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Deer antler velvet (DAV), harvested from the growing antlers of deer, is a biologically dynamic animal-derived material that has attracted scientific interest due to its regenerative characteristics and complex biochemical composition. DAV contains proteins, peptides, growth-associated factors, polysaccharides, amino acids, lipids, and minerals, which have been investigated across diverse experimental systems. Although numerous studies report immunomodulatory, antioxidant, regenerative, neuroprotective, and musculoskeletal-related effects, the strength of evidence varies considerably, with the majority of data derived from in vitro and animal models and comparatively limited well-controlled human trials. This review provides a critical and mechanism-oriented synthesis of DAV research, three analytical perspectives: (1) compositional variability and its implications for standardization and reproducibility; (2) differentiation between the hierarchy of evidence distinguishing experimental plausibility from clinically validated outcomes; and (3) translational considerations, including bioavailability, pharmacokinetics of growth-associated components, and regulatory constraints. Reported molecular mechanisms converge on established pathways governing growth regulation, redox balance, immune modulation, and tissue remodeling; however, the systemic relevance of orally administered bioactive constituents, particularly growth factors such as IGF-1, remains incompletely defined. While DAV demonstrates biological activity across multiple preclinical models and limited human studies, critical challenges persist in dose standardization, long-term safety evaluation, clinical validation, and international regulatory harmonization. Future progress will depend on the establishment of defined compositional markers, rigorous pharmacokinetic assessment, and well-powered randomized controlled trials. By integrating compositional analysis, mechanistic evaluation, and translational feasibility, this review clarifies both the potential and the current limitations of DAV in biomedical and nutraceutical applications.