Tesamorelin
GHRH (1-44) analog — Egrifta
A 44-amino-acid GHRH analog FDA-approved (as Egrifta) for HIV-related lipodystrophy. Off-label use centers on visceral fat reduction — Tesamorelin is the only GHRH analog with documented preferential visceral adipose loss in clinical trials (-15-18% at 6 months). Daily dosing required due to short half-life.
Quick reference
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.
What makes Tesamorelin clinically distinct is its preferential effect on visceral adipose tissue (the metabolically active fat around abdominal organs). Phase III trials in HIV-associated lipodystrophy showed -15-18% visceral fat reduction at 6 months — a magnitude not matched by other GHRH analogs at standard doses. The mechanism is thought to be GH-driven hormone-sensitive lipase activation specifically in visceral depots.
Off-label use in metabolic / longevity contexts targets the same effect: visceral fat reduction in users with elevated waist circumference, NAFLD / fatty liver, or insulin resistance. Practitioner reports describe meaningful improvement in waist:hip ratio and liver enzyme markers within 12-16 weeks.
Daily dosing is required because of the short half-life. This is the practical trade-off vs CJC-1295-DAC (multi-day) — Tesamorelin's specificity for visceral fat is the reason to accept the daily injection burden.
Reconstitution math
- Remove the flip-off cap from the 1-2 mg vial.
- Draw the recommended bacteriostatic or sterile water volume specified on the vial label (typically 2.1 mL).
- Inject slowly down the vial wall.
- Swirl gently. Use within 30 days when refrigerated.
- Storage: refrigerate before and after reconstitution.
Dose math
1 mg vial + 2.1 mL diluent → ~476 mcg/mL (read your specific vial labeling).
On a 100-unit insulin syringe:
- • Egrifta SV (1.4 mg vial) is reconstituted to deliver 1.4 mg per 0.5 mL injection
- • Generic preparations: read label — concentration varies by source
- • Standard daily dose: 2 mg (typically 1-2 injections depending on prep)
Safety + side-effect profile
GH-axis side effects are the dominant concern. Tesamorelin's daily-dosing schedule and longer cumulative exposure make these slightly more pronounced than the cycled GHRH analogs.
Documented serious risks: transient impaired glucose tolerance (GH-driven), fluid retention (~3-5 lbs in first month), arthralgias, paresthesias. Contraindications: active malignancy, pregnancy, severe untreated diabetes, head trauma / hypothalamic disease, pituitary tumor.
Interaction notes: caution with insulin and oral hypoglycemics (Tesamorelin can transiently raise blood glucose, which then triggers reactive hypoglycemia in over-corrected diabetics). Avoid stacking with other GHRH analogs (Sermorelin, CJC-1295) — receptor saturation, no added benefit.
- • Injection-site erythema and pain (~30% in trials)
- • Arthralgias / muscle pain in first 4-6 weeks
- • Hand / foot tingling (water retention related)
- • Transient mild fasting glucose elevation
- • Occasional nausea or peripheral edema
Frequently asked
What is Tesamorelin?
Tesamorelin is a synthetic 44-amino-acid GHRH analog FDA-approved as Egrifta in 2010 for HIV-associated lipodystrophy. Off-label use centers on visceral fat reduction — Tesamorelin is the only GHRH analog with documented preferential visceral adipose loss in trials (-15-18% at 6 months).
What is the typical Tesamorelin dose?
FDA-approved Egrifta protocol: 2 mg subcutaneous daily (no off-days). Some practitioners use lower doses (1 mg) for milder effects, but visceral fat reduction is dose-dependent — 2 mg daily is the trial-validated protocol. Cycle: continuous use for 6-12 months, then re-evaluate.
Tesamorelin vs Sermorelin / CJC-1295 — when to use which?
Sermorelin / CJC-1295: general GH axis support, sleep, lean mass, IGF-1 elevation. Tesamorelin: specifically for visceral fat reduction (waist circumference, NAFLD, insulin resistance). Tesamorelin's daily dosing burden is the trade-off for visceral specificity. Don't stack the three — they all hit the same pituitary GHRH receptor.
Does Tesamorelin help with NAFLD / fatty liver?
Yes — visceral fat reduction includes hepatic visceral fat. Practitioner reports describe improvement in liver enzyme markers (ALT, AST) and ultrasound-measured liver fat at 12-16 weeks. Tesamorelin is being studied formally for NAFLD (clinicaltrials.gov NCT02196831).
Why daily dosing instead of weekly or every-other-day?
Tesamorelin's half-life is ~26 minutes — too short for less-frequent dosing to maintain consistent GH pulse coverage. The visceral fat reduction effect requires daily exposure. Weekly variants (e.g., adding a fatty-acid side chain à la Semaglutide) are theoretical but not in development.
Is Tesamorelin safe long-term?
8+ years of cumulative safety data from the Egrifta indication. Documented effects: transient glucose elevation, mild fluid retention, arthralgias. No documented hepatotoxicity or hormonal disruption. Long-term metabolic safety is favorable in the FDA-approved population.
What are the most common Tesamorelin side effects?
Injection-site reactions (~30%), arthralgias / muscle pain in first 4-6 weeks, hand/foot tingling (water retention), transient mild fasting glucose elevation. Most resolve within the first 4-8 weeks of dosing.
Can I use Tesamorelin without a diagnosis?
FDA approval is specific to HIV-associated lipodystrophy. Off-label practitioner use targets metabolic dysfunction (elevated visceral fat, NAFLD, insulin resistance). This requires physician prescription in regulated jurisdictions; research-chemical channels exist but quality verification is essential.
Related compounds
Often researched, stacked, or compared with Tesamorelin.
Cited research
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