01 — Identity
What Is Tesamorelin?
Origin
Developed by Theratechnologies Inc. (Canada). Synthetic analog of endogenous GHRH with a trans-3-hexenoic acid group at the N-terminus for enhanced stability and prolonged receptor binding vs. native GHRH.
Chemical Class
44-amino acid GHRH analog. Identical to endogenous GHRH(1-44) except for the N-terminal fatty acid modification that increases plasma stability.
FDA Indication
Approved for HIV-associated lipodystrophy — reduction of excess visceral fat in HIV patients on antiretroviral therapy. The only FDA-approved GHRH analog for visceral fat reduction.
Administration
Subcutaneous injection. Nightly before bed — FASTED. Available in 10mg and 20mg vials — reconstitution math differs by vial size.
Tesamorelin is the most clinically proven GHRH analog for visceral adipose tissue (VAT) reduction. ENCORE and ENCORE2 Phase III trials demonstrated 15–18% reduction in VAT vs. placebo over 26 weeks. Off-label use in non-HIV populations for visceral fat reduction and GH optimization is well-supported by the mechanism.
02 — Research History
Discovery & Research Timeline
1982
GHRH(1-44) is isolated and sequenced. Theratechnologies identifies the N-terminal fatty acid modification strategy to extend GHRH half-life beyond the ~2-minute plasma half-life of the native hormone.
1990s
TH9507 (Tesamorelin) synthesized and characterized by Theratechnologies. Initial studies confirm superior stability and pituitary GH stimulation vs. native GHRH. Development pivots toward HIV lipodystrophy as a clinical indication.
2004–2008
ENCORE Phase II and III clinical trials conducted. Tesamorelin at 2mg daily demonstrates statistically significant 15–18% reduction in visceral adipose tissue vs. placebo with an excellent safety profile over 26–52 weeks.
2010
FDA approves Tesamorelin (Egrifta) for HIV-associated lipodystrophy — the first and only FDA-approved GHRH analog for visceral fat reduction. European approval follows in subsequent years.
2015–Present
Off-label use expands in functional medicine and anti-aging clinics for visceral fat reduction, GH optimization, and NAFLD improvement in non-HIV populations. Cognitive function studies in MCI patients underway. Research peptide community widely adopts Tesamorelin as the gold-standard GHRH analog.
03 — Primary Benefits
Documented Effects
01
Visceral Fat Reduction
The most clinically proven peptide for visceral adipose tissue (VAT) reduction. Phase III trials: 15–18% VAT reduction vs. placebo over 26 weeks at 2mg daily. Targets the dangerous visceral fat depot associated with metabolic syndrome and cardiovascular risk.
02
IGF-1 Elevation
Stimulates pituitary GH secretion → liver IGF-1 production. IGF-1 rises proportionally to GH output, driving body composition changes, tissue repair, and metabolic improvement.
03
Liver Fat Reduction
NAFLD studies show Tesamorelin reduces hepatic steatosis (liver fat) alongside visceral fat reduction. GH promotes hepatic fatty acid oxidation and reduces lipogenic enzyme activity in the liver.
04
Lean Mass Preservation
GH-driven IGF-1 supports lean muscle mass during fat loss. Unlike caloric restriction alone, Tesamorelin preferentially reduces fat while preserving lean tissue — improving body composition ratio.
05
Triglyceride Reduction
Clinical trials showed significant reduction in triglycerides associated with visceral fat syndrome. GH drives lipolysis in visceral adipose and reduces hepatic VLDL production.
06
Cognitive Support
Ongoing studies in mild cognitive impairment (MCI) — GH receptors are expressed throughout the brain; IGF-1 is neurotrophic. Preliminary data suggests Tesamorelin may slow cognitive decline in at-risk populations.
07
FDA-Validated Safety Profile
Extensive Phase III safety data — the most thoroughly studied GHRH analog. Well-characterized side effect profile: fluid retention, joint pain (dose-dependent), and glucose monitoring requirements are the primary considerations.
04 — Reconstitution
Mixing & Storage — Two Vial Sizes
▸ 10mg Vial
10mg + 300u BAC water = 33.3 mcg/unit
10,000 mcg total
1mg dose = 30 units
2mg dose = 60 units
▸ 20mg Vial
20mg + 300u BAC water = 66.6 mcg/unit
20,000 mcg total
1mg dose = 15 units
2mg dose = 30 units
The 20mg vial is more economical per mg and requires smaller syringe draws. At the standard 2mg daily dose, the 20mg vial provides 10 doses (10 nights) vs. 5 doses from a 10mg vial. Both deliver identical therapeutic outcomes — the concentration difference is accounted for by the unit draw adjustment above.
UNRECONSTITUTED
Refrigerate at 2–8°C. Stable at room temp for shipping. Do not freeze lyophilized powder.
RECONSTITUTED
Refrigerate at 2–8°C. Use within 4–6 weeks. Protect from light. Do not freeze.
05 — Dosing Protocol
Dose Levels & Unit Draws by Vial Size
| Level | Dose | 10mg Vial Draw | 20mg Vial Draw | Description |
|---|
| LOW |
1mg Daily nightly |
30 units |
15 units |
Starting or maintenance dose. Good for users with glucose sensitivity or first-time GH optimization. |
| STANDARD |
2mg FDA-approved daily dose |
60 units |
30 units |
The FDA-approved dose from Phase III ENCORE trials. Most researched and validated dose. Nightly, fasted, SC injection. |
⚠ Do not exceed 2mg/day. Unlike some peptides where higher doses produce greater effects, Tesamorelin at doses above 2mg does not proportionally increase GH output — receptor saturation occurs at 2mg. Higher doses only increase side effect risk (fluid retention, joint discomfort, glucose dysregulation).
06 — Timing & Frequency
When & How Often
| Variable | Recommendation | Why |
|---|
| Timing |
Nightly — 30–60 min before sleep |
GH pulses naturally during slow-wave sleep. Nightly injection primes the pituitary at sleep onset, amplifying the natural nocturnal GH pulse for maximal IGF-1 production and fat mobilization during sleep. |
| Fed State |
FASTED — 2–3 hrs no food |
Elevated insulin from recent meals inhibits GH release at the pituitary level. Fasted injection is critical for maximizing GH output. No carbohydrates after dinner if dosing at bedtime. |
| Frequency |
Daily (7×/week) |
Daily nightly dosing mirrors the Phase III protocol. Consistent daily stimulation is required for the 15–18% VAT reduction observed in trials. Unlike once-weekly peptides, Tesamorelin requires daily administration. |
| Injection Site |
SC abdomen — rotate daily |
Abdominal SC injection is standard. Rotate within the abdominal quadrants to prevent lipohypertrophy at injection sites. |
07 — Biomarker Monitoring
Lab Tests & Optimal Ranges
▸ GH Axis & Efficacy
| Biomarker | Lab Test | Clinical Range | Optimal Range |
|---|
IGF-1
Primary GH output marker |
Serum IGF-1 |
CLINICALAge-dependent |
OPTIMALUpper third of age range |
| Visceral Adipose Tissue |
DEXA scan or CT abdomen |
CLINICALBaseline measurement |
OPTIMAL10–18% reduction from baseline at 6 months |
▸ Metabolic Safety
| Biomarker | Lab Test | Clinical Range | Optimal Range |
|---|
| Fasting Glucose |
Fasting plasma glucose |
CLINICAL70–100 mg/dL |
OPTIMAL75–90 mg/dL |
| Fasting Insulin |
Serum insulin |
CLINICAL2–25 µIU/mL |
OPTIMAL2–6 µIU/mL |
| HbA1c |
Hemoglobin A1c |
CLINICAL<5.7% |
OPTIMAL4.6–5.3% |
| Triglycerides |
Lipid panel |
CLINICAL<150 mg/dL |
OPTIMAL<80 mg/dL |
| AST / ALT |
CMP |
CLINICALAST 10–40 / ALT 7–56 U/L |
OPTIMALAST <26 / ALT <26 U/L |
| CBC |
Complete Blood Count |
CLINICALStandard ranges |
OPTIMALMid-range |
⚠ Tesamorelin (Egrifta) is FDA-approved for HIV-associated lipodystrophy. Off-label use for visceral fat reduction in non-HIV populations is not FDA-approved but is mechanistically supported and widely practiced. Monitor glucose carefully — GH can reduce insulin sensitivity. Do not use in active malignancy. GH axis stimulation is contraindicated with pituitary tumor or active pituitary pathology.
08 — Cycle Protocol
Cycle Length, Frequency & Timing
STANDARD CYCLE
26 Weeks
FDA-approved protocol duration. 2mg nightly for 6 months produces the maximum documented 15–18% VAT reduction. Measurable IGF-1 rise typically seen by week 4–8.
BREAK
4–8 Weeks
Off period allows pituitary receptor recovery. Clinical data shows VAT returns partially during off period — repeat cycles are common in off-label longevity protocols.