Tesamorelin

Tesamorelin (Inj)

Tesamorelin is a synthetic growth hormone–releasing hormone (GHRH 1–44) analog approved for reduction of excess abdominal fat in HIV-associated lipodystrophy. It increases endogenous pulsatile GH secretion, raising IGF‑1 and influencing body composition and lipid metabolism.

Dosing Protocols

— 5 mg Vial —

Reconstitute: Add 2.5 mL bacteriostatic water per 5 mg vial → 2.0 mg/mL concentration.
Standard dose: 2 mg once daily (with 1 mg titration week).
Easy measuring: At 2.0 mg/mL, 1 unit = 0.01 mL = 20 mcg on a U-100 insulin syringe.
Storage: Lyophilized: refrigerate at 2–8 °C; reconstituted: refrigerate and use within 7 days.

Schedule: Daily subcutaneous injections for 12–26 weeks (extendable to 52 weeks with medical supervision).
Cycle Length: 12–26 weeks; clinical trials support up to 52 weeks with monitoring.
Goal: Reduce visceral adipose tissue and improve lipid profiles through sustained GH/IGF-1 elevation.

Frequency: Inject once daily subcutaneously, preferably in the evening to coincide with nocturnal GH release. The 2 mg daily dose is the standard FDA-approved regimen for HIV lipodystrophy.

Phase	Dose	Syringe (U-100)
Week 1	1 mg / 1000 mcg	50 units (0.50 mL)
Weeks 2–12+	2 mg / 2000 mcg	100 units (1.00 mL)

— 10 mg Vial —

Reconstitute: Add 3.0 mL bacteriostatic water per 10 mg vial → ~3.33 mg/mL concentration.
Standard dose: 2 mg once daily (with 1 mg titration week).
Easy measuring: At 3.33 mg/mL, 1 unit = 0.01 mL ≈ 33.3 mcg on a U-100 insulin syringe.
Storage: Lyophilized: refrigerate at 2–8 °C; reconstituted: refrigerate and use within 7 days.

Schedule: Daily subcutaneous injections for 12–26 weeks (extendable to 52 weeks with medical supervision).
Cycle Length: 12–26 weeks; clinical trials support up to 52 weeks with monitoring.
Goal: Reduce visceral adipose tissue and improve lipid profiles through sustained GH/IGF-1 elevation.

Frequency: Inject once daily subcutaneously, preferably in the evening to coincide with nocturnal GH release.

Phase	Dose	Syringe (U-100)
Week 1	1 mg / 1000 mcg	30 units (0.30 mL)
Weeks 2–12+	2 mg / 2000 mcg	60 units (0.60 mL)

— 20 mg Vial —

Reconstitute: Add 3.0 mL bacteriostatic water per 20 mg vial → ~6.67 mg/mL concentration.
Standard dose: 2 mg once daily (with 1 mg titration week).
Easy measuring: At 6.67 mg/mL, 1 unit = 0.01 mL ≈ 66.7 mcg on a U-100 insulin syringe.
Storage: Lyophilized: refrigerate at 2–8 °C; reconstituted: refrigerate and use within 7 days.

Schedule: Daily subcutaneous injections for 12–26 weeks.
Cycle Length: 12–26 weeks; clinical trials support up to 52 weeks with monitoring.
Goal: Reduce visceral adipose tissue and improve lipid profiles through sustained GH/IGF-1 elevation.

Frequency: Inject once daily subcutaneously, preferably in the evening to coincide with nocturnal GH release.

Phase	Dose	Syringe (U-100)
Week 1	1 mg / 1000 mcg	15 units (0.15 mL)
Weeks 2–12+	2 mg / 2000 mcg	30 units (0.30 mL)

Benefits

• Reduces visceral adipose tissue in HIV-associated lipodystrophy (approved indication)
• Increases endogenous GH pulse amplitude
• May improve lipid parameters in some populations
• May reduce liver fat in NAFLD research contexts
• Potential improvements in body composition (fat distribution)

Mechanism of Action

Acts as a GHRH receptor agonist in the pituitary, stimulating GH secretion in a more physiologic pulsatile pattern than exogenous GH. Increased GH raises hepatic IGF‑1, promoting lipolysis and altering fat partitioning, particularly visceral fat.

Side Effects

• Injection site reactions
• Arthralgia
• Peripheral edema
• Myalgia
• Carpal tunnel symptoms
• Headache
• Nausea
• Increased IGF-1 (may be excessive)
• Glucose intolerance (possible)

Side Effect Management

• Rotate injection sites
• Monitor IGF‑1 and adjust per protocol
• Monitor fasting glucose/A1c
• Stop and evaluate if significant edema, numbness/tingling, or joint pain develops

Contraindications

• Active malignancy
• Pregnancy
• Disruption of hypothalamic-pituitary axis (unless supervised)
• Acute critical illness
• Hypersensitivity

Research Citations

PubMed/DOI-linked citations for verification. Many studies are preclinical (animal/in-vitro) or early clinical.

1. Falutz J et al. Tesamorelin reduces visceral fat in HIV-infected patients with abdominal fat accumulation: a randomized trial. DOI Link
2. Stanley TL et al. Effects of tesamorelin on hepatic fat and metabolic parameters in HIV (study). DOI Link
3. Koutkia P et al. Growth hormone–releasing hormone and lipodystrophy (review). DOI Link

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