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Growth Hormone Axis

Tesamorelin

FDA-approved GHRH analog with the strongest human evidence of any GH-axis peptide for reducing visceral (organ) fat.

FDA approvedEvidence level 5 of 5: FDA-approved / large RCTsAlso: Egrifta, Egrifta SV, Egrifta WR, TH9507

Overview

Tesamorelin is a stabilized version of the full 44-amino-acid growth hormone-releasing hormone. It stimulates the pituitary to release growth hormone in natural pulses, raising IGF-1 within the normal range. It is FDA-approved to reduce abdominal visceral fat in people with HIV-associated lipodystrophy, where large randomized trials showed about a 15–18% reduction in visceral fat over six months. Smaller trials suggest it lowers liver fat and may improve executive function in older adults. Visceral fat tends to return after stopping. Because it is an approved drug with known dosing and safety data, it is the best-characterized option in the growth hormone class.

Classification
Synthetic 44-amino-acid GHRH analog, N-terminally stabilized (trans-3-hexenoyl)
Route
Subcutaneous (abdomen)
Half-life
~26–38 minutes (SC)

Mechanism of action

Primary targetGHRH receptor on pituitary somatotrophs
  1. Binds GHRH receptorStabilized N-terminus resists DPP-4 cleavage, prolonging receptor activation.
  2. Pulsatile GH secretionPituitary releases GH in physiologic pulses with feedback preserved.
  3. IGF-1 risesHepatic IGF-1 increases, typically remaining within the age-normal range.
  4. Visceral lipolysisGH preferentially mobilizes fat from visceral depots over subcutaneous fat.
  5. Hepatic fat reductionReduced liver lipid accumulation observed in HIV-associated fatty liver.
Downstream effects
  • Reduced visceral fat
  • Lower liver fat
  • Improved triglycerides
  • Possible cognitive benefit

Researched for

  • HIV-associated lipodystrophy (approved)
  • Visceral obesity
  • MASLD / fatty liver disease
  • Cognitive aging and mild cognitive impairment

Research notes

  • Phase 3 RCTs (Falutz 2007, 2010): visceral adipose tissue fell ~15–18% vs placebo at 26 weeks; regained after discontinuation.
  • RCT in HIV with fatty liver (Stanley 2019, Lancet HIV): reduced liver fat and less fibrosis progression over one year.
  • 20-week RCT in older adults (Baker 2012) showed improved executive function vs placebo; not yet replicated at scale.
  • Large trials outside HIV are lacking; modest glucose increases occur and require monitoring.

Reported side effects

  • Injection-site redness or itching
  • Joint and muscle aches
  • Peripheral edema
  • Hand numbness or tingling
  • Mild rise in blood glucose

Contraindications & cautions

  • Pregnancy
  • Disrupted hypothalamic-pituitary axis (pituitary tumor/surgery, head irradiation, hypophysectomy)
  • Active malignancy
  • Hypersensitivity to tesamorelin or mannitol

Lab monitoring

  • IGF-1
  • Fasting glucose and HbA1c
  • Lipid panel
  • Liver enzymes (and imaging if fatty liver)
  • Waist circumference / visceral fat imaging

Dosing and pricing for Tesamorelin

Dosing references and compound pricing are available to established patients in the secure portal after a medical evaluation.

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