Tesamorelin
Also known as Egrifta, Egrifta SV, Egrifta WR, TH9507
Tesamorelin is a stabilized growth hormone releasing hormone analog approved as Egrifta to reduce belly fat in people with HIV-related lipodystrophy. It is the GHRH analog with the strongest human evidence, and people use it off-label for visceral fat loss and general growth hormone support.
Reviewed by the amino101 editorial team. , first published .
Quick start
What people commonly do. Not a prescription.- Typical dose
- 1 to 2 mg
- How often
- once daily
- Where
- Subcutaneous, abdomen, rotate sites and avoid the navel and any scar tissue
- Timing
- Bedtime on an empty stomach is most common; the label allows any time of day
- Effects timeline
- IGF-1 rise 2 to 4 weeks, waist and visceral fat change 12 to 26 weeks
- Storage
- Lyophilized in fridge or freezer away from light; reconstituted in fridge 2 to 8 C, use within 4 weeks
- Cycle length
- ongoing; reassess at 3 to 6 months with IGF-1 and waist measurements
- Break between
- no planned break; visceral fat returns within months of stopping
Overview
Tesamorelin is the full 44 amino acid human GHRH sequence with a trans-3-hexenoic acid group attached to the N-terminus. That small modification protects it from DPP-IV cleavage and roughly doubles its stability in blood compared to native GHRH. It was developed by Theratechnologies and approved by the FDA in 2010 under the brand name Egrifta for reducing excess abdominal fat in HIV patients with lipodystrophy. Newer formulations (Egrifta SV and Egrifta WR) deliver the same drug with a more concentrated solution and a simpler reconstitution.
The approval rests on two large placebo controlled Phase 3 trials with over 800 participants. Daily 2 mg injections reduced visceral adipose tissue by about 15 to 18 percent over 26 weeks, with modest improvements in triglycerides and patient reported body image. The fat came back when the drug was stopped. IGF-1 rose into the upper normal range, and glucose metabolism was largely unchanged, though the label warns to monitor it. Later studies looked at liver fat in people with nonalcoholic fatty liver disease and found reductions in hepatic fat and slowed fibrosis progression.
For people outside the HIV context, tesamorelin is attractive because its efficacy is documented in real trials rather than inferred from mechanism. A trial in older adults with and without mild cognitive impairment reported improved executive function, which has fueled interest in it as a cognitive aid, but that finding has not been replicated at scale. The main practical limitations are cost and the fact that the visceral fat loss is moderate and requires ongoing use.
How it works
Tesamorelin activates the GHRH receptor on pituitary somatotrophs, prompting synthesis and pulsatile release of growth hormone. Elevated growth hormone increases lipolysis in adipose tissue, with visceral fat being especially responsive, and drives hepatic IGF-1 production. Because it works through the pituitary rather than replacing growth hormone directly, the negative feedback loop stays intact, which is why IGF-1 rises but rarely overshoots into the range seen with exogenous growth hormone. The N-terminal modification slows enzymatic degradation, giving each injection a longer window of receptor activity than native GHRH.
Where the research stands
Visceral fat reductionStrong evidence
- HIV-associated lipodystrophy. Two Phase 3 RCTs with over 800 participants showed about 15 to 18 percent visceral fat reduction over 26 weeks; this is the approved use.
- Abdominal fat in people without HIV. Smaller studies point the same direction but the large trials were all in HIV lipodystrophy.
Growth hormone and IGF-1 supportStrong evidence
- IGF-1 increase with preserved pulsatility. Human trials show IGF-1 rising into the upper normal range while growth hormone stays pulsatile.
Liver fatModerate evidence
- Nonalcoholic fatty liver disease in HIV. A 12 month RCT found reduced hepatic fat and slower fibrosis progression.
CognitionEmerging
- Executive function in older adults. A 20 week RCT in healthy older adults and those with mild cognitive impairment reported improved executive function; not replicated at scale.
LipidsModerate evidence
- Triglycerides. Modest triglyceride reductions were seen alongside fat loss in the Phase 3 trials.
- human RCTDaily 2 mg tesamorelin reduced visceral adipose tissue by roughly 15-18 percent over 26 weeks in HIV lipodystrophy versus placebo.
- human RCTTesamorelin reduced liver fat and slowed progression of fibrosis in HIV patients with nonalcoholic fatty liver disease over 12 months.
- human RCTIn healthy older adults and those with mild cognitive impairment, 20 weeks of tesamorelin improved executive function scores.
- human RCTVisceral fat returned toward baseline within 6 months of discontinuing treatment.
- human pilotTesamorelin increased IGF-1 while preserving pulsatile growth hormone secretion in healthy volunteers.
Rodent and in vitro mean no human data for that finding. Human pilot means small, often uncontrolled. Human RCT means randomized and controlled. Clinical means an approved drug with regulatory data.
Levels over time
Modeled from the half-life. Illustrative, not measured.A half-life of 30 min against dosing every 24 h means each dose has cleared before the next. Nothing stacks; you start from zero every time, and the tissue effect is what carries over.
The N-terminal modification roughly doubles the stability of native GHRH but it is still a short acting pulse generator, so it is dosed once daily and the fat loss depends on continuing to dose.
Tesamorelin dosage and protocols
The approved regimen is continuous daily use with no loading or taper, and the benefit reverses when it stops, so most people run it for at least 6 months and then decide based on bloodwork and waist measurements. There is no trial data on intermittent cycling.
| Goal | Dose | Frequency | Route |
|---|---|---|---|
| Approved dose | 2 mg | once daily | Subcutaneous, abdomen |
| Reduced dose for cost or side effects | 1 mg | once daily | Subcutaneous, abdomen |
| Stacked with a GHRP | 1 to 2 mg | once daily before bed, with 100 mcg ipamorelin | Subcutaneous |
| Maintenance after fat loss | 1 mg | once daily, or 2 mg on alternating days | Subcutaneous, abdomen |
Bedtime on an empty stomach gives the biggest pulse because it coincides with low somatostatin and the natural sleep surge, but the trials dosed at any time and still worked. Avoid eating for 30 minutes after. Rotate abdominal sites, since irritation and bruising are the most common complaints.
2 mg daily is the approved dose; some community protocols use 1 mg to reduce cost or side effects
Dose calculator
U-100 insulin syringeUnits are a volume on the syringe, not an amount of peptide. Concentration changes every time you change the water volume. The standalone calculator explains the math.
| Vial | Suggested water | Concentration | Low dose draw |
|---|---|---|---|
| 5 mg | 1 mL | 5 mg/mL | 20 units |
| 10 mg | 2 mL | 5 mg/mL | 20 units |
| 20 mg | 3 mL | 6.667 mg/mL | 15 units |
How to reconstitute Tesamorelin
- 1
Wash your hands and wipe the work surface. Swab both vial stoppers with alcohol and let them dry.
- 2
Pick the water volume with the calculator above and write it on the vial. The concentration means nothing without it.
- 3
Draw the bacteriostatic water into a mixing syringe.
- 4
Insert at an angle and let the water run down the inside wall. Never squirt it straight onto the powder.
- 5
Swirl gently or leave it to dissolve. Do not shake.
- 6
Label with the date and water volume. Store in the fridge at 2 to 8 C and use within about 4 weeks.
- 7
Unmixed vials keep for months in the fridge and longer in the freezer, sealed and out of light.
- Full walkthrough with syringe reading and site rotation: reconstitution guide.
- ✓White, fluffy cake
Lyophilized powder should look like a small white puck or fluffy cake at the bottom of the vial. That is a proper freeze-dry.
- ✓Clear after mixing
Once dissolved the solution should be water-clear with nothing floating in it.
- !Slight clumping
Small clumps that dissolve with gentle swirling are fine. Shipping compacts powder.
- ✕Collapsed or melted
Powder stuck to the sides, glassy, or shrunken means it got hot in transit. Contact the vendor.
- ✕Cloudy or particles
Persistent cloudiness or visible particles after mixing means degraded or contaminated product. Do not use it.
- Week 1 to 2
Injection site redness or itching, occasional joint stiffness or puffy hands, sleep often deeper.
- Week 2 to 6
IGF-1 rises into the upper normal range on bloodwork, early fluid retention usually settles.
- Week 6 to 12
Waist may begin to shrink by a centimeter or two, energy and recovery improve for some.
- Month 3 to 6
Visceral fat loss in the 10 to 20 percent range if the response matches the trials; subcutaneous fat changes little.
Interactions and stacking
Ipamorelinsynergistic
Adds GHRP driven synergy on the ghrelin receptor for a larger nightly pulse.
CJC-1295 (no DAC)caution
Same receptor; stacking adds little and people generally alternate rather than combine.
HGHcaution
Exogenous growth hormone suppresses the pituitary that tesamorelin relies on.
IGF-1 LR3caution
Compounds IGF-1 exposure and the associated glucose and cell growth concerns.
Semaglutide, tirzepatide, retatrutidecompatible
Different mechanisms for fat loss with no known pharmacokinetic conflict; visceral fat loss may be additive.
Insulin and diabetes medicationscaution
Tesamorelin can raise blood glucose in susceptible people; the label calls for glucose monitoring.
Corticosteroidscaution
Glucocorticoids blunt the pituitary response to GHRH.
Drugs cleared by liver enzymes (CYP450)caution
Growth hormone can alter CYP450 activity, so levels of narrow margin drugs such as anticonvulsants or cyclosporine may shift.
Safety
- ▲Injection site redness, itching, bruising, or irritation
- ▲Joint pain and stiffness
- ▲Swelling in the hands and feet, carpal tunnel symptoms
- ▲Elevated blood glucose in susceptible people
- ▲Headache or flushing
- ▲Muscle aches
- ▲Injection site redness, itching, and bruising are the most common complaints; rotate sites.
- ▲Joint pain, swelling in the hands and feet, and carpal tunnel symptoms can occur from fluid retention.
- ▲Can raise blood glucose in susceptible people; check fasting glucose and HbA1c periodically.
- ▲Contraindicated in active malignancy, pregnancy, and anyone with a disrupted hypothalamic-pituitary axis from surgery or radiation.
- ▲Fat loss is real but moderate and reverses when you stop; it is not a substitute for diet.
- ■Fasting glucose or HbA1c rises meaningfully, especially with existing prediabetes
- ■Persistent carpal tunnel symptoms or joint swelling that do not ease at 1 mg
- ■IGF-1 climbs above the reference range and stays there
- ■Any new lump, growth, or cancer diagnosis
- ■Pregnancy, or a serious allergic reaction at the injection site
Community poll
Self-reported by visitors. Not clinical evidence.Tesamorelin: frequently asked
Is tesamorelin the same as growth hormone?
No. It tells your pituitary to make more of your own growth hormone rather than supplying it from outside. That keeps the body's feedback loop intact, which is why IGF-1 usually lands in the upper normal range rather than far above it.
How much fat can I expect to lose?
In the approval trials, people lost about 15 to 18 percent of their visceral fat over six months, which translated to a couple of centimeters off the waist. Subcutaneous fat changed very little. Results outside the HIV population are less documented but seem to follow the same pattern.
Does it need to be taken forever?
The fat that comes off returns within months of stopping, so most people either continue at a maintenance dose or accept that the effect is temporary. There is no data on intermittent cycling.
Can I take it if I have prediabetes?
Use caution. Growth hormone opposes insulin, and while the trials showed only small glucose changes, the label recommends monitoring. Anyone with impaired fasting glucose should be checking bloodwork regularly.
References
- Tesamorelin, a growth hormone-releasing factor analog, in HIV-infected patients with excess abdominal fat: pooled analysis of two Phase 3 trials. Journal of Acquired Immune Deficiency Syndromes, 2010
- Effects of tesamorelin on nonalcoholic fatty liver disease in HIV: a randomised, double-blind, multicentre trial. The Lancet HIV, 2019
- Growth hormone-releasing hormone effects on brain GABA levels in mild cognitive impairment and healthy aging. JAMA Neurology, 2014
- Egrifta (tesamorelin for injection) prescribing information. US Food and Drug Administration, 2010