Tesamorelin
Egrifta, GHRH analog
Checked Oct 28, 2026
The short answer
Proven in humans for body composition (belly fat) in adults without HIV lipodystrophy
Grade A for body composition in people without HIV, result mixed: two randomized trials measured it, one showing less body fat and one showing no significant change, and neither made belly fat its main question.
- Approved?
- Approved for: reduction of excess abdominal fat in HIV-infected adult patients with lipodystrophy (FDA, 2010, Egrifta; EGRIFTA SV label revised 2/2024, EGRIFTA WR approved March 2025).
- Safety: B, characterized
- Label risks are injection-site reactions, joint pain, fluid retention and glucose intolerance, and it raises IGF-1, so the label tells prescribers to monitor IGF-1 and to avoid it in active cancer and pregnancy.
We tried it. This is what happened.
- Tesamorelin and ipamorelin: water was the ceiling PausedI ran the growth-hormone pair with strict timing, cut the dose when the water came, and stopped when it would not leave.
The full answer: what it is for, the dose, the units
What people take it for: People without HIV take it for belly (visceral) fat and body composition, and some for sleep or thinking. The only approved use is reducing excess abdominal fat in adults with HIV lipodystrophy.
Does it work for body composition (belly fat) in adults without HIV lipodystrophy? A, proven in humans. Result: mixed.
Grade A for body composition in people without HIV, result mixed: two randomized trials measured it, one showing less body fat and one showing no significant change, and neither made belly fat its main question. For its approved use in HIV lipodystrophy it is grade A and it works. Cognition has been tested three times with mixed results, and we found no controlled trial showing a sleep benefit.
Approved for: reduction of excess abdominal fat in HIV-infected adult patients with lipodystrophy (FDA, 2010, Egrifta; EGRIFTA SV label revised 2/2024, EGRIFTA WR approved March 2025). That does not carry over to body composition, sleep or cognition in people without HIV. The label states it is not indicated for weight loss management. EGRIFTA WR (tesamorelin) prescribing information, DailyMed
Safety: B, characterized. Label risks are injection-site reactions, joint pain, fluid retention and glucose intolerance, and it raises IGF-1, so the label tells prescribers to monitor IGF-1 and to avoid it in active cancer and pregnancy.
Do not use if: Active malignancy; pregnancy; disrupted pituitary axis. Monitor IGF-1, glucose and PSA.
Could it be placebo? Trials in people with HIV lipodystrophy beat placebo on visceral fat, but for belly fat, sleep or cognition in people without HIV the controlled data are small or null, so a placebo effect cannot be ruled out.
The dose people use, and the units to draw
The label doses are 1.4 mg (EGRIFTA SV) or 1.28 mg (EGRIFTA WR) once daily, and trials used 1 mg to 2 mg daily; there is no label dose for use outside HIV lipodystrophy.
| Source | Dose | How often and how | Who it was for | Link |
|---|---|---|---|---|
| EGRIFTA SV prescribing information (FDA label) | 1.4 mg (0.35 mL of reconstituted solution) | Once daily, subcutaneous injection into the abdomen | HIV-infected adults with lipodystrophy and excess abdominal fat (approved use) | Section 2 Dosage and Administration; Highlights |
| EGRIFTA WR prescribing information (FDA label) | 1.28 mg (0.16 mL of reconstituted solution) | Once daily, subcutaneous injection into the abdomen | HIV-infected adults with lipodystrophy and excess abdominal fat (approved use) | Section 2 Dosage and Administration; Highlights |
| Falutz et al., N Engl J Med 2007 | 2 mgUse this dose | Once daily subcutaneous injection for 26 weeks versus placebo | 412 people with HIV and abdominal fat accumulation | Abstract: visceral fat fell 15.2% on tesamorelin and rose 5.0% on placebo |
| Stanley et al., JAMA 2014 | 2 mgUse this dose | Once daily subcutaneous injection for 6 months versus placebo | 50 randomized people with HIV and abdominal fat | Abstract: visceral fat -34 cm2 vs +8 cm2; liver fat net -2.9% |
| Stanley et al., Lancet HIV 2019 | 2 mgUse this dose | Once daily subcutaneous injection for 12 months versus placebo | 61 people with HIV and fatty liver | Abstract: hepatic fat fraction -4.1% absolute (37% relative) versus placebo |
| Baker et al., Arch Neurol 2012 | 1 mgUse this dose | Once daily subcutaneous injection 30 minutes before bedtime for 20 weeks versus placebo | 152 adults aged 55 to 87, healthy or with mild cognitive impairment, not selected for HIV | Abstract: cognition P=.03 (intent to treat), executive function P=.005 |
| Ellis et al., J Infect Dis 2025 | 2 mgUse this dose | Once daily subcutaneous injection for 6 months versus standard of care (open label, no placebo) | 73 people with HIV and abdominal obesity | Abstract: between-group cognition difference P=.673 |
| Stewart et al., eNeurologicalSci 2026 | 1 mgUse this dose | Daily for 10 weeks versus placebo | 22 adults with normal cognition to mild cognitive impairment | Abstract: not linked with significant changes in body composition, sleep, cognition or other measures |
Label and trial doses run from 1 mg daily (Baker 2012; Stewart 2026) to 1.28 mg (EGRIFTA WR label), 1.4 mg (EGRIFTA SV label) and 2 mg daily (Falutz 2007; Stanley 2014, 2019; Ellis 2025); only the two label doses are approved, and only for HIV lipodystrophy.
Earlier lines on the site about a lower evening dose and an evening pattern had no named non-seller source and are removed. A Huberman Lab episode with Dr. Craig Koniver gives a dose, but Koniver Wellness is a clinic that sells these therapies, so it was not used. The Huberman Lab episode with Dr. Abud Bakri (June 2026) mentions tesamorelin, but the auto-transcript we could read states no mg dose. We found no Examine or Attia tesamorelin dose statement. The registry record NCT03375788 (non-HIV fatty liver) lists conflicting dose fields (2 mg versus 1.4 mg), so no dose is given for it.
Reported by the named source, never prescribed by us.
How many units do I draw?
Use the calculator: units on the syringe equal the dose in mg divided by the mg per mL of your mixed vial, times 100 for a U-100 syringe. Open the dose calculator
Why it might work
- TesamorelinGHRH analog
- Pituitary GHRH-R
- Pulsatile GH ↑
- Visceral fat ↓proven
Assumed pathway, not shown in people.
Established, not assumed: tesamorelin is a GHRH analog, it tells the pituitary to release the body's own growth hormone in a relatively natural, pulsatile way, which reduces visceral fat. Proven in human trials.
The trials, claim by claim
Result tags: the cognition claim is graded A because three randomized trials exist, and tagged mixed because one found a benefit and two found none.
Reduces visceral fat in people with HIV lipodystrophy.
Result: worked
Phase 3 randomized trials showed ~15% visceral-fat reduction over 26 weeks versus placebo, the basis for FDA approval.
Falutz et al., NEJM 2007, pivotal Phase 3 (15.2% VAT/26 wk)Lowers liver fat in people with HIV and fatty liver.
Result: worked
In an HIV-population RCT, 2 mg daily for 12 months cut hepatic fat fraction ~37% versus placebo, with less fibrosis progression. A completed 51-person trial in people without HIV (results posted Nov 2025, not yet published) showed a median liver-fat change of -5.3% on tesamorelin versus +3.6% on placebo.
Stanley et al., Lancet HIV 2019, liver fat −37%/12 moImproves cognition. Human trials are mixed: a 2012 placebo-controlled trial found a benefit and two later trials found none.
Result: mixed
Three human randomized trials tested it. A 152-person placebo-controlled trial in older adults with and without mild cognitive impairment (1 mg nightly for 20 weeks, 2012) found a favorable effect on cognition, mainly executive function. A January 2025 open-label trial (73 people with HIV, 2 mg daily versus standard care, no placebo arm) found no significant cognitive difference between groups, and a 22-person placebo-controlled pilot reported in 2026 (1 mg daily for 10 weeks) found no significant change. The A grade reflects that multiple randomized trials exist; the results disagree, so whether it improves cognition is uncertain.
Ellis et al., J Infect Dis 2025, negative cognition RCTPooled RCTs in HIV lipodystrophy show tesamorelin lowers visceral fat by roughly 21 to 28 cm2 versus placebo, with higher discontinuation on drug.
Result: worked
Two independent 2026 meta-analyses of 4 to 5 placebo-controlled RCTs (up to 909 patients) support the visceral-fat claim above.
Meta-analyses, 2026 (PMID 42538058 and PMID 41545261)In adults with fatty liver and without HIV, 12 months of tesamorelin produced a larger median liver-fat decrease than placebo in a 51-person pilot.
Result: mixed
Registry results only (medians, no p-value, biopsy endpoints unchanged), single site, no peer-reviewed paper found. Treat as a signal, not a finding.
ClinicalTrials.gov NCT03375788, results posted 2025-11-20Risks and the label warnings
Adverse events
Well-characterized from registration trials: injection-site reactions, joint pain, peripheral edema, muscle pain. These are documented frequencies, not guesses.
Contraindications
Active malignancy; pregnancy; disrupted pituitary axis. Monitor IGF-1, glucose and PSA.
Theoretical concerns
Raises IGF-1, so cancer screening and monitoring are advised; can affect glucose metabolism. Don't stack with other GH-promoting peptides without physician oversight.
What nobody knows yet
Long-term outcomes in non-HIV populations are still being studied; two small cognition trials found no significant benefit, but both were underpowered.
What else could explain the result
Because it's prescribed and monitored, tesamorelin is less confounded than the wellness peptides, but body-composition users still typically combine it with training, GLP-1s or TRT, so isolate the variable if you want to know what it's doing for you.
Is the vial what it says?
Pharmaceutical tesamorelin (Egrifta / EGRIFTA WR) is FDA-regulated and arrives with manufacturer quality assurance, a major advantage over gray-market compounds. If sourced from a compounding pharmacy instead, apply the full COA standard and confirm the pharmacy's licensure.
Half-life and storage
Half-life: Short, tesamorelin clears quickly. The newer EGRIFTA WR formulation keeps the once-daily cadence but adds room-temperature stability and a smaller injection volume.
Once mixed: A pharmaceutical product with real manufacturer quality control, a major advantage over gray-market peptides. The original needs refrigeration and careful reconstitution; the room-temperature WR version is more forgiving (room-temp storage, lower injection volume).
What I noticed, and what people report
Case study
- Tesamorelin and ipamorelin: water was the ceiling PausedI ran the growth-hormone pair with strict timing, cut the dose when the water came, and stopped when it would not leave.
What people report
Volume of reports: moderate. A real body of reports, fairly consistent.
Moderate, more than MOTS-c, less than BPC-157; deep off-label threads plus on-label patient reviews.
Visceral-fat loss and IGF-1 rise converge and are self-policing, the community warns it hits visceral, not subcutaneous, fat.
Unusually checkable, a real FDA/clinical spine exists, but we keep the community-signal grade separate from that halo.
- Users and patients consistently report visceral and abdominal fat reduction, and here it is backed by trials, not just stories.
- Improved sleep and body composition are common reports.
- Injection-site reactions, joint aches, and fluid retention are the usual complaints, matching the trial data.
Reports are anecdote, not proof.
Can you tell if it is working?
Serial DEXA showing visceral-fat (VAT) reduction over 3-6 months is the direct, trial-proven proof it's working.
Bloodwork
A lab moves, but it's noisy, indirect, or off-target, treat it as a hint, not proof.
Tesamorelin is a GHRH analog that stimulates pulsatile pituitary GH release, which drives hepatic IGF-1 production. IGF-1 is a routine serum test, so the drug's on-target pharmacodynamic action (GH-axis stimulation) shows up clearly in standard bloodwork. The catch: a rising IGF-1 confirms the drug is biologically active and that the axis was engaged, but it is an indirect proxy for the actual therapeutic endpoint (visceral/liver fat loss), which was measured by CT imaging in every pivotal trial, not by blood.
A clear rise above the patient's own baseline (in the pivotal HIV-lipodystrophy trial IGF-1 rose ~81% from baseline at 26 weeks), staying within the top of the age/sex-adjusted range. This confirms target engagement (the GH axis was stimulated), not the clinical outcome itself.
GHRH analog -> pulsatile pituitary GH release -> hepatic IGF-1. IGF-1 is the standard integrated readout of GH-axis stimulation and the FDA-label-mandated monitoring analyte for this drug, but it is monitored chiefly for safety and reflects target engagement rather than the therapeutic fat-loss endpoint.
Draw baseline
before first dose
Retest
IGF-1 at 4-8 weeks (a rise can appear within ~2 weeks)
Read this before you spend on labs
Graded partial, not direct: IGF-1 is a cheap, orderable, on-target proxy and is the exact analyte the FDA label tells prescribers to monitor, so a rise reliably shows the drug is pharmacologically active in this person. But (1) IGF-1 confirms target engagement / GH-axis stimulation, not the intended clinical outcome; the actual therapeutic effect (visceral and liver fat loss) requires imaging or waist measurement, not blood. (2) The FDA monitors IGF-1 mainly for safety (keep it from exceeding the range, linked to theoretical cancer/IGF-1 risk), so interpret against an age/sex-adjusted range, not a fixed cutoff. (3) Glucose and HbA1c can WORSEN on tesamorelin because GH is diabetogenic; that is a safety signal, not evidence the drug is 'working.' The fasting-triglyceride drop seen in trials was dropped from this audit as an efficacy marker because it is diet-confounded, noisy, and not attributable per-person.
- Falutz et al., Metabolic effects of a growth hormone-releasing factor in patients with HIV, NEJM 2007 (IGF-1 +81%) - PMID 18057338
- Stanley et al., Effect of tesamorelin on visceral fat and liver fat in HIV, JAMA 2014 - PMID 25038357
- FDA EGRIFTA SV (tesamorelin) Prescribing Information - 'Monitor IGF-1 levels during EGRIFTA SV therapy'
Other ways to track it
DEXA with VAT software (Hologic CoreScan / GE Lunar iDXA), visceral adipose tissue (VAT), plus total lean mass as a secondary readout
A working course shows a measurable drop in VAT (and often a modest rise in lean mass). The pivotal HIV-lipodystrophy Phase 3 trials averaged roughly a 15% placebo-subtracted VAT reduction over 26 weeks, measured by CT/MRI; DEXA-VAT is the consumer-accessible surrogate for that same abdominal depot (well-correlated with CT but not the exact modality the trials used, so treat it as a close proxy). VAT moves slowly, so expect little at 4-6 weeks and the real signal by 3-6 months.
Tesamorelin is a GHRH analogue whose FDA-approved, trial-proven endpoint IS visceral-fat reduction. VAT is the actual therapeutic target, unlike IGF-1, which only confirms the GH axis was engaged, not that fat came off.
MRI-PDFF / 1H-MRS (gold standard) or FibroScan with CAP (widely accessible), hepatic fat fraction
Liver-fat percentage should fall on repeat imaging. In a dedicated HIV/NAFLD trial (Stanley et al., Lancet HIV 2019), 2 mg daily cut hepatic fat fraction by roughly a third over ~12 months on MR spectroscopy and slowed fibrosis progression. FibroScan CAP is the accessible but noisier surrogate; MRI-based imaging is the clean but costlier read. Changes are slow.
Reduced liver fat is a validated secondary effect of tesamorelin's GH-mediated lipolysis, studied specifically in a dedicated HIV/NAFLD imaging trial, a real, imageable efficacy signal, though secondary to VAT and needing specialized imaging.
Tape-measure waist circumference at the umbilicus (same landmark, morning, fasted)
Waist should trend down as VAT falls. It's a near-free at-home proxy but is confounded by subcutaneous fat, hydration, posture and meal timing, so treat a 1-2 cm wobble as noise and look for a sustained multi-week downtrend, not any single reading. Note: total scale weight typically stays roughly flat in trials because the drug redistributes fat rather than driving large net loss, so do NOT use body weight as an efficacy signal, track waist, not the scale.
Waist circumference correlates with visceral adiposity and was tracked alongside imaging in the trials; it's the honest stand-in when serial DEXA isn't available, not a substitute for it.
Bottom line
The clean, trial-proven readout is falling visceral fat on serial DEXA (VAT) over 3-6 months; blood IGF-1 only tells you the GH axis fired, not that fat is coming off. Liver-fat imaging captures a real secondary benefit, and a waist tape is the cheap home proxy (noisy, sub-Q-confounded), but ignore scale weight, which stays roughly flat since the drug redistributes rather than sheds mass. One safety caution: tesamorelin is diabetogenic, so a CGM or fasting glucose will often drift UP, that's a safety signal, not evidence it's working, so do not read glucose/CGM as an efficacy tracker. Sleep, VO2max, urine, stool, and genetics have no validated human efficacy proxy here.
Logging baseline vs retest is the whole game. The Truth Tracker is our free log for bloodwork, DEXA, genetics, and wearable data, bring your own numbers.
How to track itHistory
First documented human use: Well-documented. Studied in registrational human trials leading to FDA approval in 2010 for HIV-associated lipodystrophy; the room-temperature formulation EGRIFTA WR was FDA-approved in March 2025.
- 2010FDA approves tesamorelin (Egrifta) for HIV-associated lipodystrophy.
- 2010sRCTs extend the evidence to liver fat (NAFLD) in HIV populations.
- Jan 2025Open-label cognition RCT (versus standard care) reports no significant between-group benefit.
- Mar 2025EGRIFTA WR, a room-temperature, reduced-volume formulation (1.28 mg SC once daily), FDA-approved (available Sept 2025).
All sources
- Badran et al., Obes Res Clin Pract 2026, meta-analysis of 5 RCTs in HIV lipodystrophy
- Tesamorelin literature (PubMed)
- EGRIFTA WR prescribing information (DailyMed)
- EGRIFTA SV prescribing information (DailyMed)
- EGRIFTA SV (tesamorelin) prescribing information, DailyMed, label revised 2/2024(dose table)
- EGRIFTA WR (tesamorelin) prescribing information, DailyMed, label revised 3/2025(dose table)
- Falutz J et al. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med 2007;357:2359-70. PMID 18057338(dose table)
- Stanley TL et al. Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation. JAMA 2014;312:380-9. PMID 25038357(dose table)
- Stanley TL et al. Effects of tesamorelin on non-alcoholic fatty liver disease in HIV. Lancet HIV 2019;6:e821-e830. PMID 31611038(dose table)
- Baker LD et al. Effects of growth hormone-releasing hormone on cognitive function in adults with mild cognitive impairment and healthy older adults. Arch Neurol 2012;69:1420-9. PMID 22869065(dose table)
- Ellis RJ et al. Effects of tesamorelin on neurocognitive impairment in persons with HIV and abdominal obesity. J Infect Dis 2025;231:1230-8. PMID 39813152(dose table)
- Stewart CE et al. The effect of growth hormone-releasing hormone on cognition and brain connectivity in adults with cognition ranging from normal to mild cognitive impairment. eNeurologicalSci 2026. PMID 42382101(dose table)
Not medical advice. Grades reflect the evidence as of the date above and will change as data arrives. Reports from users are anecdote, not proof. Talk to a licensed clinician before you act on anything here.