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: 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.

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; 52-week extension, 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.

Enhanced Protocol (Clinical/FDA)

Note: The standard protocol above reflects the common community protocol 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. 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): 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 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 — levels should be checked periodically per FDA labeling
• 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.