Tesamorelin protocol
Tesamorelin dosing — the only FDA-approved GHRH analogue, daily SubQ injection, visceral fat data, off-label body comp use, and side effects.
Updated May 7, 2026 · 5 min read
Tesamorelin is the heavyweight of the GHRH-analogue class. It's the only GH secretagogue with substantial human clinical data behind it, and it's the only one with an FDA approval — for HIV-associated lipodystrophy, sold under the brand name Egrifta. Off-label, it's used for body composition, particularly stubborn visceral fat.
Quick reference
| Detail | Value |
|---|---|
| Class | GHRH analogue (modified, longer-acting than Sermorelin) |
| Half-life | About 30 minutes |
| Cadence | Once daily |
| Best timing | Pre-bed, empty stomach |
| Typical dose | 1–2 mg per day |
| FDA status | Approved for HIV-LD (Egrifta) |
| Common vials | 5 mg, 10 mg |
Why Tesamorelin is different
Sermorelin, CJC-1295, and Ipamorelin sit in a regulatory gray zone — sold as research chemicals, with limited human trial data outside small studies. Tesamorelin is in a different category. It went through real Phase III clinical trials, received FDA approval, and has a published efficacy and safety record in the population it was studied in.
The clinical record matters for two reasons:
- Visceral fat reduction is well-documented in the HIV-LD population. The mechanism — GH-axis activation driving lipolysis on visceral adipose — translates to non-HIV users in principle.
- Side effect profile is better-characterized than other GHRH analogues. You know what you're walking into.
The trade-off: Tesamorelin is more expensive than Sermorelin or CJC-1295, and the side effects are more pronounced because the GH/IGF-1 elevation is meaningfully larger.
Dosing
The FDA-approved dose for HIV-LD is 2 mg SubQ daily. Off-label users typically run 1–2 mg daily depending on tolerance and goals.
| Goal | Daily dose |
|---|---|
| Conservative entry | 1 mg |
| Standard off-label | 1.5–2 mg |
| Approved HIV-LD dose | 2 mg |
Going above 2 mg/day doesn't reliably improve outcomes — the pituitary's release ceiling caps the GH response. Users chasing more effect sometimes split the daily dose into two injections (1 mg morning + 1 mg pre-bed), though most published data is on once-daily pre-bed.
Timing
Pre-bed, empty stomach. Same logic as Sermorelin and Ipamorelin — your largest natural GH pulse occurs in early deep sleep, and the injection amplifies it. High blood glucose blunts the GH response, so eat at least two hours before injection.
The morning option (split dosing) is mostly for users who tolerate Tesamorelin well and want to spread the GH stimulus across the day. There's no strong evidence the split protocol outperforms once-daily pre-bed for body composition.
Reconstitution math
Tesamorelin commonly ships in 5 mg or 10 mg vials. The standard mix:
5 mg vial + 2 mL bacteriostatic water = 2.5 mg/mL.
A 2 mg dose → 0.8 mL → 80 units on a U-100 insulin syringe.
A 1 mg dose → 0.4 mL → 40 units.
For 10 mg vials, doubling to 4 mL BAC water keeps the same concentration. Use the reconstitution calculator for exact units.
Tesamorelin is somewhat more fragile than other GHRH analogues — keep reconstituted vials refrigerated, use within 2–3 weeks, and avoid shaking when mixing.
Cycling
Most off-label users run Tesamorelin in 12–26 week cycles. The visceral fat data shows continued improvement past 26 weeks, but most non-HIV users cycle off to give the GH axis a break and to reset IGF-1 levels.
A common cycle:
| Phase | Duration | Dose |
|---|---|---|
| Cycle | 12–16 weeks | 1.5–2 mg daily |
| Off | 4–8 weeks | None |
Bloodwork (IGF-1, fasting glucose, HbA1c) at baseline, mid-cycle, and end-cycle is sensible at this dosage tier. See IGF-1 testing on a GH peptide cycle.
What to expect
Tesamorelin effects build over weeks, not days:
- Weeks 1–3: improved sleep depth, vivid dreams, mild injection-site reactions
- Weeks 4–8: subjective recovery improvement, visible body composition shift starts
- Weeks 9–16: measurable visceral fat reduction, IGF-1 elevation visible on bloodwork
Tesamorelin is not a "feel" drug after each shot. The signal is in the mirror, the waist measurement, and bloodwork at week 12.
Side effects
More pronounced than Sermorelin, generally less than synthetic HGH:
| Effect | Frequency |
|---|---|
| Injection-site reactions (redness, irritation) | Common |
| Mild fluid retention | Common, transient |
| Joint or muscle aches | Occasional |
| Numbness or tingling in hands or feet | Occasional |
| Mild insulin sensitivity drop | Common at higher doses |
| Headache | Occasional |
Tesamorelin can shift fasting glucose and insulin sensitivity meaningfully — pre-diabetics and diabetics should be cautious or avoid it. The IGF-1 elevation also raises the same theoretical cancer concerns that apply to all GH-axis interventions; anyone with active or recent cancer should not run Tesamorelin without specialist input.
Deeper coverage: GH secretagogue side effects.
When Tesamorelin makes sense
- Users who've run Sermorelin or Ipa+CJC and want a stronger GH/IGF-1 signal
- Users targeting visceral fat specifically (the data is strongest here)
- Users who value the FDA-backed clinical record over research-chem alternatives
When it doesn't:
- First-time secretagogue users (start with Sermorelin or Ipa+CJC)
- Pre-diabetics or diabetics
- Anyone with active or recent cancer
- Budget-constrained users (Tesamorelin is the most expensive secretagogue per cycle)