to high-normal levels. The firm holds two patents on this combination and is publishing research to democratize the protocol.

Peptides and safety

Sepah's position on the current peptide craze is that the category is meaningless—"it just really means drugs"—and responsible clinics must distinguish between FDA-approved peptides with substantial human literature (GLP-1s, oxytocin, sermorelin, tesamorelin) and unapproved compounds like BPC-157.

Peptide Sciences, an offshore compounder, recently shut down. Customers buying non-FDA GLP-1 alternatives found vials that either contained no active ingredient or dosing off by 50%. Because GLP-1s are glucagon agonists with cardiac effects (increased heart rate, reduced heart rate variability), improper dosing creates real side effects. Sepah argues there is no reason to take uncontrolled black-market versions when FDA-approved alternatives like tirzepatide exist and carry extensive safety literature.

Maximus publishes its own research—including studies with sample sizes in the thousands on clomiphene safety and efficacy—and works with FDA-inspected compounding pharmacies. Sepah is the largest prescriber of clomiphene in the United States.

ADHD drugs and stimulants

As a former psychiatry professor, Sepah is conservative about psychoactive drugs that work on neurotransmitters. ADHD diagnosis is problematic, he argues. Most people aren't getting full neuropsychological exams, and the condition is overdiagnosed. There's no blood biomarker for dopamine, and the screening criteria are broad.

For people with properly diagnosed ADHD, stimulants like Ritalin and Adderall can be life-changing. From a performance enhancement angle, Sepah is vocal in his criticism and has publicly opposed companies like Cerebral that promote Adderall on TikTok. Maximus won't prescribe addictive drugs because they are a Faustian bargain with significant trade-offs.

Instead, Sepah popularized "dopamine fasting" in 2019 as a behavioral intervention. The real problem for most people isn't ADHD but digital distraction—social media, gaming, gambling, shopping. He notes that China legally requires game manufacturers to take servers offline from 11 PM onward, an institutionalized form of dopamine fasting.

Testing and personalization

Maximus offers micro-dosing of tirzepatide for non-overweight people (BMI under 25) who want to reduce inflammation, impulsivity, or food noise without weight loss. The firm also offers eight different dosages of enclomiphene, from 3.125 mg to 25 mg, titrated by lab testing.

An at-home blood test using a finger stick measures about a dozen biomarkers tailored to performance medicine. Results come back next-day-air from a lab. Patients establish baselines, then after 30 days on a protocol—say, topical testosterone plus enclomiphene—they retest to ensure lab numbers are ideal.

Sepah is skeptical of wearables. As a psychologist, he says they often cause anxiety rather than clarity. A low WHOOP or Oura score sends people spiraling. He uses wearables when testing specific interventions like oxytocin, which Maximus has published improves sleep quality and extends sleep duration by about 25 minutes on average. The real test is what he calls a "randomized controlled trial of one," running an ABA protocol on your own data to see if the treatment actually works for you.

Mainstream acceptance

Sepah positions performance medicine as a move away from America's sick care system. Insurance companies deny care. Traditional medicine treats deficits, not enhancement. His vision is proactive, personalized optimization tailored to each individual's health goals.

The pattern is already moving from Hollywood to Silicon Valley. Actors have long been on TRT despite publicly claiming it's just "chicken and broccoli." Bodybuilders led the charge. Hollywood picked it up. Now founders and investors are normalizing it. The difference, Sepah argues, is that Silicon Valley should be honest about it instead of following Hollywood's playbook of denial and obfuscation.