Tesamorelin Dosage Guide
FDA-approved GHRH analog for visceral fat reduction — 2 mg daily protocol, reconstitution, injection technique, stacking with Ipamorelin, cycling, and safety.
In This Guide
What Is Tesamorelin?
Tesamorelin (brand name Egrifta) is a synthetic analog of growth hormone-releasing hormone (GHRH), consisting of the full 44 amino acids of human GHRH(1–44) with a trans-3-hexenoic acid modification at the N-terminal. This modification improves metabolic stability and resistance to enzymatic degradation compared to native GHRH. Tesamorelin received FDA approval in 2010 for the reduction of excess abdominal fat (lipodystrophy) in HIV-infected patients with lipodystrophy.
Unlike exogenous human growth hormone (HGH), Tesamorelin stimulates the pituitary gland to release GH in its natural pulsatile pattern, preserving the somatostatin negative feedback loop. This means the body's built-in brake on GH secretion remains active, reducing the risk of supraphysiological GH and IGF-1 levels. Clinical trials have demonstrated a 15–18% reduction in visceral adipose tissue over 26 weeks, with additional data from the STAY study (Stanley et al., 2019) suggesting potential cognitive benefits in HIV-positive older adults.
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Key Characteristics:
- GHRH analog (44 amino acids) — full-length human GHRH(1–44) with a trans-3-hexenoic acid N-terminal modification for improved metabolic stability
- FDA-approved (2010) — the only GHRH analog with FDA approval; indicated for HIV-associated lipodystrophy (brand name Egrifta / Egrifta SV)
- Pulsatile GH release — stimulates the pituitary to release GH in natural pulses, unlike exogenous HGH which delivers a constant dose and suppresses endogenous production
- Preserves feedback loop — somatostatin brake remains active, preventing GH overshoot and reducing the risk of side effects associated with supraphysiological GH levels
- Visceral fat specificity — clinical trials showed 15–18% reduction in visceral adipose tissue (VAT) by CT imaging over 26 weeks, with minimal effect on subcutaneous fat
- Cognitive potential — the STAY study (Stanley et al., 2019) demonstrated preservation of cognitive function in HIV-positive older adults over 12 months of Tesamorelin treatment
For a complete overview of its mechanism and research, see our full Tesamorelin profile. New to peptides? Start with the Beginner's Guide to Peptides.
How Tesamorelin Dosage Is Determined
Tesamorelin dosing is uniquely well-established among GH-related peptides because it has undergone the full FDA drug approval process. The 2 mg daily dose was selected from Phase II dose-ranging studies and confirmed in multiple Phase III randomized controlled trials (RCTs) involving over 800 patients. This stands in sharp contrast to most research peptides, whose dosing protocols are derived from animal studies and community experience.
Phase II Dose-Ranging
Phase II studies evaluated multiple doses of Tesamorelin to identify the optimal balance of efficacy and safety. The 2 mg daily subcutaneous dose emerged as the most effective for visceral fat reduction without a proportional increase in adverse events compared to lower doses. This dose was selected for confirmatory Phase III trials.
Phase III Randomized Controlled Trials
Falutz et al. (2007) and the subsequent confirmatory trial (Falutz et al., 2010) enrolled over 800 HIV-positive patients with lipodystrophy. Participants received Tesamorelin 2 mg SubQ daily or placebo for 26 weeks. The primary endpoint — change in visceral adipose tissue (VAT) by CT scan — showed a statistically significant 15–18% reduction in the Tesamorelin group versus placebo.
STAY Study (Cognitive Function)
Stanley et al. (2019) conducted the STAY study, a 12-month RCT in HIV-positive older adults. Participants received Tesamorelin 2 mg daily for 12 months. The study demonstrated preservation of cognitive function in the Tesamorelin group compared to decline in the placebo group. This remains the longest published RCT for Tesamorelin.
Extension & Long-Term Data
The Fourman et al. (2020) analysis examined extended Tesamorelin use beyond 26 weeks, with some patients treated for up to 52 weeks. Visceral fat reduction was maintained with continued use. Upon discontinuation, visceral fat tended to reaccumulate over several months, supporting the rationale for extended or cyclical protocols.
Standard Tesamorelin Dosage
Tesamorelin uses a fixed 2 mg daily dose regardless of body weight, sex, or severity of condition. This simplifies dosing compared to weight-based peptide protocols. The table below summarizes the FDA-approved dose alongside commonly used off-label variations.
| Protocol | Dose | Frequency | Notes |
|---|---|---|---|
| FDA-Approved (Egrifta) | 2 mg SubQ | Once daily | Phase III trial dose; fixed regardless of body weight; 26-week primary endpoint |
| Standard Off-Label | 2 mg SubQ | Once daily | Same dose used off-label for body composition and anti-aging; evening injection preferred |
| Conservative | 1 mg SubQ | Once daily | Lower dose used by some practitioners; less clinical data at this dose |
| 5-on / 2-off (Community) | 2 mg SubQ | 5 days per week, 2 days off | Community-derived protocol to extend vial use and reduce cost; not studied in clinical trials |
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Calculate Your Tesamorelin Dose
Tesamorelin is supplied as a lyophilized (freeze-dried) powder in vials of various sizes. You reconstitute it with diluent, then draw your dose using an insulin syringe. The concentration depends on the vial size and how much diluent you add. Egrifta kits include two vials per dose (peptide vial + sterile water diluent vial).
Worked Example:
- Vial size: 2 mg of Tesamorelin
- Diluent added: 2 mL
- Concentration: 2 mg ÷ 2 mL = 1 mg per mL
- Target dose: 2 mg (full vial)
- Volume to draw: 2 mg ÷ 1 mg/mL = 2 mL = the entire reconstituted vial (one full dose)
Quick Reference — 2 mg Vial
| Diluent Added | Concentration | 2 mg Dose | 1 mg Dose |
|---|---|---|---|
| 1 mL | 2 mg/mL | 100 units (1 mL) — full vial | 50 units (0.5 mL) |
| 2 mL | 1 mg/mL | 200 units (2 mL) — full vial | 100 units (1 mL) |
Quick Reference — 5 mg Vial (Compounding)
| Bac Water Added | Concentration | 2 mg Dose | Doses per Vial |
|---|---|---|---|
| 1 mL | 5 mg/mL | 40 units (0.4 mL) | 2.5 doses |
| 2 mL | 2.5 mg/mL | 80 units (0.8 mL) | 2.5 doses |
| 2.5 mL | 2 mg/mL | 100 units (1 mL) | 2.5 doses |
Quick Reference — 10 mg Vial (Compounding)
| Bac Water Added | Concentration | 2 mg Dose | Doses per Vial |
|---|---|---|---|
| 2 mL | 5 mg/mL | 40 units (0.4 mL) | 5 doses |
| 4 mL | 2.5 mg/mL | 80 units (0.8 mL) | 5 doses |
| 5 mL | 2 mg/mL | 100 units (1 mL) | 5 doses |
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How to Reconstitute Tesamorelin
Tesamorelin comes as a lyophilized (freeze-dried) powder that must be reconstituted before injection. The diluent depends on the product: Egrifta includes its own sterile water for injection (no preservative), while compounding pharmacy vials are typically reconstituted with bacteriostatic water (BAC water) for multi-dose use.
Supplies Needed:
- Tesamorelin lyophilized vial (2 mg Egrifta or compounding vial)
- Diluent — sterile water for injection (Egrifta kit) or bacteriostatic water (compounding vials)
- Insulin syringes (29–31 gauge, 0.5 mL or 1 mL) for injection
- Alcohol swabs (70% isopropyl alcohol)
- Clean, flat workspace
- Optional: larger syringe (1–3 mL) for drawing diluent if using a separate drawing needle
Steps
Wash Hands & Prepare Workspace
Wash hands thoroughly with soap and water. Lay out supplies on a clean surface: Tesamorelin vial, diluent (sterile water for Egrifta or bacteriostatic water for compounding vials), insulin syringe, and alcohol swabs.
Remove the Vial Caps
Flip off the plastic caps from both the Tesamorelin vial and the diluent vial. Swab both rubber stoppers with alcohol pads and let them air-dry for 10–15 seconds.
Draw Diluent
Using a fresh insulin syringe, draw the appropriate volume of diluent. For Egrifta, use the provided sterile water diluent. For compounding vials, use bacteriostatic water (BAC water). Standard reconstitution: 2 mL per 2 mg vial yields 1 mg/mL.
Add Diluent to the Peptide Calculator Vial
Insert the needle into the Tesamorelin vial through the rubber stopper. Angle the needle so the water runs down the inside glass wall — never squirt directly onto the powder cake. Release the plunger slowly.
Dissolve Gently
Remove the syringe. Let the vial sit for 1–2 minutes, then gently swirl or roll between your palms until the powder is fully dissolved. The solution should be clear and colorless. Never shake.
Label & Store Appropriately
Write the reconstitution date and concentration on the vial. Egrifta (sterile water): use within 24 hours, refrigerated. Compounding vials (BAC water): store refrigerated at 2–8°C, use within 3–4 weeks.
Storage
- Unreconstituted (powder): Store refrigerated at 2–8°C; protect from light. Egrifta kits should be stored refrigerated until use.
- Reconstituted with sterile water (Egrifta): Use immediately or within 24 hours refrigerated. No preservative — single-use only.
- Reconstituted with bacteriostatic water (compounding): Store refrigerated at 2–8°C; use within 3–4 weeks.
- Do not freeze: Freezing reconstituted Tesamorelin can damage the peptide structure through ice crystal formation.
- Protect from light and heat — keep the vial in its box or wrapped in foil, away from direct sunlight and temperatures above 25°C.
For a detailed visual walkthrough, see our Reconstitution Guide.
Tesamorelin Dosage by Goal
While Tesamorelin's fixed 2 mg dose remains the same regardless of goal, the protocol duration, timing, and monitoring approach varies by the primary objective.
Visceral Fat Reduction (FDA Indication)
The primary FDA-approved use. Tesamorelin has demonstrated a 15–18% reduction in visceral adipose tissue (VAT) over 26 weeks in Phase III clinical trials. Visceral fat is the metabolically dangerous fat surrounding internal organs, associated with cardiovascular disease, insulin resistance, and metabolic syndrome.
- Dose: 2 mg SubQ daily
- Duration: 26 weeks minimum (per clinical trial primary endpoint)
- Monitoring: CT scan or DEXA at baseline and 26 weeks to quantify VAT change; IGF-1 at baseline, 8 weeks, and 26 weeks
- Timing: Evening or bedtime injection preferred; fasted 1–2 hours
Body Composition & Anti-Aging
The most common off-label application. Users seek the body composition benefits of elevated GH (reduced body fat, improved lean mass, better skin quality, enhanced recovery) through Tesamorelin's pulsatile GH stimulation. The pulsatile release pattern is considered safer long-term than exogenous HGH.
- Dose: 2 mg SubQ daily
- Timing: Evening or bedtime (to synergize with the natural nocturnal GH pulse); fasted 1–2 hours
- Duration: 12–26 weeks, followed by a break (see Cycling)
- Monitoring: IGF-1 at baseline and 8–12 weeks; fasting glucose; body composition assessment
Cognitive Support
Based on the STAY study (Stanley et al., 2019), Tesamorelin showed preservation of cognitive function in HIV-positive older adults over 12 months. This is an emerging area of research and the data is currently limited to the HIV-positive population.
- Dose: 2 mg SubQ daily
- Duration: 12 months continuous (per STAY study protocol)
- Monitoring: IGF-1, fasting glucose, HbA1c; cognitive assessment at baseline and 6–12 months
- Note: Study population was HIV-positive older adults. Cognitive benefits may not generalize to HIV-negative populations. More research is needed.
Tesamorelin Injection Guide
Subcutaneous (SubQ) Injection — Step by Step
Wash Hands
Wash hands thoroughly with soap and water. Prepare a clean workspace with your syringe, alcohol swab, and reconstituted Tesamorelin vial.
Swab the Vial Stopper
Wipe the rubber stopper of the Tesamorelin vial with an alcohol swab. Let it air-dry for 10–15 seconds.
Draw Your Dose
Pull back the plunger to draw air equal to your dose volume. Insert the needle into the vial, push in the air, invert the vial, and slowly draw out your calculated dose (typically the full vial for a 2 mg dose from a 2 mg vial). Tap out any air bubbles.
Choose the Injection Site
The FDA-approved injection site for Tesamorelin is the abdomen. Choose a spot on the lower abdomen, at least 2–3 inches from the navel. Avoid scar tissue, bruises, or areas with visible blood vessels.
Clean the Injection Site
Swab the chosen injection site with a fresh alcohol pad. Allow to air-dry completely before injecting.
Inject
Pinch a fold of skin between your thumb and forefinger. Insert the needle at a 45-degree angle into the pinched skin fold. Push the plunger slowly and steadily. Withdraw the needle and apply light pressure with the alcohol swab if needed.
Dispose Safely
Place the used syringe immediately into a sharps container. Never recap or reuse needles.
Optimal Injection Timing
- Evening / bedtime preferred: Tesamorelin's GH pulse synergizes with the natural nocturnal GH surge that occurs during slow-wave sleep, potentially amplifying the total GH response.
- Fasted state (1–2 hours after eating): Food intake — particularly carbohydrates and fats — stimulates insulin and somatostatin release, both of which blunt GH secretion. Injecting in a fasted state maximizes the GH pulse.
- Consistency: Inject at approximately the same time each day. Tesamorelin's benefits are cumulative and depend on daily GH pulsing.
Site Rotation
- Rotate injection sites within the abdominal area to prevent lipodystrophy (localized fat loss or skin changes) at any single injection point.
- Alternate between left and right sides of the abdomen, above and below the navel line.
- Avoid the navel area — stay at least 2–3 inches away from the belly button.
Tesamorelin Cycle Duration & Timing
Tesamorelin's clinical trials used 26-week and 52-week treatment periods. Visceral fat tends to reaccumulate after discontinuation, which has led to extended and cyclical dosing protocols. Unlike some peptides, Tesamorelin does not appear to produce tachyphylaxis (rapid tolerance), but pituitary responsiveness may vary over time.
| Protocol | Duration | Frequency | Notes |
|---|---|---|---|
| Standard (FDA trial) | 26 weeks | Daily | Phase III primary endpoint; significant VAT reduction demonstrated |
| Extended | 52 weeks | Daily | Extension studies showed maintained benefit with continued use; longest studied duration |
| Cyclical | 26 weeks on, 8–12 weeks off, repeat | Daily during on-phase | Allows pituitary recovery and cost management; reassess with IGF-1 during off-phase |
| 5-on / 2-off weekly | Ongoing | 5 days per week | Community-derived; reduces cost by ~30%; not studied in clinical trials |
| Cognitive (STAY study) | 12 months continuous | Daily | Per the STAY study protocol; longest RCT data; HIV-positive population |
Post-Cycle Considerations
- Fat reaccumulation: Visceral fat tends to return after discontinuation. Extension studies show maintained reduction with continued use but partial reaccumulation after stopping.
- IGF-1 normalization: IGF-1 levels return to baseline within weeks of stopping Tesamorelin. There is no prolonged suppression of endogenous GH (unlike exogenous HGH).
- Monitoring during off-phase: Check IGF-1, fasting glucose, and body composition during the break to assess baseline recovery and decide whether to restart.
- No PCT required: Unlike exogenous HGH, Tesamorelin does not suppress the pituitary. No post-cycle therapy is needed after discontinuation.
Tesamorelin Stacking Protocols
Tesamorelin is frequently combined with other peptides to amplify the GH response or target complementary pathways. The most effective stacks leverage GHRH + GHRP synergy or combine GH-mediated effects with direct lipolysis or tissue repair.
Tesamorelin + Ipamorelin — GHRH + GHRP Synergy (Gold Standard)
The combination of a GHRH analog (Tesamorelin) with a ghrelin mimetic / GHRP (Ipamorelin) is considered the gold standard for peptide-based GH optimization. Tesamorelin provides the “signal” for GH release from the pituitary, while Ipamorelin amplifies the pulse by acting on the ghrelin receptor (GHS-R1a). The two peptides activate separate receptor pathways, producing a synergistic GH response that is significantly greater than either peptide alone.
| Compound | Dose | Frequency | Purpose |
|---|---|---|---|
| Tesamorelin | 2 mg SubQ | Once daily (evening / bedtime) | GHRH signal for pituitary GH release; pulsatile, preserves feedback |
| Ipamorelin | 200–300 mcg SubQ | Once daily (bedtime, same time as Tesamorelin) | GHRP amplification via ghrelin receptor; minimal cortisol or prolactin elevation |
Tesamorelin + AOD-9604 (GH-Mediated + Direct Lipolysis)
AOD-9604 is a modified fragment of HGH (amino acids 176–191) that promotes lipolysis without the full growth-promoting effects of GH. Pairing Tesamorelin's GH-mediated visceral fat reduction with AOD-9604's direct lipolytic action targets fat loss through two independent mechanisms.
| Compound | Dose | Frequency | Purpose |
|---|---|---|---|
| Tesamorelin | 2 mg SubQ | Once daily (evening / bedtime) | GH-mediated visceral fat reduction, metabolic improvement |
| AOD-9604 | 300 mcg SubQ | Once daily (morning, fasted) | Direct lipolysis via HGH fragment mechanism; no IGF-1 elevation |
AOD-9604 is typically injected in the morning on an empty stomach, while Tesamorelin is injected in the evening. This separates the two lipolytic signals across the day. AOD-9604 does not elevate IGF-1, so it does not compound the cancer-screening concern associated with GH elevation.
Tesamorelin + BPC-157 (GH Optimization + Tissue Repair)
BPC-157 promotes localized tissue repair, angiogenesis, and growth factor expression. Pairing it with Tesamorelin's GH elevation provides systemic growth hormone support alongside targeted injury healing. This is a common combination for users seeking both body composition benefits and accelerated recovery from injuries.
| Compound | Dose | Frequency | Purpose |
|---|---|---|---|
| Tesamorelin | 2 mg SubQ | Once daily (evening / bedtime) | Systemic GH elevation, body composition, recovery support |
| BPC-157 | 250 mcg SubQ | Once or twice daily (near injury site) | Localized tissue repair, angiogenesis, growth factor upregulation |
BPC-157 can be injected at any time of day and near the injury site, while Tesamorelin is injected at bedtime in the abdomen. The two work through entirely different mechanisms and do not interfere with each other.
Explore more combinations with our Peptide Stack Builder or browse the Top 10 Peptide Stacks guide.
Safety, Side Effects & Contraindications
Advantage Over Exogenous HGH
Tesamorelin's pulsatile GH release preserves the somatostatin feedback loop, meaning the body's natural brake on GH remains active. This is a key safety advantage over exogenous HGH, which delivers a constant dose that bypasses the pituitary and suppresses endogenous production. The result is a lower risk of supraphysiological GH and IGF-1 levels with Tesamorelin.
Common Side Effects (from Phase III Trials)
Observed in clinical trials:
- Injection site reactions (erythema, pruritus, pain, irritation) — ~13% of patients
- Arthralgia (joint pain) — ~13%
- Peripheral edema (fluid retention, swelling) — less common
- Myalgia (muscle pain) — less common
Less Common Side Effects
- Hyperglycemia / insulin resistance — GH has anti-insulin effects; monitor fasting glucose and HbA1c
- Carpal tunnel syndrome — related to fluid retention from elevated GH; usually resolves with dose adjustment or discontinuation
- Paresthesia (tingling, numbness) — related to fluid retention
- Nausea — mild, usually resolves within the first few weeks
Contraindications
- Active malignancy — FDA-labeled contraindication. GH and IGF-1 promote cell growth and could theoretically support tumor progression.
- Disrupted hypothalamic-pituitary axis — Tesamorelin requires a functioning pituitary to produce GH. Conditions such as hypophysectomy, pituitary surgery, or pituitary tumors/radiation impair the response.
- Pregnancy (Category X) — Tesamorelin is contraindicated in pregnancy. It may cause fetal harm based on its mechanism of action.
- Hypersensitivity — known allergy to Tesamorelin or any component of the formulation (including mannitol in Egrifta).
- Uncontrolled diabetes — GH has anti-insulin effects. Tesamorelin may worsen glycemic control in patients with poorly managed diabetes.
Monitoring
- IGF-1 (primary): At baseline, 8 weeks, and 26 weeks. Target: upper normal range for age. If IGF-1 exceeds the normal range, consider dose reduction or discontinuation.
- Fasting glucose & HbA1c: At baseline and periodically during treatment. GH has anti-insulin effects and may elevate blood glucose.
- Cancer screening: Age-appropriate screening before starting (PSA, mammography, colonoscopy). Repeat as clinically indicated during treatment.
- Thyroid panel: GH can affect thyroid hormone metabolism. Monitor TSH and free T4, especially if symptoms of hypothyroidism develop.
- Lipid panel: Tesamorelin has shown improvements in lipid profiles (reduced triglycerides, improved HDL) in some trials. Monitor for beneficial changes.
Drug Interactions
- Insulin & oral hypoglycemics: GH has anti-insulin effects. Dose adjustments of diabetes medications may be needed. Monitor glucose closely.
- Corticosteroids: Chronic corticosteroid use can blunt the GH response. Discuss with your provider if taking prednisone or similar medications.
- Thyroid medications (levothyroxine): GH may increase conversion of T4 to T3. Thyroid medication dose adjustments may be needed.
- Exogenous HGH: Do not combine with Tesamorelin. HGH suppresses pituitary GH production via negative feedback, directly counteracting Tesamorelin's mechanism.
- Somatostatin analogs (octreotide, lanreotide): These directly antagonize GH release and will negate Tesamorelin's effect.
Common Tesamorelin Dosing Mistakes
Avoid these common errors to get the most out of your Tesamorelin protocol:
Frequently Asked Questions
Key Takeaways
- Tesamorelin is the only FDA-approved GHRH analog — it has the strongest clinical evidence base of any GH-related peptide, with Phase III RCT data from over 800 patients
- Fixed dose: 2 mg SubQ once daily — no weight-based adjustment needed; the same dose for all patients
- Pulsatile GH release — stimulates the pituitary naturally, preserving the somatostatin feedback loop; safer than exogenous HGH
- 15–18% visceral fat reduction over 26 weeks in clinical trials; specific to visceral (not subcutaneous) fat
- Inject at bedtime, fasted — 1–2 hours after last meal to maximize the GH response; synergizes with natural nocturnal GH pulse
- Top stack: Tesamorelin + Ipamorelin (GHRH + GHRP synergy) is the gold standard for peptide-based GH optimization
- Cancer screening required before starting — GH and IGF-1 promote cell growth; active malignancy is an FDA-labeled contraindication
- Monitor IGF-1 at baseline, 8 weeks, and 26 weeks; also track fasting glucose, HbA1c, thyroid panel, and lipids
- Egrifta (sterile water) must be used within 24 hours after reconstitution; compounding vials with BAC water last 3–4 weeks refrigerated
- Do not combine with exogenous HGH — HGH suppresses pituitary function, directly counteracting Tesamorelin's mechanism
This article is for educational and informational purposes only. See our Disclaimer.
References
- Falutz J, et al. “Effects of tesamorelin (TH9507), a growth hormone-releasing factor analog, on visceral fat reduction in HIV-infected patients.” N Engl J Med. 2007;357:2359-2370. PubMed
- Falutz J, et al. “Metabolic effects of a growth hormone-releasing factor in patients with HIV.” J Clin Endocrinol Metab. 2010;95(9):4291-4304. PubMed
- Stanley TL, et al. “Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation.” JAMA. 2014;312(4):380-389. PubMed
- Fourman LT, et al. “Clinical predictors of liver fibrosis presence and progression in HIV-associated NAFLD.” Gastroenterology. 2020;159(3):989-991. PubMed
- Stanley TL, et al. “Effects of tesamorelin on neuropsychological function and brain MRI markers in HIV-infected older adults.” AIDS. 2019;33(7):1179-1188.
- Dhillon S. “Tesamorelin: a review of its use in the management of HIV-associated lipodystrophy.” Drugs. 2011;71(8):1071-1091. PubMed
- Bowers CY. “Growth hormone-releasing peptide (GHRP).” Cell Mol Life Sci. 1998;54(12):1316-1329. PubMed
- Egrifta SV (tesamorelin for injection) prescribing information. Theratechnologies Inc.
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