SAN FRANCISCO, California: Across the U.S., a growing number of people are taking obesity treatment into their own hands — literally.

From kitchen countertops to online forums, users like Missouri's Amy Spencer are part of a fast-expanding community turning to the "gray market" for weight-loss drugs. These are not FDA-approved medications, nor are they part of clinical trials. But for many, they've become the only affordable path to a treatment they believe works.

Spencer, 50, injects herself weekly with self-mixed cocktails of weight-loss drugs, including some still in clinical trials. One contains tirzepatide, the active ingredient in Eli Lilly's Zepbound. She's not part of any sanctioned study, and yet has lost 24 pounds — all for about $50 a month, a fraction of the official cost.

The ingredients for her homemade doses are shipped from China and ordered online. She stores them in her fridge, measures sterile water, dissolves the powder, and injects it into her thigh or belly.

"This is working so well for me. It's so easy. It's cheap," said Spencer. "I don't know what I would do without this medicine."

She's one of many Americans sidestepping high pharmaceutical prices by importing active ingredients labeled "for research purposes only." Forums on Reddit and Telegram offer step-by-step guidance on sourcing, dosing, and testing. One such group, StairwayToGray, has over 21,000 Telegram members and recently gained nearly 1,000 members weekly.

The appeal is clear: nearly 75 percent of U.S. adults are overweight or obese, yet only 8 percent report having used weight-loss medications, according to KFF. Insurance coverage is still limited and typically only applies to branded drugs.

The gray market filled a growing gap, especially after the FDA ordered compounding pharmacies to halt sales of cheaper, customized weight-loss meds. Imports of Chinese-made weight-loss drug ingredients surged by 44 percent in January, according to the Partnership for Safe Medicines. The group warns that it's likely an undercount, as many parcels are labeled in ways that avoid detection.

Big pharma firms like Lilly and Novo Nordisk — maker of Wegovy — say the trend is both dangerous and illegal. "You're playing the role of your doctor, pharmacist, and FDA inspector," said Shabbir Safdar, executive director of the Partnership for Safe Medicines.

That danger became real for Spencer when she overdosed on a batch of a new drug combo, cagri-tirz — a mixture of tirzepatide and cagrilintide — after miscalculating the dose. She suffered days of severe vomiting and weakness. "I was an idiot," she said. "I didn't do my math."

Still, she isn't deterred. A healthcare provider does not monitor her but describes the results — weight loss, improved blood pressure, reduced joint pain — as life-changing.

Others like Marie, a 41-year-old "soccer mom" from the Midwest, have built community-led systems for quality control. After buying Chinese-sourced tirzepatide through Telegram, she joined a group of 52 users who pooled funds to have the batch tested. A Tennessee lab confirmed its purity. Marie even gave her husband instructions in case something went wrong. "It's an honor system," she said. "These groups are very supportive."

In March, Marie helped organize testing for another batch from a different vendor. This time, 38 users shared the US$1,300 cost to verify the product. Janoshik Analytical, a Czech lab run by a former amateur weightlifter, confirmed the samples were 99.78 percent to 99.85 percent pure. Janoshik's CEO, Peter Magic, said obesity drug testing at his lab has surged, from just over 650 samples in 2023 to over 3,000 in 2024.

The FDA, meanwhile, says it continues to intercept illegal shipments at ports and warns consumers against using unverified substances. U.S. lawmakers have called on the agency to take more decisive action, especially against imports labeled as "research chemicals."

Yet, the movement shows no sign of slowing. Many of those involved know the risks but feel they have few options. "You shouldn't have to choose between your health and your wallet," reads the mission statement on one gray-market group's site.

For now, the gray market remains a self-policed ecosystem, driven by frustration, fueled by online solidarity, and operating far outside the reach of traditional medicine.