Tesamorelin — Research, Dosing & Price Guide

Tesamorelin is a synthetic analog of human growth hormone-releasing hormone (GHRH) with a trans-3-hexenoic acid modification at the N-terminus that enhances receptor binding and enzymatic stability. It is FDA-approved (as Egrifta) for the reduction of excess abdominal fat in HIV-infected patients with lipodystrophy, making it one of the few peptides with specific FDA approval for a body composition indication. Tesamorelin is the most potent GHRH analog in clinical use and has shown remarkable specificity for visceral fat reduction.

Tesamorelin binds to the GHRH receptor (GHRH-R) on pituitary somatotroph cells with higher affinity than native GHRH or sermorelin, due to the trans-3-hexenoic acid (THA) modification that protects against DPP-IV degradation and enhances receptor interaction. Upon GHRH-R activation, the same adenylyl cyclase → cAMP → PKA cascade stimulates GH synthesis and release. However, tesamorelin produces a more robust and sustained GH pulse compared to sermorelin, typically elevating IGF-1 by 40–100% from baseline. The resulting GH/IGF-1 elevation drives several body composition effects: increased lipolysis in visceral adipose tissue (which has high GH receptor density), reduced lipogenesis, increased lean mass through enhanced protein synthesis, and improved hepatic fat metabolism. Tesamorelin preserves pulsatile GH release and hypothalamic-pituitary feedback, unlike exogenous GH. Notably, tesamorelin has shown specific efficacy against visceral adipose tissue (VAT) — the metabolically dangerous deep abdominal fat associated with cardiovascular disease, insulin resistance, and NAFLD. In clinical trials, it reduced VAT by 15–18% while subcutaneous fat was less affected, suggesting a preferential mechanism related to the higher GH receptor expression and lipolytic sensitivity of visceral adipocytes. Additionally, tesamorelin has demonstrated cognitive benefits — it improved verbal memory and executive function in cognitively normal older adults, possibly through IGF-1-mediated neurogenesis and synaptic plasticity in the hippocampus.

• Phase III trials for HIV lipodystrophy (n=816) demonstrated 15–18% reduction in visceral adipose tissue (trunk fat) at 26 weeks vs. placebo
• Stanley et al. (2014, Annals of Internal Medicine) showed tesamorelin reduced liver fat by 37% in HIV patients with hepatic steatosis
• Cognition study (Baker et al., 2012, Neurology) demonstrated tesamorelin improved verbal memory and executive function in cognitively normal adults aged 55–87
• IGF-1 levels increased by 40–100% from baseline in clinical trials without exceeding physiological upper limits in most patients
• Tesamorelin preserved or improved insulin sensitivity in HIV lipodystrophy trials, despite GH's typically diabetogenic effects
• A 2019 study showed tesamorelin reduced coronary artery plaque progression in HIV patients with subclinical atherosclerosis
• The VFIT trial demonstrated reduced visceral fat and improved metabolic markers in non-HIV patients with abdominal obesity
• Long-term extension studies showed sustained visceral fat reduction with continued use, with fat regain upon discontinuation

• FDA-approved dose (Egrifta): 2 mg subcutaneous injection once daily
• Anti-aging/body composition protocols: 1–2 mg subcutaneous injection daily, typically at bedtime
• Some protocols use 1 mg daily for a more conservative approach with fewer side effects
• Inject on an empty stomach — food (especially fats/carbs) suppresses the GH response
• Bedtime administration synergizes with the natural nocturnal GH pulse
• Avoid eating within 60–90 minutes of injection
• Cycle: 3–6 months on; some clinics prescribe continuously with periodic IGF-1 monitoring
• Often combined with a GHRP (ipamorelin) for synergistic GH release
• Monitor IGF-1 levels every 3 months and adjust dose to maintain upper-normal range

Known Side Effects

• Injection site reactions (erythema, pruritus, pain) in approximately 8–13% of patients
• Arthralgia (joint pain) and myalgia — related to GH/IGF-1 elevation, reported in 10–15% of users
• Peripheral edema and water retention, especially in the first few weeks
• Paresthesias (tingling, numbness in extremities) — signs of fluid retention and nerve compression
• Headache in approximately 5% of users
• Transient hyperglycemia — GH is a counter-regulatory hormone; monitor fasting glucose and HbA1c
• Carpal tunnel-like symptoms at higher doses due to fluid retention
• Hypersensitivity reactions (rare)

Safety Profile

Tesamorelin has a well-established safety profile from FDA-approval studies and post-marketing surveillance. The most significant safety consideration is its effect on glucose metabolism — GH elevates blood glucose, and tesamorelin may worsen glycemic control in patients with diabetes or pre-diabetes. In HIV lipodystrophy trials, HbA1c increased by approximately 0.28% on average, and 4% of patients developed new-onset diabetes. However, paradoxically, the reduction in visceral fat often improves insulin sensitivity over time, partially offsetting the acute hyperglycemic effect. Tesamorelin is contraindicated in patients with active malignancy (GH/IGF-1 may promote tumor growth), disruption of the hypothalamic-pituitary axis (e.g., from surgery or radiation), and hypersensitivity to tesamorelin or mannitol. It should not be used during pregnancy (Category X — shown to cause fetal harm in animal studies). IGF-1 levels should be monitored regularly and doses adjusted to avoid supraphysiological elevation. Long-term safety in non-HIV populations is less established but appears favorable based on available data.

Week 1–2: Improved sleep quality and increased dream vividness are typically the first effects noticed. Subtle improvement in energy levels. Minor water retention and joint stiffness may occur as GH levels rise. Week 2–4: Sleep continues to improve. Recovery from exercise is noticeably better. IGF-1 levels begin rising significantly. Mild fluid retention peaks and begins stabilizing. Week 4–8: Body composition changes begin — clothes may fit differently around the midsection. Skin quality starts improving (increased hydration and elasticity). Fat loss becomes measurable, particularly in the abdominal region. Week 8–16: Significant visceral fat reduction (10–15%). Lean mass improvements become apparent. Cognitive benefits may emerge — improved focus, verbal fluency, and mental clarity. Metabolic markers (triglycerides, liver enzymes) begin improving. Week 16–26: Full effects manifest with 15–18% visceral fat reduction. Visible abdominal slimming. Improved exercise capacity. Hair and nail growth may accelerate. Benefits continue as long as treatment continues; fat regain occurs gradually after discontinuation.

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