Tesamorelin Dosage: 1mg/Day, 5 On/2 Off 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.

Research-context information only. Tesamorelin is the active ingredient in an FDA-approved product for HIV-associated lipodystrophy; research-peptide and compounded forms are not FDA-approved and are sold for research purposes only. Protocols, doses, and reactions reported below come from published clinical trials and self-reported community sources. This article reports what has been documented, not what should be done. Consult a licensed physician for personal medical decisions.

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

Quick Reference: Commonly Reported Community Protocol

Commonly reported community 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 is described in community sources as giving receptors periodic rest while maintaining consistent GH stimulation throughout the work week. The 8-week cycle length is described as balancing efficacy with cost management and receptor sensitivity.

Community protocols describe morning or evening dosing interchangeably; consistent timing is the documented standard approach. Fasted injection is commonly described in community sources as slightly optimizing GH response. Tesamorelin does not use a loading phase; documented protocols describe a direct 1 mg starting dose with no loading phase.

Continuous use versus cycling: what the trials documented

The community 8-on/8-off pattern is one approach; the clinical record describes another. In the Phase 3 program, tesamorelin was dosed at 2 mg subcutaneously every day for 52 continuous weeks with no scheduled breaks. IGF-1 reached its elevated plateau by week 26 and was maintained at that level through week 52, and visceral-fat reduction was sustained across the full year — the trials documented no tachyphylaxis (no loss of response over time) on continuous daily dosing (Falutz et al., 2007; Falutz et al., 2010). Trial data also documented that visceral fat re-accumulated after dosing stopped.

Community sources therefore describe two documented paths. Cycled use (commonly 8 weeks on, 8 weeks off) is typically described in the context of cost management and letting IGF-1 normalize between blocks. Continuous use mirrors the FDA-approved protocol, where the trial evidence for a sustained, non-attenuating response is strongest. In the trials, IGF-1 was monitored against the laboratory reference range, and published protocols described dose reduction when IGF-1 rose above it.

FDA-Approved Clinical Protocol (Higher Dose)

Note: The community protocol above reflects the commonly reported 1 mg dose. The FDA-approved protocol below uses the higher clinical dose.

The trial protocol ran continuously at 2 mg/day (the current label doses the newer formulation at 1.4 mg/day for similar exposure). Community protocols use 1 mg with cycling to manage cost and receptor sensitivity, with community sources reporting GH elevation; this dose has no Phase III data. In the Phase III extension, visceral fat re-accumulated after 2 mg dosing was discontinued. To estimate your total spend per cycle, see our tesamorelin cycle cost calculator. When you're ready to source, the tesamorelin buying guide covers which 4 of 7 vendors publish COA with mass spec verifying the 5,196 Da identity, plus vial-size selection (5mg vs 10mg).

Routes of Administration

Subcutaneous (only route): Trial protocols and FDA labeling describe rotating injection sites between left and right abdomen, with documented avoidance of scar tissue and the navel area. Community reconstitution guides note 27–30 gauge, ½ inch needle use.

Reconstitution Quick Reference

10 mg vial + 2 mL BAC water = 5 mg/mL. At that dilution, a 1 mg dose corresponds to 20 units on an insulin syringe. One vial lasts 10 doses.

Community protocols describe gentle swirling — not shaking — to avoid degradation, with storage at 2–8°C and use within 28 days.

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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., 2007): 412 HIV-infected patients received 2 mg daily SC for 26 weeks. Visceral adipose tissue fell ~15% (versus a ~5% rise on placebo), IGF-1 rose ~81%, lipids improved, and there was no significant glucose perturbation. A pooled analysis of two Phase 3 trials (806 patients) confirmed the effect and carried it through 52 weeks of continuous dosing without loss of response (Falutz et al., 2010). A separate safety-extension trial documented that visceral fat re-accumulated when dosing stopped (Falutz et al., 2010).

Metabolic Benefits (Stanley et al., 2012): In a post hoc analysis of the two Phase 3 trials, patients whose visceral fat fell by at least 8% had greater triglyceride reductions, improved adiponectin, and preserved glucose control over 52 weeks compared with non-responders. Lean body mass also rose 1.3 kg versus placebo on DXA in the second Phase 3 trial (Falutz et al., 2010).

Liver Benefits (Stanley et al., 2014): In a 50-patient RCT, 6 months of 2 mg daily reduced liver fat (net treatment effect −2.9% lipid-to-water ratio) alongside visceral fat. ALT did not change significantly; AST fell modestly versus placebo.

The community standard of 1 mg represents a 50% reduction from the FDA dose, accounting for cost management and community sources' view that GHRH analogs show effects across a range of doses; the Phase III data cover only 2 mg. The 5-on/2-off schedule gives receptors periodic rest within the work week; the trial-validated alternative, described above, is continuous daily dosing.

Stacking Protocols

Tesamorelin + Ipamorelin (GHRH + GHRP)

Synergistic GH release through complementary pathways. Pairing tesamorelin with another GHRH analog (sermorelin, CJC-1295) is generally described as redundant rather than synergistic — they act on the same GHRH receptor, so a second analog adds little once one saturates the response. The documented supra-additive effect comes from the GHRH + GHRP pairing above.

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 — FDA labeling describes periodic IGF-1 monitoring
• Contraindicated with active malignancy, pregnancy, and hypothalamic-pituitary disruption

mg to Units Conversion

On a standard 100-unit insulin syringe, each "unit" equals 0.01 mL (so 100 units = 1 mL). Once tesamorelin is reconstituted, the conversion from a target dose to syringe units depends on the chosen dilution.

The two reconstitution ratios most often described in community protocols are below.

Reconstitution A: 10 mg vial + 2 mL BAC water (5 mg/mL) — the standard dilution from the Quick Reference above.

Reconstitution B: 10 mg vial + 1 mL BAC water (10 mg/mL) — less BAC water for a lower total volume, so smaller draws and less fridge space.

These conversions reflect the dilutions documented in community reconstitution protocols. They report how the math is described, not a recommended dosing schedule.