Tesamorelin
Tesamorelin is a daily injection that signals the body to release its own growth hormone. It is FDA-approved as Egrifta, only for extra belly fat in adults with HIV. It copies GHRH, the brain’s natural signal for growth hormone. The body stays in control of the release, so growth hormone still comes in natural pulses.
What it’s studied for
- Deep belly fatStudied in humans
In adults with HIV, deep belly fat dropped about 15% over 26 weeks, and about 18% by one year. source
- Liver fatStudied in humans
In people with HIV and fatty liver, liver fat fell by more than a third. source
- Lean massStudied in humans
A review of 5 trials found lean mass went up by about 1.4 kg. source
New here? Three things worth knowing first
What’s a peptidepeptideA short chain of amino acids. Proteins are long chains; peptides are short ones, usually under 50 amino acids.? A short chain of amino acids, the building blocks of protein. Many act like messengers in the body.
Why the vial has to be mixed. It ships as a dry powder. You add bacteriostatic waterbacteriostatic waterSterile water with a little benzyl alcohol that stops bacteria growing, so a mixed vial lasts days or weeks. Often called BAC water., and the amount you add decides how many unitsunitsMarks on an insulin syringe. On a U-100 syringe, 100 units = 1 mL. How many units equal a dose depends on how much water was added. on the syringe equal one dose. The calculator does that math.
SubcutaneoussubcutaneousUnder the skin, into the fat layer. The usual route for peptide injections. Often shortened to sub-Q. injection, Once daily. Subcutaneous means into the fat layer just under the skin. It uses a small insulin syringe. Any word with a dotted underline on this page opens a short definition.
Dosage guidelines
Once a day, on an empty stomach, usually before bed. The trials used one fixed dose, 2 mg a day, with no step-up.
The doses below come from published reference protocols and, where they exist, the human trials. Tap a row to load it into the calculator.
Figures reviewed against their sources in October 2026. Where a trial or approved label sets a schedule, it is shown first; where a label sets one fixed dose, the FAQ below says so.
Standard protocol (trial dose). 2 mg once a day on an empty stomach, for at least 26 weeks in the trials. No data supports lower doses.
The dose used in every major trial · 2 mg (2,000 mcg), once daily · Continuous daily dosing for at least 26 weeks in the trials
| Step | Dose per injection | Draw to | |
|---|---|---|---|
| 1 | 2 mg (2,000 mcg) | 40 units |
Doses marked “between 5-unit marks” sit between the 5-unit lines on a 1 mL syringe; the 1-unit lines on a 0.5 mL or 0.3 mL syringe make them easier to read.
Units are for a 10 mg vial mixed with 2 mL of water. Change the vial in the calculator
Full protocol details
Other protocols described
- Approved label dose (HIV lipodystrophy). The approved forms list 1.4 mg (Egrifta SV) or 1.28 mg (Egrifta WR) a day. The original trials tested 2 mg.
Mixing in the protocols: 5 mg vial + 1 mL bacteriostatic water · 5 mg/mL (5,000 mcg/mL). 2 mg = 40 units. At 2 mg a day, a vial lasts 2.5 days..
Standard protocol (trial dose)
The dose used in every major trial
- Dose
- 2 mg (2,000 mcg)
- How often
- Once daily
- Timing
- Fasted, 30 to 60 minutes before bed; or fasted in the morning, at least 2 hours before eating. Morning dosing is the described alternative when a night dose disrupts sleep
- Route
- Subcutaneous, usually the abdomen below the navel, rotating sites and skipping scarred, bruised or irritated skin
- How long
- Continuous daily dosing for at least 26 weeks in the trials
No dose-finding data supports lower doses.
Off-label cycle
- Dose
- 2 mg
- How often
- Once daily
- Timing
- Fasted, as in the standard protocol
- Route
- Subcutaneous
- How long
- 3–6 months
- Break
- 1–2 months
Some practitioners run continuous lower doses instead, which is less studied.
With ipamorelin
Dual-pathway GH release
- Dose
- 1–2 mg tesamorelin + 100–200 mcg ipamorelin
- How often
- Once daily
- Timing
- Together, before bed, fasted. Both in the same window; dosing apart is described as giving two smaller pulses
- Route
- Subcutaneous
- How long
- 60–90 days
Approved label dose (HIV lipodystrophy)
The approved use
- Dose
- 1.4 mg (Egrifta SV) or 1.28 mg (Egrifta WR)
- How often
- Once daily
- Route
- Subcutaneous
Label doses for the current pharmaceutical forms. The original trials used 2 mg.
Cycle
Continuous daily dosing for at least 26 weeks in the trials
When a step up happens
User reports describe stepping up only after progress has stalled for two weeks or more, and only if the previous step was tolerated. Everyone is different.
Timing: Fasted, 30 to 60 minutes before bed; or fasted in the morning, at least 2 hours before eating. Morning dosing is the described alternative when a night dose disrupts sleep.
Peptide calculator
Already filled with this vial. Change anything you like.
How much is in your vial?
Check the label. The most common strengths:
Every 10 units = 1 mg.
20 units. 1 mL of BAC water
How the vial is mixed
The powder has to be dissolved in bacteriostatic (BAC) water before use. For a 10 mg vial this page uses 2 mL, which puts the usual dose on a round syringe mark: every 10 units is 0.5 mg.
STEP 1Wipe both topsAlcohol pad on the peptide vial and the BAC water vial.
STEP 2Draw 2 mL of waterThat’s 2 full 1 mL syringes.
STEP 3Add it slowlyAim at the glass wall, not at the powder.
STEP 4Swirl, don’t shakeRoll gently until clear. Refrigerate after.What to watch for
- Redness, itching, pain or flushing where the injection goes inStudied in humans
- Joint or muscle pain, and swelling in the hands or feetStudied in humans
- Tingling or numbnessStudied in humans
- A short-term rise in blood sugarStudied in humans
- Poor sleep with a bedtime doseReported by users
Not for anyone with cancer now or in the past, pituitary problems or past head radiation. Also not for pregnancy, breastfeeding or anyone under 18. Talk to a doctor first, especially with diabetes or prediabetes.
Reasons to get medical help right away: trouble breathing, swelling of the face or throat, chest pain, fainting, or any severe or worrying reaction.
Full side-effect list and who should avoid it
In published research
- Injection-site reactions were the most frequent: redness, swelling, pain, itching, and flushing lasting 10 to 20 minutes
- Joint pain, muscle pain, swelling in the hands or feet, tingling or numbness
- Fasting glucose rose temporarily at 2 weeks in one study and was back to normal by 6 months
- No serious adverse effects in the 2026 meta-analysis
- The label warns of a possible higher risk of tumors and of IGF-1 rising well above normal
What users report
- Sleep disruption with night dosing, which users describe resolving by switching to morning dosing
- Carpal tunnel symptoms from fluid retention
- Rare allergic reactions (rash, hives, trouble breathing), described as a reason to stop at once
Theoretical concerns
- Prediabetes or insulin resistance could worsen, which is why glucose monitoring is described
Not for
- Active cancer or any history of cancer
- Pituitary disorders, tumors or surgery, or radiation to the head
- Known allergy to tesamorelin
- Pregnancy
- Breastfeeding
- Under 18
Use caution with
- Diabetes or prediabetes
- History of head injury
- Kidney or liver disease
- Heart disease or recent heart surgery
- Breathing problems or asthma
- Migraines or epilepsy
- Adrenal disorders
- Other GH products (not combined)
- Estrogen therapy, glucocorticoids, insulin and diabetes medicines
- Storage before mixing: refrigerated at 2–8°C (36–46°F), or frozen at −20°C (−4°F) for longer, away from light
- Storage after mixing: room temperature, 20–25°C (68–77°F), never refrigerated or frozen, used within 7 days, and discarded if cloudy, thick or gel-like. Its water-repelling regions clump in the cold. The pharmaceutical form contains a stabilizer that research-grade product usually lacks, and standard purity certificates do not detect this clumping
How the body handles it
- Peak in the blood 30 minutes to 1 hour after an injection under the skin
- Half-life about 26 minutes (natural GHRH: about 2 minutes)
- Each dose produces a GH burst of 2 to 3 hours
- IGF-1 stabilizes over 2 to 4 weeks of daily dosing
Supplies
What 12 weeks of the schedule above takes, counted dose by dose.
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Stacking
What the community pairs with tesamorelin, and why. None of these pairings has been tested in a trial.
- IpamorelinReported by users
The body has two signals that release growth hormone. Tesamorelin uses one and ipamorelin the other, so protocols describe both together before bed, on an empty stomach.
Also used alongside it, with no interactions described: BPC-157 and TB-500, GLP-1 drugs such as semaglutide, tirzepatide and retatrutide, and testosterone therapy.
Not combined with: Injected growth hormone, because it triggers the body’s own brake on growth-hormone release.
Go deeper
Every study, community report and source behind this page.
What the studies show14 findings, each with its evidence label
Status, October 2026. FDA-approved (first in 2010, as Egrifta) to reduce excess abdominal fat in adults with HIV and lipodystrophy; the current forms are Egrifta SV (1.4 mg daily) and Egrifta WR (1.28 mg daily, approved March 2025), and it is not approved for weight loss or any other use. Source
How it works
Stage one is GH release. Tesamorelin binds GHRH receptors on the GH-producing cells of the pituitary, so the body releases its own growth hormone. The natural pulse pattern and the somatostatin brake stay in place.
Stage two is IGF-1igf-1A growth factor the liver makes in response to growth hormone. Blood tests use it to track growth-hormone activity.. The liver converts GH into IGF-1, and that step needs insulin. Fasting gives the largest GH pulse, with insulin low and ghrelin high, so a fasted dose overnight followed by breakfast is described as fitting that sequence.
Tesamorelin covers only the GHRH pathway. That is the reasoning behind pairing it with a ghrelin-pathway peptidepeptideA short chain of amino acids. Proteins are long chains; peptides are short ones, usually under 50 amino acids. such as ipamorelin.
It peaks in the blood 30 minutes to an hour after an injection under the skin, with a half-lifehalf-lifeHow long it takes for half of a compound to leave the body. A longer half-life usually means less frequent dosing. of about 26 minutes against about two minutes for natural GHRH. Each dose produces a GH burst of 2 to 3 hours.
Benefits
Each one carries an evidence label, so you can see how much is actually known.
Less visceral fat
In adults with HIV, 26 weeks of daily tesamorelin cut visceral fatvisceral fatFat stored deep around the organs, as opposed to the fat under the skin. by about 15 to 20%. source
Lean mass kept or gained
A 2026 meta-analysis of 5 trials found lean mass rose by 1.42 kg. source
Blood lipids
Triglycerides fell by about 50 mg/dL and the total-to-HDL cholesterol ratio improved in the HIV trials. source
Liver fat
In people with HIV and fatty liver disease, liver fat fell by 37% and fewer showed fibrosis progression. source
Natural GH rhythm
Because the pituitary still controls release, GH keeps its pulse pattern rather than staying at a constant level, as described on its label. source
Thinking skills
In one 20-week trial in older adults with and without mild cognitive impairment, executive function improved. In a 2025 trial in people with HIV, the difference in cognition was not significant. source
Recovery, collagen and joints
Described by users and inferred from higher GH and IGF-1igf-1A growth factor the liver makes in response to growth hormone. Blood tests use it to track growth-hormone activity.; not measured in trials.
What the science shows
Phase 3 trial, HIV abdominal fat (human, 2007)
Studied in humansMulticenter, double-blind, placeboplaceboAn inactive version given to some trial participants so the real effect can be measured fairly.-controlled trial in 412 people with HIV, 2 mg a day under the skin for 26 weeks. Visceral fatvisceral fatFat stored deep around the organs, as opposed to the fat under the skin. fell 15.2% against a 5.0% rise on placebo. Triglycerides dropped 50 mg/dL, the cholesterol ratio improved, IGF-1igf-1A growth factor the liver makes in response to growth hormone. Blood tests use it to track growth-hormone activity. rose 81%, lean mass held, and glucose tolerance did not worsen. source
Pooled phase 3 results and extension (human, 2010)
Studied in humansWith continued use over 12 months, the visceral fat reduction reached about 18%. source
Visceral and liver fat (human, JAMA 2014)
Studied in humansRandomized trial in 50 people with HIV. Net visceral fat change was −16.6%, and the liver's fat-to-water ratio fell by a net 2.9%. source
Fatty liver disease (human, Lancet HIV 2019)
Studied in humansDouble-blind, multicenter trial in 61 people with HIV and fatty liver disease. Liver fat fraction fell 37%. 35% reached liver fat below 5%, against 4% on placebo, and fibrosis progressed in 10% against 37%. source
Meta-analysis of 5 trials (human, 2026)
Studied in humansVisceral fat fell 27.71 cm², trunk fat 1.18 kg and liver fat 4.28%, while lean mass rose 1.42 kg. No serious adverse effects and no disturbance of blood sugar. source
Cognition in older adults (human, 20 weeks)
Studied in humansIn older adults with and without mild cognitive impairment, executive function improved over 20 weeks. source
Cognition and waist size in HIV (human, 2025)
Studied in humansOpen-label phase 2phase 2A mid-stage human trial that tests dose and early effect in hundreds of people. Phase 3 confirms results in thousands. trial in 73 people with HIV and abdominal obesity. Waist size fell significantly; the difference in cognition was not significant, and IGF-1 did not track with cognition. source
What the community reports5 user reports, a timeline and 5 pairings
What to expect
Sleep is described as improving.
Reported by usersIGF-1igf-1A growth factor the liver makes in response to growth hormone. Blood tests use it to track growth-hormone activity. settles at its new level with daily dosing.
Studied in humansRecovery is described as improving as IGF-1 stabilizes.
Reported by usersVisible body-composition change, described when diet and training are in place.
Reported by usersThe largest visceral fatvisceral fatFat stored deep around the organs, as opposed to the fat under the skin. reduction in the trials came over 26 weeks of daily dosing. Some fat returned after stopping.
Studied in humansEvery major trial was in people with HIV; there is no randomized trial in healthy adults. Off-label, it is described for body recomposition and healthy aging, and protocols frame at least 3 to 6 months of daily use as the time it takes.
What people report
Gathered from user communities. Anecdotal: useful for what to expect, not proof.
Waist size
Waist and abdominal measurements shrink over 3 to 6 months, most consistently on 2 mg daily. Lower or irregular doses are described as giving weaker results.
Sleep and recovery
Better sleep in 2 to 4 weeks, and faster recovery once IGF-1igf-1A growth factor the liver makes in response to growth hormone. Blood tests use it to track growth-hormone activity. settles.
Injection-site reactions
Redness, itching and flushing lasting 10 to 20 minutes are described as more common and stronger than with CJC-1295 or ipamorelin. Head rush and a racing heart are described as less common.
Cost
The top complaint. At 2 mg a day, a 5 mg vial lasts 2.5 days, or about 12 vials a month.
Ruined vials
Many users report losing vials to refrigeration after mixing; the peptidepeptideA short chain of amino acids. Proteins are long chains; peptides are short ones, usually under 50 amino acids. gels in the cold.
Stacking
How it is described alongside other compounds.
Ipamorelin
Described as the most logical pairing: tesamorelin covers the GHRH pathway and ipamorelin the ghrelin pathway. Dosed together, fasted, before bed.
BPC-157 and TB-500
No interaction concerns described. Those peptides have no fasting rule.
GLP-1 drugs (Retatrutide, Semaglutide, Tirzepatide)
No interaction concerns or timing conflicts described.
Testosterone therapy
No interaction concerns described.
Injected GH
Listed as a combination not to run. It triggers somatostatin feedback that blunts the pituitary's response.
Common questions8 questions
Common questions
Is it better for visceral fat than CJC-1295?
They share the mechanism; what differs is the trial data. No head-to-head study exists.
Why does it cost so much more?
The dose is 2 mg a day against about 100 to 200 mcg for CJC-1295, at similar vial prices, which makes CJC-1295 roughly 10 times cheaper per day. The one edge described for tesamorelin is that it keeps the body's natural feedback in place.
Can mixed tesamorelin go in the fridge?
No. It gels in the cold. After mixing it is kept at room temperature and used within 7 days.
When is it dosed?
Fasted, 30 to 60 minutes before bed, or in the morning at least 2 hours before food.
Does it need cycling?
Cycling has not been shown to be necessary. Off-label practice is 3 to 6 months on, 1 to 2 months off.
Does a lower dose work?
No evidence supports lower doses; 2 mg is what the trials used.
What does “minimum effective dose” mean?
It is the lowest dose that still produces the effect someone is after. User reports describe starting there and staying there for as long as it keeps working, rather than climbing toward the top of the range. Side effects tend to rise with dose, and the top of each range on this page is a ceiling people report, not a target.
When does the dose go up?
On its approved label, tesamorelin is used at one fixed daily dose with no step-up; the label dose depends on the form (1.4 mg for Egrifta SV, 1.28 mg for Egrifta WR), and the original trials used 2 mg. The ranges on this page come from reference sites. User reports describe staying on a dose while it is still working rather than climbing toward the top of the range. There is no prize for getting to the top dose fast.
Source material8 studies and documents
References
- Falutz J, et al. N Engl J Med. 2007;357(23):2359-2370. pubmed.ncbi.nlm.nih.gov/18057338/…
- Falutz J, Potvin D, Mamputu JC, et al. J Acquir Immune Defic Syndr. 2010;53(3):311-322. pubmed.ncbi.nlm.nih.gov/20101189/…
- Stanley TL, Feldpausch MN, Oh J, et al. JAMA. 2014;312(4):380-389. pubmed.ncbi.nlm.nih.gov/25038357/…
- Stanley TL, Fourman LT, Feldpausch MN, et al. Lancet HIV. 2019;6(12):e821-e830. pubmed.ncbi.nlm.nih.gov/31611038/…
- Badran AS, Helal A, Shata KS, Ayesh H. Obes Res Clin Pract. 2026. pubmed.ncbi.nlm.nih.gov/41545261/…
- Baker LD, et al. Arch Neurol. 2012;69(11):1420-1429. pubmed.ncbi.nlm.nih.gov/22869065/…
- Ellis RJ, Vaida F, Hu K, et al. J Infect Dis. 2025;231(5):1230-1238. pubmed.ncbi.nlm.nih.gov/39813152/…
- Egrifta WR prescribing information. FDA, 2025. www.accessdata.fda.gov/drugsatfda_docs/label/202…
Related
What is Tesamorelin?
Tesamorelin is the full 44-amino-acid GHRH sequence with one change: a small fatty-acid group (trans-3-hexenoic acid) on its first amino acid. That shields it from DPP-4, the enzyme that breaks natural GHRH down within minutes. It was developed in Canada and approved by the FDA in 2010 as Egrifta, to reduce excess abdominal fat in adults with HIV and lipodystrophy. The current forms are Egrifta SV (1.4 mg daily) and Egrifta WR (1.28 mg daily, approved March 2025). It is not approved for weight loss or any other use, is prescription-only in its pharmaceutical form, and is prohibited in tested sport. Its reputation for visceral fatvisceral fatFat stored deep around the organs, as opposed to the fat under the skin. reflects what the trials measured, which was visceral fat on CT scans. The mechanism is the same GHRH signal as CJC-1295 and sermorelin.
What people look into Tesamorelin for
Every line carries an evidence label, so you can see how much is actually known.
Less visceral fatvisceral fatFat stored deep around the organs, as opposed to the fat under the skin.: In adults with HIV, 26 weeks of daily tesamorelin cut visceral fat by about 15 to 20%.source
Studied in humansLean mass kept or gained: A 2026 meta-analysis of 5 trials found lean mass rose by 1.42 kg.source
Studied in humansBlood lipids: Triglycerides fell by about 50 mg/dL and the total-to-HDL cholesterol ratio improved in the HIV trials.source
Studied in humansLiver fat: In people with HIV and fatty liver disease, liver fat fell by 37% and fewer showed fibrosis progression.source
Studied in humansNatural GH rhythm: Because the pituitary still controls release, GH keeps its pulse pattern rather than staying at a constant level, as described on its label.source
Studied in humansThinking skills: In one 20-week trial in older adults with and without mild cognitive impairment, executive function improved. In a 2025 trial in people with HIV, the difference in cognition was not significant.source
Studied in humansRecovery, collagen and joints: Described by users and inferred from higher GH and IGF-1igf-1A growth factor the liver makes in response to growth hormone. Blood tests use it to track growth-hormone activity.; not measured in trials.
Reported by usersMix and measure: a 10 mg vial
Go deeper
How it works, in plain words
Stage one is GH release. Tesamorelin binds GHRH receptors on the GH-producing cells of the pituitary, so the body releases its own growth hormone. The natural pulse pattern and the somatostatin brake stay in place.
What did the study measure?
No single study is featured for Tesamorelin; the human trials are linked from the uses above.
Sources
Side effects and who should avoid it
Side effects and limits, stated plainly. If anything here applies to you, talk to a doctor first.