Tesamorelin Dosing: 1mg 5on/2off Protocol

Tesamorelin is a synthetic GHRH analog that stimulates endogenous growth hormone production. It is the only FDA-approved treatment for reducing visceral fat in HIV-associated lipodystrophy, with Phase III trial data showing both visceral fat reduction and increased lean body mass.

FDA-approved for HIV lipodystrophy. Off-label community use is growing but lacks equivalent clinical evidence. This is not medical advice.

Quick Reference: Standard Protocol

Standard protocol: 1 mg subcutaneous, 5 days on / 2 days off, for 8 weeks on / 8 weeks off. For the full tesamorelin profile, vendor pricing, and stacking options, see our tesamorelin peptide page.

Cycling Details

The 5on/2off schedule gives receptors periodic rest while maintaining consistent GH stimulation throughout the work week. The 8-week cycle length balances efficacy with cost management and receptor sensitivity.

Morning or evening dosing both work — pick one and stay consistent. Fasted injection may slightly optimize GH response. Tesamorelin does not use a loading phase; start at 1 mg from day one.

Enhanced Protocol (Clinical/FDA)

Note: The standard protocol above follows the cheat sheet at 1 mg. The FDA-approved protocol below uses the higher clinical dose.

The FDA protocol runs continuously at 2 mg/day. Community protocols use 1 mg with cycling to manage cost and receptor sensitivity while still achieving meaningful GH elevation. Discontinuation leads to visceral fat regain regardless of dose. To estimate your total spend per cycle, see our tesamorelin cycle cost calculator.

Routes of Administration

Subcutaneous (only route): Abdomen is the FDA-approved injection site — rotate left/right sides. Avoid scar tissue, bruises, and the navel area. Use 27-30 gauge, 1/2 inch needle.

Reconstitution Quick Reference

10 mg vial + 2 mL BAC water = 5 mg/mL. Your 1 mg dose is 20 units on an insulin syringe. One vial lasts 10 doses.

Swirl gently — do not shake. Refrigerate at 2-8°C and use within 28 days.

Where These Numbers Come From

Tesamorelin has robust Phase III clinical trial data — unusual among peptides covered here.

Pivotal Phase III Trial (Falutz et al., 2010): 816 HIV-infected patients received 2 mg daily SC for 26 weeks. Results showed ~18% reduction in visceral adipose tissue (CT-measured), improved body image scores, and no significant glucose perturbation. Effects reversed upon discontinuation.

Metabolic Benefits (Stanley et al., 2012): Visceral fat reduction was associated with improved triglycerides and cholesterol ratios. Patients also showed significant increases in lean body mass alongside fat reduction — true body recomposition.

Liver Benefits (Falutz et al., 2014): Reduced liver fat and improved ALT, suggesting hepatoprotective effects beyond visceral fat alone.

The community standard of 1 mg represents a 50% reduction from the FDA dose, accounting for cost management and the principle that GHRH analogs show meaningful effects across a range of doses. The 5on/2off schedule prevents receptor desensitization.

Stacking Protocols

Tesamorelin + Ipamorelin (GHRH + GHRP)

Synergistic GH release through complementary pathways. Do not combine with other GHRH analogs (sermorelin, CJC-1295) — same receptor.

Tesamorelin + Semaglutide

Dual approach to body composition — different mechanisms, complementary effects.

Side Effects & Safety

• Injection site reactions — erythema, pruritus, irritation (~10% in trials)
• Arthralgia — joint pain, mild to moderate
• Peripheral edema — mild fluid retention
• Paresthesias — tingling/numbness in hands (carpal tunnel-like, GH-mediated)
• Glucose monitoring — GH can antagonize insulin; no significant perturbation at 26 weeks in trials
• IGF-1 monitoring — levels should be checked periodically per FDA labeling
• Contraindicated with active malignancy, pregnancy, and hypothalamic-pituitary disruption

Frequently Asked Questions

What is the standard tesamorelin dose?

1 mg subcutaneous, 5 days on / 2 days off, cycled 8 weeks on / 8 weeks off. Draw 20 units from a 10 mg vial reconstituted with 2 mL BAC water.

What is the FDA-approved tesamorelin dose?

2 mg subcutaneous once daily, continuous use. This is the only protocol with Phase III clinical trial support, validated in HIV-associated lipodystrophy.

How quickly does tesamorelin reduce visceral fat?

Phase III trials measured ~18% visceral fat reduction at 26 weeks. Some response may be detectable by 8-12 weeks, but the full effect requires sustained use.

Does tesamorelin build muscle?

Yes. Sustained GH release drives protein synthesis via IGF-1, and clinical trials showed significant increases in lean body mass alongside visceral fat reduction.

How does tesamorelin compare to sermorelin?

Both are GHRH analogs. Tesamorelin has FDA approval, Phase III data, and a stability modification. Sermorelin is older, less potent, but significantly cheaper. Both stimulate endogenous GH through the same receptor.

How do I reconstitute tesamorelin?

Add 2 mL BAC water to a 10 mg vial (5 mg/mL). 1 mg = 20 units on an insulin syringe. Swirl gently, refrigerate, use within 28 days.

Related Guides

• Tesamorelin Benefits — 6 research-backed effects including visceral fat reduction and cognition
• Tesamorelin Results Timeline — Week-by-week timeline from first injection to 6 months
• Tesamorelin Reconstitution Guide — Step-by-step mixing with dilution charts
• Sermorelin Dosing Guide — Alternative GHRH analog, lower cost
• CJC-1295 + Ipamorelin Guide — GHRH + GHRP combination protocols
• Ipamorelin Dosing Guide — Clean GHRP for stacking with GHRH analogs
• GHRH vs GHRP — Understanding the two GH-releasing pathways
• Calculate Your Tesamorelin Cycle Cost — Estimate vials needed and total cost
• Peptides and TRT: 8 Synergies That Amplify Results — How tesamorelin pairs with TRT
• Best Peptides for Muscle Growth (2026) — All 10 muscle-building peptides ranked

References

For educational and research purposes only. This is not medical advice. Tesamorelin is FDA-approved for HIV-associated lipodystrophy; off-label use should be discussed with a physician.