Tesamorelin (10 mg)

At a Glance

Tesamorelin is a synthetic growth hormone-releasing hormone (GHRH) analogue with a trans-3-hexenoic acid modification for DPP-4 resistance. FDA-approved as EGRIFTA for HIV-associated lipodystrophy, it stimulates endogenous pulsatile growth hormone release from the pituitary, increasing IGF-1 levels and preferentially mobilising visceral adipose tissue.[1]

• Reconstitute: Add 3.0 mL bacteriostatic water → 3.33 mg/mL concentration.
• Standard dose: 1–2 mg once daily, subcutaneous (abdomen), preferably in the evening.
• Easy measuring: At 3.33 mg/mL on a U-100 syringe, 1 unit = 0.01 mL ≈ 33.3 mcg. A 2 mg dose = 60 units / 0.60 mL.
• Storage: Lyophilised: refrigerate at 2–8 °C; reconstituted: refrigerate at 2–8 °C; use within 4 weeks.

Overview

• Goal: Stimulate endogenous pulsatile GH release to reduce visceral fat, improve body composition, and increase IGF-1 levels.[1]
• Schedule: Once-daily subcutaneous injection (abdomen) for 12–26 weeks.
• Dose range: 1–2 mg daily.
• Reconstitution: 3.0 mL BAC water per 10 mg vial → 3.33 mg/mL.
• Injection site: Abdomen only (per FDA label); rotate within the abdominal area.

What You’ll Need

Plan based on a 12-week cycle at 2 mg daily (84 injections, 168 mg total).

• Tesamorelin Vials (10 mg each): 168 mg needed ÷ 10 mg per vial → 17 vials.
• Insulin Syringes (U-100, 1 mL): 84 injections → 84 syringes.
• Bacteriostatic Water (10 mL bottles): 3.0 mL per vial → 6 × 10 mL bottles.
• Alcohol Swabs: 2 per injection → 168 swabs per 12-week cycle.

How to Reconstitute

1. Allow refrigerated lyophilised vial to reach room temperature (10–15 minutes).
2. Draw 3.0 mL bacteriostatic water with a sterile syringe.
3. Inject slowly down the inner vial wall; do not spray directly onto the powder.
4. Roll gently in hands for 30 seconds or swirl in a circle until dissolved — do not shake. Solution should be clear.
5. Label with reconstitution date; refrigerate at 2–8 °C. Avoid freeze-thaw cycles. Use within 4 weeks.

Dosing Schedule

Begin at 1 mg daily for the first week to assess tolerance, then increase to 2 mg daily. Evening administration aligns with natural nocturnal GH pulsatility. The 10 mg vial provides 5 days at the 2 mg dose or 10 days at the 1 mg dose. Tesamorelin has a very short elimination half-life (8–11 minutes), but its downstream effects on GH release and IGF-1 elevation persist for hours.[1]

Protocol Details

• Week 1: 1 mg (30 units / 0.30 mL) once daily in the evening — tolerability assessment.
• Weeks 2+: 2 mg (60 units / 0.60 mL) once daily in the evening — standard dose.[1]
• FDA-approved dose: 1.4 mg daily (EGRIFTA SV).
• Cycle: 12–26 weeks; clinical trials support up to 52 weeks with monitoring.

Storage

• Lyophilised: Refrigerate at 2–8 °C (35–46 °F); protect from light.
• Reconstituted: Refrigerate at 2–8 °C. Avoid freeze-thaw cycles. Use within 4 weeks.
• Appearance: Clear solution. Discard if cloudy, coloured, or particulate.

How Tesamorelin Works

Tesamorelin is a 44-amino acid synthetic GHRH analogue with a trans-3-hexenoic acid modification at the N-terminus that confers resistance to DPP-4 enzymatic degradation, extending its effective signalling window.[1]

It binds GHRH receptors on pituitary somatotroph cells, stimulating the release of endogenous growth hormone in a pulsatile, physiological manner. The elevated GH increases hepatic IGF-1 production and enhances lipolysis, with preferential mobilisation of visceral fat through upregulation of lipolytic enzymes and beta-adrenergic receptor sensitivity in visceral adipocytes. Unlike exogenous GH injection, tesamorelin preserves the body’s natural feedback loops and pulsatile GH secretion pattern.[2]

Good to Know

• Administer in the evening to align with the natural nocturnal growth hormone pulsatility.
• Inject into the abdomen only (per FDA prescribing information); rotate to different areas of the abdomen.
• Monitor IGF-1 levels during therapy; persistent elevations may warrant dose adjustment.
• Tesamorelin stimulates endogenous GH release (unlike exogenous GH), preserving natural pulsatile secretion patterns.
• Monitor fasting glucose — tesamorelin may affect glucose tolerance in some individuals.
• Contraindications: Active malignancy, pregnancy, hypersensitivity to tesamorelin, disruption of hypothalamic-pituitary axis.
• Visceral fat reduction: FDA-approved for reducing excess abdominal fat in HIV-associated lipodystrophy; 26-week studies show significant visceral adipose tissue reduction.[1]
• Body composition: Increases skeletal muscle area and density alongside fat reduction.[2]
• Lipid profile: May improve triglycerides and cholesterol ratios.
• Side effects: Injection site reactions (erythema, pruritus, pain), arthralgia, myalgia, peripheral oedema, carpal tunnel syndrome symptoms.
• Metabolic monitoring: May cause glucose intolerance; monitor fasting glucose during prolonged use.
• One of few FDA-approved peptides — more clinical safety data available than most research peptides.
• For background on Tesamorelin's mechanism, evidence, and safety profile, see What Is Tesamorelin?.

Tips for Best Results

• Combine with regular resistance training to maximise the muscle-building effects of elevated GH/IGF-1.
• Maintain a moderate caloric deficit if fat loss is the primary goal — tesamorelin enhances lipolysis but does not replace dietary control.
• Adequate sleep (7–9 hours) is critical — the majority of GH secretion occurs during deep sleep.
• Monitor carbohydrate intake; tesamorelin may affect glucose metabolism.
• Avoid eating within 2 hours of injection — insulin blunts GH secretion.

Injection Tips

• Clean the vial stopper and injection site with separate alcohol swabs; allow both to air-dry fully before proceeding.
• Using a 29–31 gauge insulin syringe (5/16″ to 1/2″ needle), draw the calculated dose precisely.
• Pinch a fold of skin and insert the needle at 45° into subcutaneous fat (90° is acceptable with a short needle into a well-pinched fold).
• Inject slowly over 2–3 seconds; do not aspirate. Withdraw the needle, apply gentle pressure, and do not rub the site.
• Rotate injection sites (abdomen, thighs, upper arms) and dispose of each syringe in a sharps container immediately after use.