Metabolic Reset
Designed to support lean composition and metabolic health.
TesamorelinMOTS-COptional: NAD+
Peptide therapy · GHRH analog
Tesamorelin, FDA-approved GHRH analog for visceral fat reduction.
Tesamorelin occupies a precise clinical niche: an FDA-approved growth hormone-releasing hormone (GHRH) analog that specifically targets excess visceral adipose tissue, the metabolically active fat that accumulates deep in the abdomen. Unlike recombinant human GH, tesamorelin works by stimulating your pituitary to release its own growth hormone in physiologic pulses, preserving the body's natural regulatory feedback. This distinction matters clinically.
What it is
Tesamorelin is a synthetic 44-amino-acid analog of growth hormone-releasing hormone (GHRH), modified at the N-terminus with a trans-3-hexenoic acid group for improved stability against endogenous peptidase degradation.
It is manufactured as Egrifta and Egrifta WR (approved March 2025, requiring weekly rather than daily reconstitution) by Theratechnologies. The FDA-approved indication is the reduction of excess visceral adipose tissue (VAT) in adults with HIV-associated lipodystrophy. Tesamorelin is sometimes compounded as a 503A product for off-label non-HIV use, though the branded FDA-approved product is available and generally preferred given its established manufacturing standards.
How it works
Tesamorelin binds GHRH receptors on somatotroph cells in the anterior pituitary, stimulating them to release growth hormone (GH) in a pulsatile, physiologic pattern. This in turn raises insulin-like growth factor-1 (IGF-1).
Why the distinction from recombinant HGH matters. Recombinant human growth hormone (rhGH) delivers GH directly, producing non-pulsatile supraphysiologic peaks that override natural feedback regulation. Tesamorelin preserves the pituitary's own pulsatile secretion pattern, respecting the IGF-1 feedback axis. This is thought to reduce the risks associated with sustained high GH exposure (glucose intolerance, joint swelling, acromegalic features) compared with rhGH at equivalent doses.
The GH/IGF-1 rise produced by tesamorelin drives lipolysis specifically in visceral adipose tissue, without apparent effect on subcutaneous fat. The pivotal LIPO-001 trial (Falutz et al., NEJM 2007; n=412 HIV-positive patients with lipodystrophy) demonstrated approximately 15 to 18 percent reduction in visceral fat versus placebo at 26 weeks. Stanley et al. (2014; n=48, abdominally obese non-HIV adults) reported approximately 9 percent VAT reduction in a single small trial.
Conditions and use cases
Where tesamorelin has a clinical role.
- FDA-approved: excess visceral adipose tissue in adults with HIV-associated lipodystrophy on stable antiretroviral therapy.
- Off-label: abdominally obese non-HIV adults with metabolic syndrome, based on limited RCT data (one small trial). Requires informed consent and shared decision-making.
- Tesamorelin does not significantly reduce total body weight or subcutaneous fat. It targets visceral fat specifically.
- Patients seeking total body weight reduction should consider GLP-1 therapy, which has substantially more robust evidence.
Expected timeline
What patients commonly observe.
Week 0 to 2
IGF-1 rise begins
IGF-1 starts climbing toward plateau by week 4. Injection site reactions are the most common early effect.
Week 2 to 4
IGF-1 plateau
IGF-1 reaches plateau by week 4. Glucose monitoring established.
Month 1 to 3
VAT reduction measurable
Visceral fat reduction measurable by CT or DEXA at week 12.
Month 3 to 6
Peak VAT reduction
Peak VAT reduction (~15 to 18 percent in the LIPO-001 HIV trial) at week 26. VAT and IGF-1 normalize toward baseline after discontinuation.
Stacks that include this therapy
Tesamorelin appears in this stack.
Investment and access
Care plans, not menus.
Genesis Longevity therapies are dispensed only after a complimentary consultation and Good Faith Exam. Schedule yours to receive a personalized plan tailored to your biology and goals.
Side effects
What patients commonly report.
Common. Injection site reactions (redness, pain, swelling) in approximately 30 to 40 percent of trial patients. Arthralgia and myalgia. Peripheral edema (fluid retention).
Metabolic. Glucose intolerance and potential new-onset hyperglycemia. Monitoring with HbA1c every 3 months is required. IGF-1 elevation above 3× ULN in approximately 5 percent of patients requires dose adjustment or discontinuation.
Contraindications
Who should not use this therapy.
Show contraindications
Active malignancy. GH/IGF-1 axis activation raises theoretical concern.
Pituitary disease, hypopituitarism, or pituitary tumor history. GHRH stimulation may be ineffective or contraindicated.
Pregnancy. Category X. Disrupts glucose homeostasis.
Diabetic retinopathy. GH-axis activation may worsen retinopathy.
Hypersensitivity to tesamorelin or mannitol (excipient).
Pairs well with
Therapies that complement this protocol.
- 503A compounded
NAD+ Injection
Cellular energy, cognitive function, and systemic antiaging support.
Moderate evidence - Research peptide
MOTS-C
Mitochondrial efficiency, metabolic flexibility, and endurance.
Weak evidence - FDA-approved
TRT (Testosterone)
Lab-guided testosterone restoration for men.
Strong evidence
Frequently asked
Frequently asked questions about Tesamorelin.
No. Tesamorelin specifically targets visceral fat. It does not reliably reduce total body weight or subcutaneous fat. Subcutaneous fat and overall weight typically remain stable.
Off-label only. One small RCT (n=48) suggests modest VAT reduction in non-HIV abdominal obesity. The FDA-approved indication remains HIV lipodystrophy. Off-label use requires shared decision-making and informed consent acknowledging the limited evidence base.
No. VAT and IGF-1 return toward baseline after discontinuation. Maintenance therapy is typically required for sustained effect.
Tesamorelin can raise fasting glucose and worsen insulin sensitivity, particularly in those with prediabetes or insulin resistance. Glucose monitoring every 3 months is required, and it is contraindicated in diabetic retinopathy.
Tesamorelin stimulates your pituitary to release your own GH in physiologic pulses. Recombinant HGH delivers GH directly, bypassing the pituitary's regulatory feedback and producing non-physiologic peak levels.
Standard dosing is 2 mg subcutaneous daily (Egrifta SV) or Egrifta WR (weekly reconstitution, smaller injection volume). Injected into the abdomen with site rotation. All dosing is provider-determined following a Good Faith Exam.
Sources
Citations & references
- [1]MedlinePlus, Tesamorelin drug information. Source
- [2]Wikipedia, Tesamorelin. Source
- [3]Contagion Live, FDA approves Egrifta WR (F8 formulation) March 2025. Source
- [4]Premera Medical Policy 5.01.530, Tesamorelin coverage criteria. Source
- [5]DrugBank, Tesamorelin. Source
- [6]Falutz J et al. NEJM 2007;357:735–47 (LIPO-001 RCT, pivotal HIV lipodystrophy trial).
- [7]Stanley TL et al. J Clin Endocrinol Metab 2014;99:3071–8 (non-HIV abdominally obese RCT).
Status & disclosures
- FDA-approved on-label · off-label use disclosed
- Tesamorelin (Egrifta and Egrifta WR) is FDA-approved for excess visceral adipose tissue in adults with HIV-associated lipodystrophy. Off-label use for visceral adiposity in non-HIV patients requires shared decision-making and disclosure of limited RCT data.
- Compounding alternative
- 503A compounded tesamorelin is sometimes used off-label, though the branded FDA-approved product is generally preferred for its established manufacturing standards.
- WADA banned
- Tesamorelin is on the World Anti-Doping Agency Prohibited List in some categories. Athletes subject to WADA testing should not use this therapy.
- Provider supervision required
- Therapy requires a Good Faith Exam, IGF-1 and glucose monitoring, and ongoing provider supervision. Educational information on this page is not medical advice.
Next step
Talk to a Genesis provider about Tesamorelin.
Schedule a consultation. Physician-led, evidence-graded.
Or keep reading: See the Metabolic Reset stack