Tesamorelin and Ipamorelin
Does adding ipamorelin to tesamorelin help with belly fat, or is tesamorelin enough on its own?
Reviewed by the amino101 editorial team. .
Also searched as Tesa Ipa, Tesamorelin ipamorelin blend, Egrifta ipamorelin stack.
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.
Ipamorelin is a pentapeptide that triggers growth hormone release through the ghrelin receptor without the cortisol, prolactin, or hunger spikes seen with older GHRPs. It is the most popular GHRP in the community, usually stacked with a GHRH analog.
Tesamorelin and ipamorelin are stacked for the same reason as CJC-1295 and ipamorelin: a GHRH analog plus a GHRP releases more growth hormone than either alone. The difference is the GHRH half. Tesamorelin is FDA approved as Egrifta for reducing visceral fat in HIV-associated lipodystrophy, with two phase 3 trials of over 800 people showing about 15 to 18 percent visceral fat loss over 26 weeks at 2 mg daily. That is the strongest human evidence of any growth hormone peptide. Ipamorelin has phase 1 and 2 data for growth hormone release and safety but no outcome trials. The combination has never been studied, and the tesamorelin trials ran it alone. Off-label use in people without HIV is extrapolation.
People reach for this stack when the goal is specifically belly fat rather than general growth hormone support, or when they want the GHRH analog with trial data behind it. The questions are whether the ipamorelin adds anything to the fat loss, how the two are dosed together, and how it compares to the cheaper CJC-1295 pairing. The tesamorelin vs ipamorelin page compares the compounds alone. This page is educational and not a treatment recommendation; tesamorelin is a prescription drug and ipamorelin is unapproved.
Why people combine Tesamorelin and Ipamorelin
Tesamorelin is the full 44 amino acid GHRH sequence with an N-terminal modification that roughly doubles its stability. Its visceral fat data comes from real placebo controlled trials, not mechanism. Later trials showed reduced liver fat and slower fibrosis in fatty liver disease over 12 months. If the goal is visceral fat, this is the GHRH analog to build on.
Ipamorelin acts on the ghrelin receptor, which both triggers release directly and lowers somatostatin tone. Combined with a GHRH analog the pulse is larger than the sum of the parts. The hope is that a bigger pulse means more lipolysis in visceral fat. That is plausible and unmeasured.
Both work through the pituitary rather than replacing growth hormone, so the body's negative feedback stays intact. In the tesamorelin trials IGF-1 rose into the upper normal range and stayed there, rather than overshooting the way exogenous growth hormone can. Ipamorelin at 100 mcg does not change that picture much, though total IGF-1 is still worth checking.
Ipamorelin has never been shown to add visceral fat loss on top of tesamorelin; the 15 to 18 percent figure was tesamorelin alone. The fat comes back within months of stopping either way. Neither compound touches subcutaneous fat much, and neither is a substitute for a calorie deficit. Someone expecting the ipamorelin to turn a moderate effect into a dramatic one will be disappointed.
Tesamorelin and Ipamorelin dosage and protocol
What appears in research and community protocols for each compound in the stack. Not a prescription.
| Peptide | Dosage | Frequency | Timing and route |
|---|---|---|---|
| Tesamorelin | 1 to 2 mg | once daily before bed | subcutaneous in the abdomen, rotating sites, on an empty stomach; 2 mg is the approved dose, 1 mg is used for cost or side effects |
| Ipamorelin | 100 mcg | once daily before bed, with the tesamorelin | subcutaneous at the same time, no food for 30 minutes after |
Tesamorelin is not cycled in its approved use; the trials ran 26 weeks and the fat returned within 6 months of stopping. People run the stack for at least 3 to 6 months and reassess with IGF-1 and waist measurements. Ipamorelin is conventionally run 8 to 16 weeks with a break, so some people keep tesamorelin continuous and cycle the ipamorelin on and off underneath it.
- •Bedtime fasted dosing gives the biggest pulse, but the tesamorelin trials dosed at any time and still worked. Fasting matters more for the ipamorelin half.
- •Injection site redness, itching and bruising are the most common tesamorelin complaints. Rotate abdominal sites and avoid the navel and scar tissue.
- •Fasting glucose and HbA1c at baseline and every few months. The tesamorelin label calls for glucose monitoring.
- •A maintenance phase at 1 mg daily or 2 mg on alternating days is what people use after the fat loss, since stopping reverses it.
Work out syringe units for any of these in the dosage calculator.
Can you mix Tesamorelin and Ipamorelin in one syringe?
The two are injected at the same time, and the compound pages describe pairing 1 to 2 mg of tesamorelin with 100 mcg of ipamorelin in one sitting; many people draw both into one syringe. Branded Egrifta comes as its own kit and is not meant to be mixed with anything, so the shared syringe approach applies to research grade vials reconstituted with bacteriostatic water. No stability data exists for the mixture, and no copper or pH concern either. Some vendors sell pre-mixed tesamorelin and ipamorelin blends at a ratio that gives roughly 1 to 2 mg of tesamorelin per 100 to 200 mcg of ipamorelin; the calculator helps check the vial math.
What to expect, week by week
- Week 1 to 2
Injection site redness or itching, flushing right after the dose, sometimes joint stiffness or puffy hands. Sleep is 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
The waist may shrink by a centimeter or two. Energy and recovery improve for some people.
- Month 3 to 6
Visceral fat loss in the 10 to 20 percent range if the response matches the tesamorelin trials. Subcutaneous fat changes little, and the stack does nothing visible for someone who is not also in a calorie deficit.
Side effects and cautions
- ▲Injection site redness, itching, bruising or irritation, the most common complaint in the tesamorelin trials
- ▲Joint pain and stiffness
- ▲Swelling in the hands and feet, carpal tunnel symptoms
- ▲Elevated blood glucose in susceptible people
- ▲Headache, flushing or a brief head rush after the dose
- ▲Muscle aches
- ▲Mild appetite increase from ipamorelin
- ■Active cancer, pregnancy, or a disrupted hypothalamic-pituitary axis from surgery or radiation. These are tesamorelin label contraindications.
- ■Prediabetes or diabetes. Growth hormone opposes insulin and both compounds can push fasting glucose up; this needs regular bloodwork and a clinician who knows about the stack.
- ■Anyone on drugs with a narrow margin cleared by liver enzymes, such as anticonvulsants or cyclosporine. Growth hormone can shift CYP450 activity.
- ■Anyone already on exogenous growth hormone, or on CJC-1295 of either type. Same receptor or suppressed pituitary, so stacking adds little but side effects.
Tesamorelin and ipamorelin is the growth hormone stack for someone whose main target is visceral fat and who wants the half of the stack with real trial data. Tesamorelin alone would do most of the work; the ipamorelin is a modest, cheap addition that makes the nightly pulse bigger and may help sleep, with no evidence it adds to the fat loss. That makes the honest version of this stack tesamorelin, plus ipamorelin if you want it. Someone whose goals are sleep, recovery or general growth hormone support is better served by CJC-1295 and ipamorelin at a fraction of the cost. Someone who only wants fat loss and does not care about growth hormone at all belongs on the weight loss page, because a GLP-1 drug moves total weight far more than any secretagogue moves visceral fat. Anyone with diabetes, a cancer history or a pituitary problem needs a clinician before touching it. Educational only.
Tesamorelin and Ipamorelin: frequently asked
Is tesamorelin better than CJC-1295 for stacking with ipamorelin?
For visceral fat, tesamorelin has the trial data and Mod GRF 1-29 has none. For general growth hormone support, sleep and recovery, the two GHRH analogs do similar things and Mod GRF 1-29 costs far less. The CJC-1295 and ipamorelin page covers the cheaper version.
What is the tesamorelin and ipamorelin dosage?
Reported protocols pair 1 to 2 mg of tesamorelin with 100 mcg of ipamorelin, once daily before bed on an empty stomach. The 2 mg tesamorelin figure is the approved Egrifta dose. People drop to 1 mg for cost or joint symptoms. The peptide dosage chart lists both.
How much belly fat does tesamorelin lose?
About 15 to 18 percent of visceral fat over 26 weeks in the approval trials, which worked out to a couple of centimeters off the waist. That was tesamorelin alone, in HIV lipodystrophy. Nobody has measured whether ipamorelin adds to it.
Can you take tesamorelin and ipamorelin with a GLP-1 drug?
The tesamorelin page lists semaglutide and tirzepatide as compatible with no known conflict, and visceral fat loss may be additive. Ipamorelin can raise hunger slightly, which works against the GLP-1. The tirzepatide and ipamorelin page covers that combination and the muscle loss question.
Does the fat stay off after stopping tesamorelin?
No. Visceral fat returned toward baseline within 6 months of stopping in the trials. People either continue at a maintenance dose or accept that the effect is temporary.
Can tesamorelin and ipamorelin go in the same syringe?
Research grade vials of both are commonly drawn together since they are injected at the same time. Branded Egrifta is a separate kit and is not meant to be mixed. There is no stability study of the combination.
Related reading
Pulsatile growth hormone release
Weight loss while limiting muscle loss
An approved GHRH analog with fat loss trials versus the community's favorite GHRP.
The two halves of the most popular GH stack. What does each one do, and which CJC-1295 are you actually buying?
One is a GHRP, one is a GHRH analog. Why are they compared, and why are they usually combined?
Guide
Dosage
GLP-1
Two GHRH analogs with approval histories. Which one still earns the price?
Sources
- Tesamorelin, a growth hormone-releasing factor analog, in HIV-infected patients with excess abdominal fat: a pooled analysis of two multicenter, double-blind placebo-controlled phase 3 trials with safety extension data. Journal of Acquired Immune Deficiency Syndromes, 2010
- Effects of tesamorelin on non-alcoholic fatty liver disease in HIV: a randomised, double-blind, multicentre trial. The Lancet HIV, 2019
- Ipamorelin, the first selective growth hormone secretagogue. European Journal of Endocrinology, 1998