GH-Axis
Tesamorelin: GH-Axis Support for Recomposition
Tesamorelin is a GHRH analog that restores natural, pulsatile growth hormone secretion. Unlike exogenous HGH, it works through your body's own axis—triggering GH release from the pituitary rather than replacing it.
The clinical data is strong: 15–20% visceral fat reduction with lean mass preservation. For people losing weight on GLP-1 agonists and watching strength disappear alongside fat, tesamorelin offers anabolic support during the cut.
At a Glance
| Property | Value |
|---|---|
| What it is | Synthetic GHRH(1-44) analog |
| Mechanism | Restores pulsatile GH secretion |
| Key outcome | 15–20% VAT reduction + lean mass preservation |
| Dose | 1–2 mg SC, 30–60 min before bed |
| Cycle | 12–16 weeks on, 2–4 weeks off |
| FDA status | Approved for HIV lipodystrophy; off-label for recomp |
Clinical Evidence
| Trial | Population | Duration | Finding |
|---|---|---|---|
| NEJM 2010 | HIV lipodystrophy | 26 wk | 15–20% VAT reduction |
| Lancet HIV 2019 | HIV + NAFLD | 12 mo | Reduced liver fat, slowed fibrosis |
| Metabolism 2014 | Obese adults (non-HIV) | Variable | Improved body composition |
The evidence base is strong. VAT (visceral adipose tissue) drops while lean mass holds. Triglycerides improve. Glucose stays stable.
Why It Matters for GLP-1 Users
GLP-1 agonists drive fat loss but provide no anabolic protection. Studies show 25–40% of weight lost on GLP-1s can be lean mass.
| What GLP-1s Provide | What Tesamorelin Provides |
|---|---|
| Appetite suppression | GH pulsatility restoration |
| Fat loss driver | Lean mass preservation |
| Glucose control | Nitrogen retention during deficit |
GLP-1s create the deficit. Tesamorelin protects what you don't want to lose.
The timing logic: GLP-1 effects peak during waking hours (mobilization, activity). Tesamorelin-driven GH pulses peak during sleep (repair, protein synthesis). Day for breakdown, night for protection.
Dosing Protocol
Reconstitution note: Use bacteriostatic water with sodium chloride (isotonic) to reduce injection site sting and prevent welts.
| Parameter | Recommendation |
|---|---|
| Dose | 1–2 mg |
| Route | Subcutaneous (abdomen or thigh) |
| Timing | 30–60 min before bed, 2+ hours fasted |
| Cycle | 12–16 weeks on, 2–4 weeks off |
Titration:
| Phase | Dose | Duration |
|---|---|---|
| Start | 1 mg nightly | 2–4 weeks |
| Increase | 2 mg nightly | If needed after 2–3 weeks |
| Adjust | EOD dosing | If IGF-1 runs high or side effects |
Week 8 checkpoint: Get IGF-1 labs. Target physiologic elevation (high-normal), not supraphysiologic. If IGF-1 exceeds 350–400 ng/mL, reduce dose.
GLP-1 + Tesamorelin Protocol
GLP-1 agonist: Weekly injection per standard protocol
Tesamorelin: 1–2 mg SC, 30–60 min before bed
Resistance training: 3–4× per week
Protein: 1.6–2.2 g/kg body weightThe GLP-1 handles appetite. Tesamorelin handles hormonal support. Training provides stimulus. Protein provides building blocks.
Side Effects
| Effect | Notes |
|---|---|
| Edema (fluid retention) | Most common. Dose-related, reversible |
| Tingling/numbness | Carpal-tunnel-like. Resolves with dose reduction |
| Injection site reactions | Rotate sites |
| Joint/muscle aches | Usually transient |
Metabolic notes:
- IGF-1 elevation: Expected—this is the mechanism working
- Glucose: Small shifts possible; monitor if diabetic
- Lipids: Generally improve
Monitoring
| Timepoint | Tests |
|---|---|
| Baseline | IGF-1, fasting glucose, HbA1c, lipids |
| Week 8 | IGF-1 (critical decision point) |
| Ongoing | Symptoms; glucose if at-risk |
Who Should Consider Tesamorelin
Good candidates:
- Training adults with central adiposity
- GLP-1 users concerned about muscle loss
- Those with documented NAFLD
- Willing to work with provider and do bloodwork
Not good candidates:
- Active cancer (IGF-1 contraindicated)
- Uncontrolled diabetes
- Those seeking quick fix without training foundation
- WADA athletes (prohibited)
Tesamorelin vs HGH
| Factor | Tesamorelin | Exogenous HGH |
|---|---|---|
| Mechanism | Stimulates your own GH | Replaces with synthetic |
| Pulsatility | Preserved | Flat-line |
| Shutdown risk | Low | Higher |
| Side effect profile | Cleaner | More |
Tesamorelin works with your body's systems rather than bypassing them.
FAQ
Is tesamorelin the same as HGH?
No. Tesamorelin stimulates your pituitary to release its own GH in natural pulses. HGH replaces your production with synthetic hormone.
How long to see results?
Sleep quality improves in 1–2 weeks. Strength stabilizes by weeks 3–6. Body composition changes consolidate by week 8–12.
Can you take it with semaglutide?
Yes. They work on different axes and are complementary. GLP-1 drives fat loss; tesamorelin provides anabolic support.
What time of day?
30–60 min before bed, at least 2 hours after eating. Aligns with natural nocturnal GH secretion.
What are the side effects of tesamorelin?
The most common side effect is fluid retention (edema), which is dose-related and reversible. Some people experience tingling or numbness in the hands (carpal tunnel-like symptoms)—reducing the dose usually resolves this. Injection site reactions occur but are minimized by rotating sites. Joint and muscle aches are usually transient in the first weeks. Serious side effects are rare at physiologic doses.
How do I dose tesamorelin?
Start at 1mg subcutaneously nightly, 30–60 minutes before bed, at least 2 hours fasted. After 2–3 weeks, you can increase to 2mg if needed and tolerated. Check IGF-1 levels at week 8—if they exceed 350–400 ng/mL, reduce the dose or switch to every-other-day dosing. The goal is physiologic elevation, not supraphysiologic levels.
Do I need to cycle tesamorelin?
Yes. Standard protocols run 12–16 weeks on, followed by 2–4 weeks off. Cycling preserves pituitary sensitivity and prevents sustained IGF-1 elevation. Unlike exogenous HGH, tesamorelin works through your own axis, so breaks allow the system to reset naturally. Some practitioners use shorter on-cycles with longer breaks.
What blood tests should I monitor on tesamorelin?
At minimum: IGF-1 at baseline and week 8 (the critical decision point for dose adjustment). Also check fasting glucose, HbA1c, and lipid panel at baseline. If you're at risk for diabetes, monitor glucose more frequently—small shifts are possible. IGF-1 is the key marker: you want it in the high-normal range, not supraphysiologic.
Can tesamorelin help with belly fat?
Yes—this is its primary clinical indication. Studies show 15–20% reduction in visceral adipose tissue (VAT) over 26 weeks. Tesamorelin specifically targets visceral fat, the metabolically dangerous fat around organs, while preserving lean mass. It's FDA-approved for HIV lipodystrophy specifically because of this visceral fat reduction effect.
How do I reconstitute and store tesamorelin?
Reconstitute with bacteriostatic water containing sodium chloride (isotonic) to reduce injection site reactions. Inject water slowly against the vial wall, then gently swirl—don't shake. Store unreconstituted powder refrigerated. Once reconstituted, keep at 2–8°C and use within 28 days. Protect from light. The commercial Egrifta formulation comes with specific diluent and instructions.
Is tesamorelin legal?
Yes, with a prescription. Tesamorelin (brand name Egrifta) is FDA-approved for HIV-associated lipodystrophy. For other uses (recomposition, anti-aging), it's prescribed off-label. It's also available through compounding pharmacies. However, it's prohibited by WADA for competitive athletes. For non-athletes with a prescription, there are no legal restrictions.
Who shouldn't take tesamorelin?
Active cancer or history of cancer is the main contraindication—IGF-1 elevation can promote tumor growth. Uncontrolled diabetes requires caution since GH affects glucose metabolism. Pregnant or nursing women should avoid it. People with pituitary disorders may not respond normally. Anyone unwilling to do bloodwork and work with a provider shouldn't use it—IGF-1 monitoring is essential, not optional.
Related
- Semaglutide Guide — the GLP-1 benchmark
- Tirzepatide Guide — dual-agonist with better body composition
- AOD-9604 Guide — lipolytic fragment (pairs with tesamorelin)
- GLP-1 Comparison — compare all three
- Retatrutide Guide — triple-agonist investigational
- GLP-1 Muscle Preservation — protecting lean mass
References
- Falutz J, et al. Effects of tesamorelin on body composition in HIV. NEJM 2010.
- Stanley TL, et al. Tesamorelin on hepatic transcriptomic signatures in HIV-NAFLD. Lancet HIV 2019.
- Makimura H, et al. Metabolic effects of GHRH analog in obese adults. Metabolism 2014.
Tesamorelin (Egrifta) is FDA-approved only for HIV lipodystrophy. All other uses are off-label. Consult a healthcare provider.