Highest Use Is Not Fastest Growth
Per-capita GLP-1 use is highest in Appalachia and the Deep South (West Virginia, Kentucky, Louisiana), while 2023 to 2024 growth was fastest in the Northeast (Rhode Island, Massachusetts, New Jersey).
Regulations Research
Federal and State Rules,For What You Actually Offer.
Start with your state, then check the federal floor for the services on your menu. Everything here is sourced and dated, and it points to the agency or statute behind it.
Federal summaries current as of October 2026.
Compare Every State
What a clinic has to build depends first on whether your state enforces the corporate practice of medicine. Pick a state to open its guide.
- Strict CPOM · MSO-PC · 17 states — Physician-owned PC plus an MSO
- CPOM enforced · 15 states — CPOM enforced, more flexibility
- Non-CPOM · 18 states — Ownership is freer; a medical director is still required
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
Select a state to open its guide. Shading follows each state's corporate practice of medicine classification.
02 / By What You Offer
Browse by Service
Each group starts from the federal rules that apply and links to our guides on how states layer their own requirements on top.
Compounded Drugs and Peptides
FDA compounding rules (section 503A for patient-specific prescriptions, 503B for registered outsourcing facilities) plus state pharmacy law.
Hormones and Controlled Substances
Prescription drug rules, DEA scheduling for controlled substances such as testosterone, and state controlled-substance and telehealth rules.
Aesthetics and Devices
Prescription neuromodulators and fillers, FDA-regulated devices, and state delegation and scope-of-practice rules for who may inject or operate lasers.
IV Therapy and Infusions
Prescription fluids and additives, pharmacy and nursing scope rules, and in some states IV-specific statutes.
Ownership, Structure and Staffing
State corporate practice of medicine doctrine, professional-entity statutes, fee-splitting rules and nurse practitioner and physician assistant scope.
Where the Growth Is, State by State
Which states are seeing a boom in GLP-1s, aesthetics, testosterone and wellness, and what regulators are doing about it. Every number links to its source, and where no state-level data exists we say so.
Nevada, Arizona and Florida Are the Densest
On a per-capita basis Nevada (7.5 per 100,000 residents), Arizona (5.7) and Florida (5.1) have the most physician-supervised med spas, against a US average of about 3.
Testosterone Interest Runs Mountain West and South
Relative Google search interest in testosterone ranks highest in Utah, Oklahoma, Idaho, Arkansas and Wyoming, and pharmacy-record patient growth was strongest in the South.
Peptides, HRT and IV Have No State Data
No credible public state-level dataset exists for peptide therapy, menopausal hormone therapy, IV hydration or longevity clinics, so we show national context and regulatory movement instead of inventing a ranking.
Where GLP-1 Use Is Highest, and Where It Is Growing
Two different state rankings that do not agree, which is the point: volume and growth each tell a different story. Both are commercial claims data and exclude cash-pay and compounded prescriptions.
Highest Use per 100 Residents
Lowest
- Hawaii5.1
- Nevada7.4
- Rhode Island7.5
- Colorado7.8
- Oregon7.9
Purple Lab commercial claims, via GLP-1 Newsroom2024
Read with care: Prescriptions per 100 residents, not a share of people. Claims only; the underlying report was not directly accessible.
Fastest Growth, 2023 to 2024
Declining
- Louisiana-11.6%
- South Dakota-11.1%
- Idaho-11%
- Vermont-2%
Purple Lab commercial claims, via GLP-1 Newsroom2023 to 2024
Read with care: Percent change in prescriptions. A news article summarizing the data, not a primary report. Excludes cash-pay and compounded.
GLP-1 Use Has Roughly Tripled Nationally
Gallup found 11% of US adults currently use a GLP-1 for weight loss in mid-2026, up from 3% in 2024. Of current users, 66% use a brand-name drug and 18% use a compounded or custom-mixed one. No state breakdown is published.
GallupMay 28 to June 5, 2026
Read with care: Survey self-report, national only.
Where Med Spas Are Concentrated
The available state data is point-in-time counts and demand indexes from vendors, not growth series. It shows where the market is dense today, not how fast it is growing. We found no state-level growth rate for med spas.
Physician-Supervised Med Spas per 100,000 Residents
The US average is about 3 per 100,000. Florida, California, Texas and Arizona together hold roughly 35% of US locations.
OrbitalUpdated June 2026
Read with care: Orbital sells med spa lead data, and the state split is its own estimate, rounded to the nearest 10. AmSpa does not publish state counts.
Most Med Spa Locations
OrbitalUpdated June 2026
Read with care: Strict physician-supervised definition. Another Orbital page with a broader definition prints different counts, so the two should not be compared.
Botox Interest Index, Top States
A composite of Google searches for 31 Botox-related terms, clinician and clinic density, and Google Trends interest. Nine of the top ten states are in the West or Northeast.
Avinity Health, via NewBeautyAugust 2026 data
Read with care: A marketing-style index measuring search interest and provider density, not procedures performed. Only two scores were published.
The Industry Keeps Compounding
AmSpa describes the US med spa industry as past $17 billion and growing by more than $1 billion a year. AmSpa states its report does not break results down by state or city.
American Med Spa AssociationCurrent
Read with care: National only.
Testosterone and Hormone Therapy
Testosterone has two partial state-level views. Menopausal hormone therapy has none, only national growth figures.
Testosterone Search Interest, Highest States
Invigor Medical analysis of Google TrendsJuly 2024 to July 2025
Read with care: Relative interest within each state, not volume, for the term "testosterone", which also catches supplement and bodybuilding searches. The publisher is a telehealth company that sells TRT.
Growth in Testosterone Patients by Region, 2018 to 2022
The Midwest did not show comparable growth. Nationally, patients filling testosterone prescriptions rose from about 1.22 million to 1.66 million.
Selinger and Thallapureddy, PLoS One2018 to 2022
Read with care: Built from prescription-monitoring data from only 25 of 51 programs; California, Florida, Michigan, New York and North Carolina are missing. Use the regional direction only.
Testosterone Prescribing Is Rising Again
The share of US men with an active testosterone prescription fell to 0.64% in 2021, then rose to 0.95% in the first half of 2026. Epic Research also reports prescriptions of hormone replacement therapy for women up 72% since 2021.
Epic ResearchPublished July 2026
Read with care: National only. The HRT headline is from the title of a November 2025 Epic Research report we could not read in full.
Peptides, IV Therapy and Longevity
No credible public state-level dataset exists for these categories, so there is no ranking here. What follows is the regulatory movement that is shaping them.
BPC-157 Cleared an FDA Advisory Vote
On July 23, 2026, an FDA advisory committee voted 8 to 6, with one abstention, to add BPC-157 to a compounding list. The vote is non-binding and needs FDA sign-off, so its status can still change.
ABC NewsJuly 2026
Read with care: One news report; confirm against FDA before relying on it.
IV Hydration Is Largely Unregulated by State
A 2025 JAMA Internal Medicine study found that, as of June 2024, no state had enacted legislation specifically regulating IV hydration spas, and only Alabama, North Carolina, South Carolina and Vermont addressed all four oversight areas studied. Texas HB 3749 limited elective IV therapy to licensed providers from September 1, 2025.
CSPI, on a JAMA Internal Medicine studyPublished October 2025
Read with care: Regulatory data, not growth data.
DEA Telemedicine Flexibilities Run Through 2026
The DEA's telemedicine flexibilities for prescribing controlled substances, which include testosterone, were extended through December 31, 2026, and a special registration rule had not been finalized as of late 2025. Plan for a possible change on January 1, 2027.
McDermott Will and SchultePublished 2026
Read with care: Secondary legal summary; check the DEA for the current rule.
Regulatory Movement
What States Are Doing About the Boom
Registration for Non-Physician-Owned Med Spas
SB 282, effective July 1, 2026, requires non-physician-owned med spas to register, name a responsible practitioner and use good-faith exams by an MD, DO, NP or PA. Registration is expected to begin around January 2027.
AmSpa summaryPharmacy Board Pulls Med Spa Licenses
The Ohio Board of Pharmacy revoked four med spa licenses over compounded semaglutide and tirzepatide, and the attorney general warned 14 more med spas, according to a May 2025 report.
WYSOCompounded GLP-1s Still Sold After the Shortage
A secret-shopper study from August to October 2025 found 75 businesses selling compounded GLP-1s after FDA ended the shortages, and 58.7% added additives.
Healio, on JAMA Health ForumCompounded Weight-Loss Documentation Bill Died
SB 860, which would have set documentation rules for compounded weight-loss drugs, died in committee on March 13, 2026.
Florida SenateFigures are from the third-party sources linked on each card and were current as of October 2026. Several are vendor estimates or news summaries rather than primary reports, which each card notes. This is market context, not a legal or clinical recommendation.
What Applies in Every State
Federal rules set the minimum. States can and often do add to them. Summaries are current as of October 2026; the linked sources control if anything has changed.
503A and 503B Compounding
Section 503A covers state-licensed pharmacies compounding for an identified patient under a prescription. Section 503B covers FDA-registered outsourcing facilities, which can compound without patient-specific prescriptions but must meet current good manufacturing practice. Which lane a product comes from decides what a clinic can lawfully stock and administer.
As of October 2026GLP-1 Compounding
FDA resolved the tirzepatide shortage in December 2024 and the semaglutide shortage in February 2025, and shortage-based compounding discretion has ended. FDA said in February 2026 that it intends to restrict GLP-1 active ingredients in mass-marketed compounded drugs and to act against ads claiming a compounded drug is the same as, or as proven as, the approved one. In April 2026 it proposed excluding semaglutide, tirzepatide and liraglutide from the 503B bulks list. That proposal was not final when we last checked.
- FDA: compounding policy as supply stabilizes ↗
- FDA: action on non-approved GLP-1 drugs ↗
- FDA: proposed 503B bulks list exclusion ↗
Peptides
Removal of a peptide from FDA's Category 2 list does not make it compoundable. In July 2026 FDA's compounding advisory committee voted to recommend adding BPC-157 and some other peptides to the 503A bulks list. That vote is advisory, FDA staff opposed adding BPC-157, and we found no final FDA action. Products sold as "research use only" are not for human use, whatever the label implies.
As of October 2026Telemedicine and Controlled Substances
DEA flexibilities that allow prescribing controlled substances, including testosterone, by telemedicine without a prior in-person visit run through December 31, 2026. A permanent special-registration rule has not been finalized as far as we could confirm, so plan for the possibility that in-person requirements return on January 1, 2027.
As of October 2026Menopausal Hormone Therapy Labeling
FDA announced in November 2025 that it was removing boxed warnings on cardiovascular disease, breast cancer and dementia from menopausal hormone therapy labels, and approved label changes for several products in February 2026. The endometrial cancer warning remains.
As of October 2026Health Claims and Advertising
The FTC expects health claims to be supported by competent and reliable scientific evidence, and its staff guidance emphasizes randomized controlled human trials for benefit claims. FDA separately treats claims that a product treats a disease as drug claims. Clinics are responsible for their own marketing, including claims made on their behalf.
As of October 2026Adverse Event Reporting
Serious adverse events involving drugs and devices can be reported to FDA through MedWatch. Clinics should also have an internal process for recording and escalating adverse events to their medical director.
As of October 202605 / Official Databases
Check the Source Yourself
Where the rule lives in a database or a registry, go to the agency. These are the ones we use most.
Next Step
Rules Checked. Now Build on Them.
A clinic that fits its state's rules starts with a physician licensed there, a structure that matches the law and protocols for every service. We connect you with all three.
This page is educational and not legal advice. Laws, rules and agency positions change, and a state's rule can differ from the summary here. Confirm with the cited agency or with licensed healthcare counsel in your state before acting. Spot something out of date?Tell us.