Tesamorelin
GHRH (1-44) analog — Egrifta
Tesamorelin is a synthetic analog of growth-hormone-releasing hormone (GHRH) that prompts the pituitary to release growth hormone. It is FDA-approved (as Egrifta) only to reduce excess abdominal fat in adults with HIV and lipodystrophy. In a phase 3 trial, 2 mg daily for 26 weeks reduced visceral (deep belly) fat by 15.2%, versus a 5.0% increase on placebo.
Quick reference
How Tesamorelin is dosed in practice
Per the FDA labels, tesamorelin is injected SubQ into the abdomen once a day. Egrifta WR (an 11.6 mg vial, mixed once and used for 7 days) is dosed at 1.28 mg daily; Egrifta SV (a 2 mg vial, mixed daily) at 1.4 mg daily; the original Egrifta at 2 mg daily, the dose used in the phase 3 trials. The doses differ because the formulations differ: the WR label says WR and SV are not substitutable, so follow the dose and mixing instructions for the product you have.
There's no titration — you start at the full label dose. In the trials, the visceral fat came back after people stopped, so the effect lasts only while you take it.
Where the numbers come from: the FDA label and the phase 3 trials. Off-label use for visceral fat or fatty liver uses the same doses (some protocols use 1 mg a day, with less evidence at that dose); this guide does not list more than 2 mg a day.
Work out the units to draw with the reconstitution calculator and how long a vial lasts with the vial duration calculator.
How Tesamorelin works
Tesamorelin is a synthetic 44-amino-acid analog of full-length GHRH (1-44). It binds the pituitary GHRH receptor and triggers GH pulse release — same upstream pathway as Sermorelin / CJC-1295.
Its approval rests on its effect on visceral adipose tissue — the fat around the abdominal organs. In the phase 3 trial in adults with HIV, 2 mg daily for 26 weeks reduced visceral fat by 15.2% (versus a 5.0% increase on placebo), raised IGF-1 by 81% and lowered triglycerides.
In a separate trial in people with HIV and fatty liver, 2 mg daily for 12 months reduced liver fat more than placebo (a 37% relative reduction). Whether these effects carry over to people without HIV hasn't been established in trials; use outside the approved indication is off-label.
Daily dosing is needed because tesamorelin is cleared quickly — its job is to trigger a GH pulse each day, not to stay in the body.
Reconstitution math
- Use the diluent and instructions that come with your product — Egrifta WR, Egrifta SV and the original Egrifta are each mixed differently.
- Wipe the vial stoppers with alcohol.
- Add the diluent slowly down the vial wall.
- Roll gently until dissolved. Do not shake.
- Store and use as the package insert directs.
Dose math
Concentration depends on the product and the diluent volume — read the package insert or pharmacy label.
Label doses:
- • Egrifta WR: 1.28 mg once daily (one vial lasts 7 days after mixing)
- • Egrifta SV: 1.4 mg once daily
- • Original Egrifta: 2 mg once daily
- • Compounded preparations: concentration varies — confirm the volume per dose with the pharmacist
Safety + side-effect profile
Side effects come mostly from raised GH and IGF-1. They are documented in the FDA label and the phase 3 trials.
Label warnings and precautions: raised blood sugar and possible new diabetes, fluid retention, joint pain, hypersensitivity reactions, injection-site reactions, and raised IGF-1 (which should be monitored). Do not use with: disruption of the hypothalamic-pituitary axis (pituitary surgery or tumor, hypopituitarism, head radiation or head trauma), active cancer, pregnancy, or known allergy to tesamorelin or mannitol.
Interaction notes: with insulin or other diabetes medicines, blood sugar needs monitoring and doses may need adjusting. Don't combine with other GHRH analogs (sermorelin, CJC-1295) — same receptor, no added benefit.
- • Joint pain (arthralgia)
- • Injection-site redness, itching or pain
- • Pain in the arms or legs, muscle pain
- • Swelling in the hands or feet (fluid retention)
- • Tingling or numbness
- • Higher blood sugar
Frequently asked
What is Tesamorelin?
Tesamorelin is a synthetic analog of full-length GHRH, FDA-approved in 2010 (as Egrifta) to reduce excess abdominal fat in adults with HIV and lipodystrophy. It works by prompting the pituitary to release growth hormone. Use for other kinds of belly fat is off-label.
What is the typical Tesamorelin dose?
Per the FDA labels: 1.28 mg SubQ once daily for Egrifta WR, 1.4 mg once daily for Egrifta SV, or 2 mg once daily for the original Egrifta (the dose used in the phase 3 trials). WR and SV are not substitutable, so use the dose for the product you have. There's no titration and no off-days. Off-label protocols use the same range (some use 1 mg), never more than 2 mg a day.
Tesamorelin vs Sermorelin / CJC-1295 — when to use which?
Sermorelin and CJC-1295 are used off-label for general GH-axis goals (sleep, IGF-1). Tesamorelin is the one with phase 3 evidence for reducing visceral fat, in adults with HIV. All three act on the same pituitary GHRH receptor, so don't combine them.
Does Tesamorelin help with NAFLD / fatty liver?
In a trial in people with HIV and fatty liver (NCT02196831), tesamorelin 2 mg daily for 12 months reduced liver fat more than placebo (a 37% relative reduction). It isn't approved for fatty liver, and it hasn't been tested this way in people without HIV.
Why daily dosing instead of weekly or every-other-day?
Tesamorelin is cleared quickly, and its job is to trigger a GH pulse each day, so it's dosed daily. That's how it was tested and approved.
Is Tesamorelin safe long-term?
Tesamorelin has been on the market since 2010, and the phase 3 trials ran up to 52 weeks. Known effects include higher blood sugar, fluid retention and joint pain. In the trials, visceral fat came back after stopping, so benefits last only while you take it.
What are the most common Tesamorelin side effects?
Per the label and trials: joint pain, injection-site redness or itching, pain in the arms or legs, muscle pain, swelling, tingling or numbness, and higher blood sugar. Most are mild to moderate.
Can I use Tesamorelin without a diagnosis?
FDA approval covers only excess abdominal fat in adults with HIV and lipodystrophy. Other uses are off-label and need a prescriber in most places. Products sold outside pharmacies are unregulated, so their contents and dose are unknown.
Related compounds
Often researched, stacked, or compared with Tesamorelin.
Cited research
Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med, 2007.
Effects of tesamorelin on non-alcoholic fatty liver disease in HIV: a randomised, double-blind, multicentre trial. Lancet HIV, 2019.
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