How to dose tesamorelin

Tesamorelin dosing: the essentials

• The protocol starts out at 0.25 mg a day by the subcutaneous route, with upward titration to a maximum of 2 mg a day
• The research cycle lasts for 8–12 weeks, followed by 4 weeks off
• An evening injection, 30–60 minutes before going to sleep, aligns the peak of the peptide with the largest endogenous GH pulse that the body produces, the one that comes with deep sleep
• The pre-filled 32 mg pen marks the dose directly in milligrams: the 32 in the name is the total amount of compound that the pen carries, not the dose
• Rotate the injection sites between four areas of the abdomen and the hip, keeping a minimum of 2 cm from the previous puncture, and avoid using the same quadrant within any 96-hour period
• Store it at 2–8 °C and protected from light: 24 months unopened and 12 months from the first puncture; without a refrigerator it lasts for 30 days at room temperature (maximum 30 °C). Do not freeze it
• As of 2026, tesamorelin is not authorised as a medicine in the EU; it is supplied for research use only

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Tesamorelin is dosed by the subcutaneous route once a day. The research protocol starts at 0.25 mg a day and titrates upwards to a maximum of 2 mg a day, given in the abdomen and, in the best case, timed so as to take advantage of the deep-sleep GH pulse, which concentrates the greater part of the 24-hour secretion of GH [5]. Starting at the low step reduces the reactions at the injection site and makes it possible to detect fluid retention or any dysregulation of glucose at an early stage.

The cycle is set at 8–12 weeks of administration followed by 4 weeks off. This is the structure of a research protocol, and not a treatment regimen of any kind [7].

As of 2026, tesamorelin is not authorised as a medicine in the EU [6].

What tesamorelin is and how it works

Tesamorelin is a synthetic 44-amino-acid analogue of human growth hormone-releasing hormone (GHRH), modified at the N-terminus with a trans-3-hexenoic acid group so that it resists cleavage by dipeptidyl peptidase IV and has a longer plasma stability than native GHRH(1-44) [1]. It binds to the GHRH receptors on the somatotrophs of the pituitary and triggers an endogenous release of GH, with the consequent rise in hepatic IGF-1, rather than supplying the hormone exogenously and directly [1][4].

That mechanistic distinction matters a great deal for the design of the protocol. Unlike somatropin, which floods the circulation with recombinant GH and suppresses hypothalamic-pituitary feedback, tesamorelin preserves the pulsatile secretion of GH and remains subject to the negative feedback of somatostatin and of IGF-1 [1]. The practical consequence is that the GH peaks follow the body's own circadian rhythm, so the timing of the injection in relation to the onset of deep sleep is not a minor detail but something of genuine relevance.

In pharmacokinetic terms, tesamorelin has a short plasma half-life following subcutaneous administration, of the order of 26–38 minutes, but it drives a sustained elevation of IGF-1 that justifies once-daily administration [1][4]. The reference clinical dose comes from the approval of Egrifta by the FDA in 2010, at 2 mg a day by the subcutaneous route for HIV-associated visceral adiposity, on the basis of the Falutz et al. study in NEJM 2007, which reported a reduction in VAT of ~15% versus placebo at 26 weeks [1]. That 2 mg figure is the anchor in the literature against which the modern Egrifta SV schedule of 1.4 mg is calibrated [1][4].

For anyone comparing GHRH analogues with GHRP combinations, see CJC-1295 vs ipamorelin.

The tesamorelin dosing protocol at a glance

The research protocol starts at 0.25 mg subcutaneously once a day and titrates upwards to a maximum of 2 mg a day. The cycle lasts for 8–12 weeks, and it is followed by 4 weeks off. The table below carries that structure over to the pen format that is the usual one for research material.

Tesamorelin is given once a day, normally in the evening, in order to align the ~26–38-minute pharmacokinetic peak with the GH pulses of deep sleep [5]. Anyone combining it with a GHRP should first compare CJC-1295 + ipamorelin dosing.

Why evening administration matters: the logic of the GH pulse

Evening administration aligns the tesamorelin peak with the largest endogenous GH pulse of the 24-hour cycle, which occurs at the start of deep sleep (slow-wave sleep, SWS). Van Cauter et al. (JAMA, 2000) reported that the greater part of daily GH secretion in healthy men is released during nocturnal SWS, with the dominant pulse tightly coupled to the very first episode of SWS, around 60–90 minutes after falling asleep [5]. That is the physiological window in which the somatotrophs are at their most sensitive.

The pharmacokinetics are what make that timing calculation manageable. Tesamorelin has a terminal plasma half-life of around 26–38 minutes after subcutaneous injection. Injecting 30–60 minutes before sleep places the maximum occupancy of the GHRH receptor in the pituitary in the very same window in which the somatotrophs are physiologically primed to discharge. The exogenous stimulus reinforces a pulse that is already programmed, rather than triggering another one that is out of phase.

Morning administration turns that logic on its head. On waking, the GH axis is in a trough dominated by somatostatin, with elevated cortisol and rising negative feedback from IGF-1. A GHRH analogue given in that state produces, at the same dose in milligrams, a smaller and more blunted pulse, without the SWS amplification of the IGF-1 response that follows. In the published literature there is no controlled study that compares morning tesamorelin against evening tesamorelin head to head, but the mechanistic rationale for evening administration is what underlies the before-sleep dosing convention of research protocols; the Falutz trials (NEJM 2007) and the Egrifta label specify only a once-daily subcutaneous injection, without fixing a time of day [1][4].

Practical timing window

Anyone running a combination of GHRH and GHRP should apply exactly the same circadian logic; see CJC-1295 vs ipamorelin for the receptor-level distinction before planning any co-administration.

The 32 mg tesamorelin pen: how the dose is dialled

Body Pharm's tesamorelin arrives in the form of a pre-filled multi-dose pen with a 3 ml cartridge. There is nothing at all to reconstitute: the dose dial marks the dose directly in milligrams, so the figure that you select is the amount that is delivered. The 32 in the name is the total amount of compound that the pen contains, not the dose.

Step-by-step procedure

1. Bring to room temperature. Take the pen out of the refrigerator and let it reach room temperature before injecting. A cold solution stings more at the moment of administration.
2. Check the appearance. The solution should be clear and colourless. Discard the pen if the solution is cloudy, yellowish or contains any particles.
3. Prepare the site. Clean the injection site with a 70% isopropyl alcohol wipe and let it dry fully.
4. Dial the dose. Select on the dose dial the number of milligrams that the protocol calls for: 0.25 mg at the start, the figure that you have titrated to afterwards, and never above 2 mg a day. There are no volume or concentration calculations involved at any point.
5. Administer and record. Inject subcutaneously, note down the dose and the site in the log, and put the pen back in storage at 2–8 °C.

For anyone planning a GHRH and GHRP combination with this protocol, the receptor-level rationale is in CJC-1295 vs ipamorelin, and the dosing that is specific to the combination is in CJC-1295 + ipamorelin dosing.

Reported parameters for subcutaneous administration

The published protocols and the clinical technique literature describe the subcutaneous administration of tesamorelin into the fatty tissue of the abdomen, the thigh or the lateral hip using a short needle of insulin gauge, with a flatter angle (around 45°) in leaner subjects (visible abdominal definition, BMI roughly below 22) and a steeper angle (around 90°) when the subcutaneous depth exceeds around 10 mm. The sequence below summarises the steps that are documented in the literature for daily doses that are dialled on a multi-dose pen.

1. Hand hygiene. The standard aseptic technique in the literature calls for washing the hands with soap and warm water for at least 20 seconds before touching the pen.
2. Site preparation. The protocols describe cleaning the injection site with a 70% isopropyl alcohol wipe in a single outward spiral and letting it dry for around 10 seconds, since, according to reports, injecting while the alcohol is still wet stings and affects the peptide along the track of the puncture.
3. Skin fold. The usual practice is to lift a 2–3 cm fold between the thumb and the forefinger in order to separate the subcutaneous layer from the underlying muscle.
4. Needle angle. The angles described range from around 45° in leaner subjects to around 90° where there is more subcutaneous tissue, an angle logic that matches the insulin-pen technique described in the general literature on diabetes.
5. Administration speed. In the literature, a slow, even administration over 3–5 seconds is associated with less local pressure and less weal formation than faster boluses are.
6. Withdrawal. The protocols describe withdrawing the needle at the same angle of entry, releasing the skin fold and pressing gently with dry gauze for 5–10 seconds; rubbing the site is associated with dispersion of the depot and with more bruising.
7. Needle disposal. Used needles go straight into a puncture-resistant sharps container; once full, the containers are disposed of in accordance with the local regulations.

Site rotation pattern

Rotate clockwise between four areas in order to avoid lipohypertrophy and drift in absorption: upper left abdomen (≥5 cm lateral to the navel), upper right abdomen, right lateral hip or outer thigh, left lateral hip or outer thigh. Within any one area, keep a minimum distance of 2 cm from the previous puncture and do not repeat the same quadrant within a 96-hour period. With the GHRH analogues, the abdominal sites offer the most reproducible absorption of all; the thigh and the hip serve as relief for the rotation, not as primary sites.

Storage and stability: keeping tesamorelin active

Tesamorelin is a peptide that is sensitive both to heat and to light, so refrigerated, light-protected storage from the moment of delivery through to the last dose is what keeps the potency stable over the course of a protocol. The pre-filled pen arrives ready to use, and it is always kept in the same temperature range, regardless of whether it has been started or not.

Discard the pen immediately on any of the following signs: cloudiness, visible particles, a yellowish tint or any other change in colour, or a history of freezing and thawing. Peptide aggregation is not always visible to the eye; a pen that has been through hot transport should be considered compromised even if the liquid looks clear.

If a GHRH + GHRP combination is being run alongside the tesamorelin, exactly the same cold-chain rules apply to the companion peptide. See the protocol notes in CJC-1295 + ipamorelin dosing for the storage logistics that are specific to the combination.

Tesamorelin versus other GHRH peptides: where it sits

Tesamorelin is the only GHRH analogue that has a completed phase III programme and an FDA-approved indication (HIV-associated lipodystrophy, 2 mg a day or 1.4 mg a day in Egrifta SV) [1][4], which gives it the most robust package of human data of any of the peptides in the class. Sermorelin and CJC-1295 never cleared that bar; ipamorelin, for its part, belongs to an entirely different mechanistic category.

The mechanistic separation matters when it comes to the design of the protocol. Tesamorelin and sermorelin both bind to the pituitary GHRH receptor and preserve endogenous pulsatility, so they fit cleanly into the rhythm of somatostatin. Ipamorelin acts on a different receptor, and that is why GHRH + GHRP combinations generate a supra-additive release of GH rather than a simple sum. To compare a combination with tesamorelin monotherapy, the CJC-1295 vs ipamorelin comparison deals with the mechanistic logic, and the details of the protocol are in CJC-1295 + ipamorelin dosing.

Research observations and reported outcomes

The published tesamorelin studies at 2 mg a day report a mean reduction in visceral adipose tissue (VAT) of ~15% over 26 weeks versus placebo in cohorts with HIV-associated lipodystrophy [1][2]. These are research observations made in one specific patient population, not end points that have been reproduced or claimed for Body Pharm's research product, and they are not results that should be carried over without reservation to healthy adults.

The core data come from Falutz et al. (NEJM, 2007), in which 412 subjects with HIV lipodystrophy received either 2 mg of tesamorelin a day subcutaneously or placebo for 26 weeks. The between-group difference in VAT at the L4–L5 level, as measured by CT, was approximately −13 to −15%, with a reduction in trunk fat and a minimal effect on limb fat [1]. IGF-1 rose significantly in the active arm relative to baseline, consistent with intact downstream pituitary signalling [1]. The pooled analysis of the two phase 3 trials with extension data (Falutz et al., J Clin Endocrinol Metab 2010) found that the reduction in VAT was maintained with continued treatment through 52 weeks, whereas discontinuation led to a return towards baseline [2].

Notice: all of the figures above describe published research in patients with HIV lipodystrophy. Body Pharm sells tesamorelin exclusively for laboratory research; no claim of efficacy or of safety is made for any human use whatsoever.

Frequently Asked Questions

Can tesamorelin be dosed twice a day?

There is no published clinical study that uses a schedule split into two administrations a day. Given the plasma half-life of ~26–38 minutes, but with sustained downstream signalling of GH and IGF-1, once-daily dosing is enough to trigger the pulse that is being sought; giving it twice a day would risk pituitary desensitisation with no efficacy data to justify it.

At what time of day should tesamorelin be injected?

In the evening, around 30–60 minutes before going to sleep. Van Cauter et al. (JAMA, 2000) reported that the greater part of daily GH secretion occurs during deep sleep, with the largest pulse at the start of SWS [5]. Giving it before sleep reinforces that endogenous pulse instead of having to overcome the daytime somatostatin tone.

How long does a typical tesamorelin research cycle last?

The research protocol is set at 8–12 weeks of administration followed by 4 weeks off. The published clinical studies ran for longer than that: Falutz et al. lasted 26 weeks at 2 mg a day, and the open-label extensions continued through to 52 weeks with a sustained reduction in VAT [1][2]. Those are trial data, not the structure of this protocol.

Does tesamorelin have to be used in cycles?

In this research protocol, yes: 8–12 weeks of administration and then 4 weeks off. It is a structure of the protocol, not a clinical indication; the published studies dosed continuously, and discontinuation reverses the VAT changes back towards baseline within a matter of months [2].

What is the difference between 0.25 mg and 2 mg?

0.25 mg a day is the starting step of the protocol, intended to check tolerability (injection-site reactions, fluid retention, the IGF-1 response). 2 mg a day is the ceiling of the protocol, which is reached only by titrating up to it. As a trial reference, 2 mg a day is also the dose that achieved the ~15% reduction in VAT in the 2007 NEJM study [1]. Anyone comparing GHRH options with GHRP combinations will also find the CJC-1295 vs ipamorelin comparison useful, or the CJC-1295 + ipamorelin dosing protocol for the design of the combination.

Research notice and legal disclaimer

Note as of 2026. All Body Pharm products, tesamorelin included, are supplied exclusively for in vitro research and analytical purposes. They are not intended for consumption by people or by animals, they are not for use as a medicine and they are no substitute for any medical advice.

As of 2026, tesamorelin is not authorised as a medicine in the EU [6]. Researchers are themselves responsible for complying with the applicable legal requirements and with the institutional and ethical frameworks that govern their work.

The dosing parameters discussed in this guide describe schedules taken from published clinical studies; they are not in any way a recommendation for personal use. For the context of adjacent protocols within this research group, see CJC-1295 vs ipamorelin and CJC-1295 + ipamorelin dosing.

Next steps

Tesamorelin research protocols start at 0.25 mg a day in order to establish a tolerability profile and titrate upwards from there, without going beyond 2 mg a day, in blocks of 8–12 weeks with 4 weeks off between them. It is worth having a cold chain ready before the shipment arrives, and defining a route for the disposal of the needles as well. For anyone considering a GHRH and GHRP combination, CJC-1295 vs ipamorelin describes the mechanistic rationale, and CJC-1295 + ipamorelin dosing covers the dosing and the timing of the combination.

Sources

1. Falutz J, et al. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med. 2007. pubmed.ncbi.nlm.nih.gov/18057338
2. Falutz J, et al. Effects of tesamorelin (TH9507), a growth hormone-releasing factor analog, in human immunodeficiency virus-infected patients with excess abdominal fat: a pooled analysis of two multicenter, double-blind placebo-controlled phase 3 trials with safety extension data. J Clin Endocrinol Metab. 2010. pubmed.ncbi.nlm.nih.gov/20554713
3. Stanley TL, et al. Reduction in visceral adiposity is associated with an improved metabolic profile in HIV-infected patients receiving tesamorelin. Clin Infect Dis. 2012. pubmed.ncbi.nlm.nih.gov/22495074
4. DailyMed (NIH), product label for Egrifta / Egrifta SV (tesamorelin), approved by the FDA in 2010 for HIV-associated lipodystrophy; approved posology. dailymed.nlm.nih.gov
5. Van Cauter E, et al. Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. JAMA. 2000. pubmed.ncbi.nlm.nih.gov/10938176
6. EMA, list of medicines for human use authorised in the EU (EPAR). ema.europa.eu — accessed in October 2026 for the compound's regulatory status.
7. Body Pharm dosing protocol for the tesamorelin pen (0.25 mg a day, up to 2 mg, cycles of 8–12 weeks) (supplier specification, reviewed in October 2026). Supplier research protocol, not a peer-reviewed study.