Tesamorelin: uses, evidence and status

compound file

The answer, first. A synthetic 44 amino acid growth hormone-releasing factor analog with an added hexenoyl group, approved in the United States in 2010 as Egrifta. The strongest evidence is for visceral fat in HIV-associated lipodystrophy, graded A — approval or replicated trials. The approved indication.

CT-measured visceral fat fell 15.2% against a 5.0% placebo rise over 26 weeks in 412 adults, IGF-I up 81.0% ¹. A second trial in 404 replicated it, and stopping reversed it ².

What it is used for

Every use graded on its own evidence, not the compound as a whole. 5 outcomes, ranked by what the human record supports.

#outcome · human · animal · gradewhat the best evidence actually shows

01Visceral fat in HIV-associated lipodystrophy2 phase 3 RCTs, 816 adults · not the basis of approvalgrade AThe approved indication. CT-measured visceral fat fell 15.2% against a 5.0% placebo rise over 26 weeks in 412 adults, IGF-I up 81.0% ¹. A second trial in 404 replicated it, and stopping reversed it ².

02Visceral fat in abdominal obesity without HIV1 RCT, 60 adults · nonegrade BRandomized against placebo for 12 months in 60 abdominally obese adults with low GH output ⁴. Visceral fat effect −35 cm², 95% CI −58 to −12, and triglycerides −37 mg/dL ⁴. One trial, one selected population.

03Liver fat in HIV-associated fatty liver disease1 RCT, 61 adults · nonegrade BRandomized and double-blind in 61 adults with HIV and a hepatic fat fraction of 5% or more ⁵. Liver fat fell 4.1 points absolute at 12 months, a 37% relative drop ⁵. Not replicated.

04Cognition in older adults1 RCT, 152 randomized · nonegrade B1 mg daily for 20 weeks in 152 adults aged 55 to 87 improved executive function, P=0.005, and cut percent body fat 7.4% ⁶. Fasting insulin rose 35% in the impaired group.

05Trunk muscle area in the labelled populationexploratory reanalysis, 341 scans · nonegrade CReanalysis of the two phase 3 trials found truncal muscle density up 1.56 to 4.86 Hounsfield units and rectus area up 0.44 cm² ⁷. Only responders were included and no strength outcome was tested.

gradewhat it means

ARegulatory approval, or multiple adequately-powered trials agreeing with each other

BAt least one well-powered human randomised trial, with the direction replicated

CSmall or open-label human trials only

DAnimal or mechanism data only, with no controlled human outcome

EA claim the human trials have already killed

How it works

The proposed mechanism, in three steps. A mechanism is a reason to run a trial, never a substitute for one.

1targetBinds and stimulates human growth hormone-releasing factor receptors on the pituitary with potency similar to the endogenous hormone ³.

2signalPituitary somatotrophs release growth hormone. Serum IGF-I rose 81.0% over 26 weeks against a 5.0% fall on placebo ¹.

3effectThe visceral fat compartment shrinks. Subcutaneous abdominal fat did not change in the 12-month obesity trial, P=0.40 ⁴.

What it does not do

Claims the current record does not support. Worth knowing before you set expectations.

not supported by the evidence

Weight loss. The label states it is not indicated for weight-loss management because the effect on body weight is neutral ³.
A flatter, more visible stomach. Trials measured visceral fat by CT. Subcutaneous abdominal fat, the layer you can see, did not change, P=0.40 ⁴.
Muscle growth. No trial measured strength or muscle protein synthesis. With growth hormone itself both matched placebo despite a larger fat-free mass gain ⁸.
Approval covers off-label goals. The approval attaches to HIV-associated lipodystrophy, 1.4 mg daily and one manufactured product ³. Nothing else is covered by it.

How it is used

What published protocols administered, and what the community reports doing. Descriptive on both counts, and never a recommendation.

routeSubcutaneous injection into the abdomen once daily, injection sites rotated ³.

formatLyophilised powder reconstituted with sterile water immediately before each dose ³.

published dosesThe label doses 1.4 mg subcutaneously once daily, using the 2 mg per vial formulation ³. Both pivotal trials used 2 mg daily of the earlier 1 mg per vial product for 26 weeks ¹². The non-HIV obesity trial used 2 mg daily for 12 months ⁴.

human pharmacokineticsMean elimination half-life 8 minutes after a single 1.4 mg subcutaneous dose in healthy subjects ³. Bioavailability is under 4% ³.

reported conventionsAs reported on bodybuilding forums and catalogued in a 2026 clinical review, 2025 to 2026: 2 mg subcutaneously once daily ⁹. In cycles of 8 to 12 weeks ⁹. That is the labelled daily dose, used outside the labelled population. Convention, not guidance.

commonly paired withIpamorelin CJC-1295 Semaglutide

This site does not publish protocols to follow. The doses above are what studies administered or what users report, stated as facts about the literature and the market. How protocols are structured, mixing and storage and the reconstitution calculator cover the arithmetic.

What to expect

Where a trial measured it, the trial. Where only the community reports it, that is said out loud.

onsetThe pivotal trials measured visceral fat once, at week 26, where it had fallen 15.2% ¹. The non-HIV obesity trial read out at 12 months ⁴. No trial reports a week at which a change becomes noticeable outside a scanner.

most common reportThe measured result is a smaller visceral fat compartment with body weight unchanged. The label calls the effect weight neutral ³.

adverse effectsAcross 543 treated and 263 placebo over 26 weeks: injection-site reactions 17% against 6%, arthralgia 13% against 11%, oedema and myalgia 6% against 2% ³. New diabetes 5% against 1%, hazard ratio 3.3 ³. In 53 adults with type 2 diabetes, 12 weeks changed no glycaemic measure ¹¹.

the stop signalThe label directs discontinuation on evidence of recurrent malignancy ³. It directs review if IGF-1 stays elevated ³. It directs a risk-benefit reconsideration in anyone whose visceral fat has not fallen ³.

Approval and status

What regulators and sport bodies have actually said, separately from what the evidence shows.

approvalApproved by FDA in 2010 for HIV-associated lipodystrophy, marketed as Egrifta SV ³.

FDAAn approved product with a full label. Contraindicated in pregnancy, active malignancy and a disrupted hypothalamic-pituitary axis ³. Not indicated for weight management ³.

sport [WADA]Prohibited at all times, class S2.2.4 ¹⁰.

sold asapproved medicine

Covered in depth

These reports grade Tesamorelin at length and carry their own verified reference lists.

Fullness Is Not Muscle: What Tesamorelin, CJC-1295 With Ipamorelin, and MOTS-c Actually Do to Body Composition

Three compounds, three different stories, and one measurement problem that explains all of them. The scan moves. The muscle does not.

Check the vial

The grade above describes a molecule studied under controlled conditions. It says nothing about the powder in a particular vial.

That gap is the one part of this market a reader can actually close. How to read a certificate of analysis covers the five measures in five minutes, and the 2026 audit grades vendors on the documents they publish against a rubric printed in full.

Questions we get

What is Tesamorelin used for?

It is approved for one thing: reducing excess abdominal fat in adults with HIV and lipodystrophy ³. In the pivotal trial of 412 adults, CT-measured visceral fat fell 15.2% over 26 weeks against a 5.0% rise on placebo ¹.

Outside that population the record is thinner: one 12-month trial in 60 obese adults without HIV, one liver-fat trial, and one cognition trial ⁴⁵⁶.

How is Tesamorelin used?

Descriptively, and from the label: 1.4 mg of the 2 mg per vial formulation, injected subcutaneously into the abdomen once daily ³. Reconstituted with sterile water immediately before the dose ³.

The pivotal trials dosed 2 mg daily of an earlier formulation for 26 weeks ¹². As reported on forums and catalogued in a 2026 review, 2 mg daily in 8 to 12 week cycles ⁹. Convention, not guidance.

How long does Tesamorelin take to work?

The trials do not answer that in the way the question is usually meant. Visceral fat was measured at week 26 in both phase 3 studies and at 12 months in the obesity trial ¹²⁴.

No published trial reports a week at which an effect becomes noticeable. The endpoint was a CT compartment, not a mirror, and the two are not the same thing.

Does Tesamorelin cause weight loss?

No. The label states plainly that it is not indicated for weight-loss management because its effect on body weight is neutral ³. It moves fat between compartments rather than off the body.

In 60 obese adults over 12 months, visceral fat fell by an estimated 35 cm² ⁴. Subcutaneous abdominal fat did not change, P=0.40 ⁴.

Is Tesamorelin banned in sport?

Yes. WADA lists growth hormone releasing factors under S2.2.4, naming tesamorelin explicitly ¹⁰. The whole S2 class is prohibited at all times, in and out of competition ¹⁰. Being an approved medicine does not change that. It changes only whether a therapeutic use exemption can be sought.

References

Falutz J, Allas S, Blot K, et al. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med. 2007;357:2359-2370. PMID 18057338
Falutz J, Potvin D, Mamputu JC, et al. Effects of tesamorelin in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. J Acquir Immune Defic Syndr. 2010;53:311-322. PMID 20101189
US Food and Drug Administration. EGRIFTA SV [tesamorelin] for injection, prescribing information. Revised 02/2024. accessdata.fda.gov
Makimura H, Feldpausch MN, Rope AM, et al. Metabolic effects of a growth hormone-releasing factor in obese subjects with reduced growth hormone secretion: a randomized controlled trial. J Clin Endocrinol Metab. 2012;97:4769-4779. PMID 23015655
Stanley TL, Fourman LT, Feldpausch MN, et al. Effects of tesamorelin on non-alcoholic fatty liver disease in HIV: a randomised, double-blind, multicentre trial. Lancet HIV. 2019;6:e821-e830. PMID 31611038
Baker LD, Barsness SM, Borson S, et al. Effects of growth hormone-releasing hormone on cognitive function in adults with mild cognitive impairment and healthy older adults. Arch Neurol. 2012;69:1420-1429. PMID 22869065
Adrian S, Scherzinger A, Sanyal A, et al. The growth hormone releasing hormone analogue, tesamorelin, decreases muscle fat and increases muscle area in adults with HIV. J Frailty Aging. 2019;8:154-159. PMID 31237318
Yarasheski KE, Zachwieja JJ, Campbell JA, Bier DM. Effect of growth hormone and resistance exercise on muscle growth and strength in older men. Am J Physiol. 1995;268:E268-E276. PMID 7864103
Dominikowski A, Rekos Z, Olejarz M, et al. The emerging landscape of performance-enhancing peptides modulating the GH-IGF1 axis. Front Endocrinol. 2026;17:1822475. PMID 42395176
World Anti-Doping Agency. The Prohibited List, 2026. Section S2.2.4, growth hormone releasing factors. wada-ama.org
Clemmons DR, Miller S, Mamputu JC. Safety and metabolic effects of tesamorelin in patients with type 2 diabetes: a randomized, placebo-controlled trial. PLoS One. 2017;12:e0179538. PMID 28617838

Inside Your Peptides is published by the owners of the next lab, a vendor graded elsewhere on this site. We sell nothing here, and this page carries no vendor link. Grades follow the published criteria in our editorial policy — never referral terms. Research and education only. Not medical advice.