protocols
Tesamorelin for Injury Recovery: GH Timing and Sleep-Timed Repair
Connective tissue doesn't rebuild on your schedule—it rebuilds during sleep. GH pulses during slow-wave sleep trigger IGF-1 production, which drives collagen synthesis and tissue consolidation. When this rhythm is disrupted (from pain, poor sleep, chronic stress, or injury itself), tissue can be structurally repaired but never fully consolidates.
This is the "almost healed, but keeps flaring" pattern. Progress for a few weeks, then mystery regression. The injury site is warm and supple, but strength plateaus 10–15% below baseline. Sleep feels unrefreshed despite adequate hours.
Tesamorelin is a GHRH (Growth Hormone Releasing Hormone) analog that restores nocturnal GH pulsatility—amplifying your body's own sleep-timed repair signals rather than replacing them with exogenous hormone.
At a Glance
| Property | Details |
|---|---|
| What it is | Synthetic GHRH(1-44) analog |
| Mechanism | Restores pulsatile, nocturnal GH secretion |
| Primary effect | Sleep-timed tissue repair; IGF-1-driven collagen synthesis |
| Dose | 1–2 mg subcutaneous, 30–60 min before sleep |
| Cycle | 8–12 weeks |
| When to add | Sleep disrupted; recovery unpredictable; strength plateaued despite good structural repair |
Optional: Ipamorelin
| Property | Details |
|---|---|
| What it is | Ghrelin receptor agonist (GH secretagogue) |
| Mechanism | Extends GH pulse window without cortisol spike |
| Dose | 200–500 mcg nightly (with Tesamorelin) |
| When to add | Tesamorelin alone insufficient after 4 weeks |
Key principle: Tesamorelin is not a healing peptide—it's a timing peptide. It makes existing repair consolidate during sleep instead of oscillating unpredictably.
Who This Is For
Use Tesamorelin If:
- Sleep is choppy, dreams are flat, or you wake unrefreshed
- Recovery feels "random"—good days followed by mystery flares
- Strength has plateaued 10–15% below baseline despite solid rehab
- Structural repair looks good (tissue warm, supple) but consolidation isn't sticking
- You're running a base protocol (BPC-157, TB-500) and need the next layer
Skip Tesamorelin If:
- Tissue is still cold, stiff, or poorly perfused → Need more BPC-157/TB-500
- Energy crashes even at rest → Need NAD+ first
- Pain is clearly structural (not recovery-timing related)
- You haven't tried improving sleep hygiene first
- Active malignancy or proliferative retinopathy (contraindicated)
Do I Need the Base Protocol First?
Recommended but not required. Tesamorelin works best when layered on top of foundational repair:
| Scenario | Recommendation |
|---|---|
| Acute injury (<4 weeks) | Start with BPC-157 + TB-500 |
| Chronic injury with multiple bottlenecks | Start with 5-compound base protocol |
| Sleep/recovery timing is the clear limiter | Tesamorelin can be added earlier |
| Already running base protocol, sleep issues persist | Add Tesamorelin |
Tesamorelin amplifies repair that's already possible. If tissue lacks blood flow (needs BPC-157), cellular mobility (needs TB-500), or energy (needs NAD+), there's less to amplify. But if structural repair is progressing and sleep-timed consolidation is the bottleneck, Tesamorelin addresses that directly.
How Tesamorelin Works
The Problem: Disrupted GH Pulsatility
Growth hormone isn't released continuously—it pulses, primarily during slow-wave (deep) sleep. Each pulse triggers hepatic IGF-1 production, which drives:
- Collagen synthesis
- Protein anabolism
- Tissue repair consolidation
When this pulsatile pattern is disrupted (common with chronic pain, poor sleep, stress, or injury), repair becomes unpredictable:
| Normal GH Pattern | Disrupted GH Pattern |
|---|---|
| Strong nocturnal pulses | Flattened, irregular release |
| IGF-1 peaks during sleep | Variable, inconsistent IGF-1 |
| Collagen synthesis overnight | Erratic tissue turnover |
| Predictable recovery | "Two steps forward, one step back" |
What Tesamorelin Does
Tesamorelin is a GHRH analog—it binds pituitary GHRH receptors and triggers your own GH release in natural pulses. Unlike exogenous HGH (which provides constant, flat-line hormone), tesamorelin preserves circadian rhythm and endogenous feedback.
| Pathway | Effect | What You Notice |
|---|---|---|
| Nocturnal GH pulse amplification | Deeper, more consistent GH peaks during slow-wave sleep | More restorative sleep; waking less stiff |
| IGF-1 production | Sustained IGF-1 for tissue synthesis | Tendons and muscles rebuild "overnight" |
| Sleep architecture support | GH pulses reinforce slow-wave sleep | Fewer night wakings |
| Collagen turnover | Organized, predictable remodeling | Progress sticks; fewer mystery flares |
Tesamorelin vs Exogenous HGH
| Factor | Tesamorelin | Exogenous HGH |
|---|---|---|
| Mechanism | Stimulates your own GH | Replaces with synthetic |
| Pulsatility | Preserved | Flat-line |
| Circadian alignment | Yes | No |
| Shutdown risk | Low | Higher |
| Side effect profile | Cleaner | More pronounced |
For injury recovery, Tesamorelin is preferred because it works with your body's timing rather than overriding it.
Adding Ipamorelin (Optional)
Ipamorelin is a ghrelin receptor agonist that extends the GH pulse window without spiking cortisol. It works synergistically with Tesamorelin:
- Tesamorelin provides the GHRH signal that initiates the GH pulse
- Ipamorelin reduces somatostatin brake and extends pulse duration
When to Consider Ipamorelin
| Add Ipamorelin If | Skip Ipamorelin If |
|---|---|
| Tesamorelin alone for 4+ weeks without expected improvement | Tesamorelin is working well |
| Higher-burden recovery (severe injury, high training load) | First cycle; want to assess Tesamorelin response |
| Need extended GH window | Concerned about IGF-1 elevation |
Evidence Note
There are no clinical trials specifically testing Tesamorelin + Ipamorelin for injury recovery. The combination is based on:
- Tesamorelin monotherapy trials (VAT, NAFLD, lipodystrophy)
- Ipamorelin pharmacology studies
- Classical GHRH + GHS synergy physiology
Treat the combination as mechanistically plausible but not directly validated.
Dosing Protocol
| Compound | Dose | Frequency | Route | Timing | Notes |
|---|---|---|---|---|---|
| Tesamorelin | 1–2 mg | Nightly | SubQ | 30–60 min before sleep | 2+ hours after last meal |
| Ipamorelin (optional) | 200–500 mcg | Nightly | SubQ | With Tesamorelin | Add after 4 weeks if needed |
Titration
| Phase | Dose | Duration |
|---|---|---|
| Start | 1 mg nightly | 2–4 weeks |
| Increase | 1.5–2 mg nightly | If needed after 2–3 weeks |
| Adjust | EOD dosing | If IGF-1 runs high or side effects |
Implementation Notes
- Timing is critical: Inject at least 2 hours after your last meal (carbs and fats blunt GH release)
- 30–60 minutes before sleep is optimal to align with slow-wave stages
- Check IGF-1 at weeks 4 and 8 to keep levels physiologic (high-normal, not supraphysiologic)
- Can co-inject Tesamorelin + Ipamorelin in the same syringe
- Do NOT mix with NAD+ (pH incompatible)
Weekly Schedule (Example)
If running with base protocol, continue base compounds. Add:
| Compound | Mon | Tue | Wed | Thu | Fri | Sat | Sun |
|---|---|---|---|---|---|---|---|
| Tesamorelin | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM |
| Ipamorelin (if using) | 300 mcg PM | 300 mcg PM | 300 mcg PM | 300 mcg PM | 300 mcg PM | 300 mcg PM | 300 mcg PM |
Standalone use (sleep timing is the primary issue):
| Compound | Mon | Tue | Wed | Thu | Fri | Sat | Sun |
|---|---|---|---|---|---|---|---|
| Tesamorelin | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM | 1.5 mg PM |
Timeline: What to Expect
Weeks 1–2
| What's happening | GH timing beginning to consolidate |
| What you notice | More restorative sleep; waking less stiff |
| Challenge | Stay consistent; effects are subtle at first |
Weeks 2–4
| What's happening | IGF-1 production stabilizing; collagen turnover becoming predictable |
| What you notice | Fewer "mystery flares" after rehab |
| Decision point | If not improving, verify timing and consider adding Ipamorelin |
Weeks 4–8
| What's happening | Sleep architecture and nocturnal anabolism stable |
| What you notice | Recovery predictable; strength gains stick |
| Lab check | IGF-1 at week 4 and 8; adjust dose if supraphysiologic |
Weeks 8–12
| What's happening | Tissue consolidation; strength approaching baseline |
| What you notice | Progress continues without regression |
| Decision point | Continue, taper, or transition to maintenance |
Monitoring
| Timepoint | Tests | Target |
|---|---|---|
| Baseline | IGF-1, fasting glucose, HbA1c, lipids | Establish reference |
| Week 4 | IGF-1 | High-normal range |
| Week 8 | IGF-1, glucose | Critical decision point |
| Ongoing | Symptoms, sleep quality | Adjust based on response |
IGF-1 targets:
- Goal: Physiologic high-normal (age-adjusted upper quartile)
- Concern: >350–400 ng/mL (consider dose reduction)
- Avoid: Supraphysiologic elevation (acromegalic range)
Managing Side Effects
| Issue | Primary Mitigation | Secondary Options |
|---|---|---|
| Edema (fluid retention) | Dose-related; usually transient | Reduce dose if persistent |
| Injection site reactions | Rotate sites | Use isotonic bacteriostatic water |
| Tingling/numbness (carpal tunnel-like) | Dose reduction | EOD dosing |
| Joint/muscle aches | Usually transient (first weeks) | Monitor; reduce if persistent |
| Mild arthralgia | Monitor; usually resolves | Reduce dose if bothersome |
Metabolic notes:
- IGF-1 elevation is expected—this is the mechanism working
- Glucose: Small shifts possible; monitor if diabetic or pre-diabetic
- Lipids: Generally improve
Contraindications
Do not use if:
- Active malignancy or history of cancer (IGF-1 can promote tumor growth)
- Proliferative retinopathy
- Pregnancy or breastfeeding
Use with medical supervision if:
- Uncontrolled diabetes or severe insulin resistance
- History of pituitary disorders
- Advanced cardiovascular disease
Sports compliance: Tesamorelin and Ipamorelin are prohibited by WADA/USADA. Competitive athletes need team physician guidance.
What Comes Next
Signs Tesamorelin Is Working
- Restorative sleep stable ≥2 weeks
- Waking less stiff; dreams more vivid
- Recovery becomes predictable (fewer mystery flares)
- Strength gains stick after rehab sessions
- No swelling after moderate/heavy sessions
If Issues Persist
If you've optimized GH timing but still experience relapse under load (progress then flare with increased training intensity), consider the SS-31 add-on for mitochondrial stability.
If neuropathic symptoms persist (burning, tingling, allodynia), consider ARA-290 for small-fiber nerve support.
Maintenance Options
After 8–12 weeks:
- Taper off if recovery goals met
- Periodic cycles (4–6 weeks every 6–12 months) for long-term resilience
- Reduced frequency (EOD or 3× weekly) for maintenance
FAQ
What's the difference between Tesamorelin and HGH?
Tesamorelin stimulates your pituitary to release its own GH in natural, circadian-aligned pulses. HGH replaces your production with synthetic hormone in flat-line, non-pulsatile elevation. For injury recovery, Tesamorelin's preserved pulsatility and circadian alignment make it generally preferred.
How long until I notice something?
Sleep quality often improves in 1–2 weeks. Recovery predictability improves by weeks 3–4. Strength consolidation becomes apparent by weeks 6–8.
Do I need to fast before injection?
Yes. Inject at least 2 hours after your last meal. Carbohydrates and fats blunt GH release, reducing Tesamorelin's effectiveness.
Can I use Tesamorelin without BPC-157/TB-500?
Yes, if sleep timing is your clear bottleneck and structural repair is progressing. Tesamorelin works independently but is often more effective layered on foundational repair.
What if sleep doesn't improve on Tesamorelin?
- Verify timing (30–60 min before sleep, 2+ hours fasted)
- Check sleep hygiene basics (darkness, temperature, consistency)
- Consider adding Ipamorelin
- Rule out other causes (sleep apnea, chronic pain, anxiety)
- Check labs—if IGF-1 isn't rising, reassess source/storage
Can I use Ipamorelin without Tesamorelin?
You can, but they work better together. Tesamorelin provides the GHRH signal that initiates the GH pulse; Ipamorelin extends and amplifies it. Using Ipamorelin alone still produces GH release but without the same circadian synchronization.
How do I know if Tesamorelin is working?
Early signs (weeks 1–2): More restorative sleep, vivid dreams, waking less stiff.
Later signs (weeks 3–6): Recovery becomes predictable, fewer mystery flares, strength gains stick, less regression after heavy sessions.
Are there long-term risks?
Tesamorelin has been studied in multi-year trials for HIV lipodystrophy with a reasonable safety profile. Primary theoretical concerns:
- IGF-1 elevation in contexts where growth signals are harmful (undiagnosed malignancy)
- Prolonged supraphysiologic IGF-1 (monitor and adjust)
IGF-1 monitoring helps keep levels physiologic. Most practitioners use 8–12 week cycles with breaks rather than indefinite use.
Do I need to cycle Tesamorelin?
Yes. Standard protocols run 8–12 weeks on, followed by 4–8 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.
A note on TB-500 vs TB-4 in the base protocol
If you're running the base protocol that includes TB-500: most vendors selling "TB-500" are actually selling full TB-4 (thymosin β4). Check your Certificate of Analysis—molecular weight ~800 Da is the fragment, ~4,900 Da is the full protein. Both work for tissue repair; the dosing recommendations account for either.
Related Guides
- 5-Compound Base Protocol — The foundation this layers onto
- BPC-157 + TB-500 Protocol — Simpler foundational option
- ARA-290 for Nerve Pain — Small-fiber nerve support
- SS-31 Add-On — Mitochondrial stability
- Tesamorelin for Recomposition — Body composition focus
References
- Tesamorelin Phase 3 VAT trial (HIV lipodystrophy): NEJM 2010
- Tesamorelin in abdominal obesity with reduced GH: PMC3513535
- Tesamorelin and hepatic fat (NAFLD): Lancet HIV 201930021-8)
- GHRH+GHS synergy physiology: [Veldhuis 2009, deconvolution analyses]
This content is for educational purposes only. Tesamorelin is FDA-approved for HIV lipodystrophy only; other uses are off-label. Ipamorelin is not FDA-approved. Peptide therapy requires medical supervision. Consult a qualified healthcare provider before starting any protocol.