Tesamorelin Dosage: Complete Dosing and Protocol Guide [2026]

Master tesamorelin dosing, visceral fat reduction protocols, and advanced stacking strategies for optimal body composition results.

Understanding Tesamorelin

Tesamorelin is a synthetic growth hormone-releasing hormone (GHRH) analog that's FDA-approved for treating HIV-associated lipodystrophy. Unlike sermorelin, tesamorelin has a much longer half-life and produces more sustained growth hormone elevation, making it exceptionally effective at targeting visceral fat—the dangerous abdominal fat surrounding your organs.

Tesamorelin's primary claim to fame is its specific ability to reduce visceral adiposity. Clinical trials in HIV patients showed 25-40% reductions in visceral fat over 26 weeks while having minimal impact on subcutaneous fat. This targeted fat loss mechanism makes tesamorelin the peptide of choice for anyone seeking to reduce belly fat and improve central body composition, particularly those with metabolic syndrome or central obesity patterns.

The peptide was originally developed for HIV patients experiencing lipodystrophy (abnormal fat redistribution), but it's become increasingly popular among athletes, bodybuilders, and anti-aging practitioners. Tesamorelin's strength compared to other GH peptides is its exceptional visceral fat-targeting ability, while its drawback is a higher incidence of side effects like joint pain compared to milder peptides like sermorelin.

Standard Tesamorelin Dosing

The standard and most effective tesamorelin dose is 2 milligrams (2mg) administered once daily via subcutaneous injection. This translates to 14mg per week. Clinical trials supporting visceral fat reduction used 2mg daily, making this the evidence-backed dose for measurable results. A 2mg dose produces consistent 25-40% visceral fat reductions when combined with a reasonable diet and exercise program.

Some advanced users increase dosing to 2.5-3mg daily for enhanced fat loss results, though this increases side effect risk without proportional benefit increases. Conversely, doses below 1.5mg daily generally produce minimal measurable visceral fat reduction, though some users report improved recovery and energy at lower doses.

Most practitioners recommend consistent daily dosing rather than cycling on and off throughout the week. Tesamorelin's extended half-life allows for daily dosing that produces stable growth hormone elevation. Unlike some compounds that require cycling to prevent tolerance, tesamorelin works better with consistent daily administration for the full duration of your cycle.

Reconstitution and Storage

Tesamorelin arrives as a lyophilized (freeze-dried) powder and requires reconstitution before use. The reconstitution process is straightforward but must be done carefully to preserve peptide integrity.

For a standard 6mg vial, use 3mL of bacteriostatic water to create a concentration of 2mg/mL. This makes dosing simple: drawing 1mL provides exactly 2mg. Alternatively, if your vial contains 6mg and you use 2.24mL of bacteriostatic water, you'll create a concentration of approximately 2.68mg/mL, giving you 2mg per 0.75mL of solution. The first method (3mL per 6mg) is simpler for most users.

To reconstitute, start by swabbing both the tesamorelin vial and bacteriostatic water vial tops with sterile alcohol pads. Draw the appropriate amount of bacteriostatic water into a sterile syringe. Inject the water slowly into the tesamorelin vial at an angle—never inject straight down, as this causes excessive foaming. Allow the vial to sit for 2-3 minutes without shaking. The powder will slowly dissolve into a clear solution. Gentle rolling of the vial is acceptable if needed to speed dissolution, but never shake vigorously.

Store reconstituted tesamorelin at 2-8°C (standard refrigerator temperature) and never freeze. The reconstituted solution remains stable for approximately 30 days if stored properly. Always use sterile syringes and needles for both reconstitution and injection to prevent bacterial contamination.

Injection Technique and Best Practices

Tesamorelin is administered as a subcutaneous injection, identical to sermorelin. Choose injection sites with adequate subcutaneous fat: lower abdomen (avoid directly over abs), upper outer thigh, or back of the arm. Pinch a fold of skin and inject at a 45-90 degree angle until you feel slight resistance indicating you're in the subcutaneous layer, not muscle.

Inject slowly over 3-5 seconds and maintain consistent injection site rotation daily to prevent lipohypertrophy (abnormal fatty tissue thickening) or lipoatrophy (tissue degeneration). Rotate between at least 4-6 different injection sites in different areas. This reduces inflammation, improves absorption consistency, and prevents localized tissue damage.

The optimal injection time is evening, 30-60 minutes before bed, as this aligns with your body's natural growth hormone pulse during sleep. However, unlike sermorelin, tesamorelin's extended half-life means timing is slightly less critical—morning or afternoon injections will still work, though evening remains preferable. Avoid injecting into scar tissue, bruised areas, or regions with visible inflammation.

Most users find that 25-29 gauge needles work well for tesamorelin injection. Some prefer 31 gauge for minimal tissue trauma, though these require steady hands. Never use dull or reused needles, as these increase injection site reactions and tissue trauma.

Cycle Duration and Protocol Structure

Standard tesamorelin cycles last 12-16 weeks. The FDA-approved clinical trial for HIV lipodystrophy was 26 weeks, but most practitioners find that 12-16 weeks is optimal for healthy individuals seeking visceral fat reduction. This duration allows sufficient time for your body to respond with measurable visceral fat loss and other benefits while minimizing potential long-term side effects.

Most results become visible around week 6-8, with peak visceral fat loss occurring at weeks 12-16. If you're using tesamorelin as part of a body composition transformation, combining it with a structured resistance training program and moderate caloric deficit accelerates results dramatically. The peptide's effects compound with proper nutrition and exercise.

After completing a 12-16 week cycle, take 4 weeks off before starting another cycle. This allows your natural growth hormone production to normalize and prevents receptor downregulation. Some practitioners recommend taking slightly longer breaks (6-8 weeks) between tesamorelin cycles due to its more potent effects compared to sermorelin, though this isn't essential for most users.

Visceral Fat Reduction Mechanism and Results

Tesamorelin's visceral fat-targeting mechanism relates to how growth hormone affects different fat tissue types. Growth hormone preferentially mobilizes visceral fat (deep abdominal fat surrounding organs) over subcutaneous fat (fat under the skin) due to differences in growth hormone receptor density between these tissues.

Clinical data from HIV lipodystrophy trials shows visceral fat reductions of 25-40% over 26 weeks with 2mg daily tesamorelin, often while subcutaneous fat remains relatively stable. This selective fat loss pattern makes tesamorelin ideal for reducing metabolic risk markers: it lowers insulin resistance, improves glucose metabolism, reduces inflammation markers, and improves lipid profiles—all benefits of visceral fat reduction.

Real-world results vary based on baseline visceral fat amount, diet quality, exercise consistency, and genetics. Users with significant visceral fat accumulation see faster and more dramatic results. Those already lean experience slower, more subtle visceral fat reduction. Combining tesamorelin with a caloric deficit and regular resistance training (particularly high-intensity interval training) maximizes visceral fat loss while preserving lean muscle mass.

HIV-Associated Lipodystrophy and Medical Use

Tesamorelin is FDA-approved specifically for treating HIV-associated lipodystrophy, a condition where antiretroviral medications cause abnormal fat redistribution: fat accumulates in the abdomen, back of the neck, and breasts while being lost from the face, arms, and legs. This condition increases cardiovascular risk and metabolic dysfunction significantly.

For HIV patients with documented lipodystrophy, tesamorelin is considered standard medical care. The peptide selectively reduces visceral fat accumulation without interfering with antiretroviral medication effectiveness. HIV patients on stable antiretroviral regimens can safely use tesamorelin at 2mg daily for extended periods (clinical trials lasted 26+ weeks) with regular monitoring.

Non-HIV users employing tesamorelin for body composition purposes follow similar protocols but typically use shorter 12-16 week cycles with breaks between cycles. Medical supervision is recommended for anyone using tesamorelin, particularly those with diabetes risk factors or baseline elevated glucose, as tesamorelin can modestly increase blood glucose in susceptible individuals.

Side Effect Management and Monitoring

Tesamorelin is generally well-tolerated, but side effects occur more frequently than with milder peptides like sermorelin. The most common side effects are injection site reactions (mild redness, swelling, itching), facial flushing, and headaches. These typically resolve within the first 1-2 weeks as your body adapts.

Joint pain and carpal tunnel-like symptoms are more pronounced with tesamorelin due to its stronger GH-stimulating effects. Growth hormone increases fluid retention in joints, and rapid GH elevation can cause inflammation. If you experience significant joint pain, reduce your dose by 25-50%, ensure adequate hydration (3-4 liters daily), add collagen or glucosamine supplementation, and increase sleep.

Tesamorelin can modestly elevate blood glucose and increase diabetes risk in susceptible individuals. Monitor fasting glucose and HbA1c every 4-6 weeks if you have metabolic risk factors. If glucose rises above 125 mg/dL fasting, reduce tesamorelin dose or discontinue until blood glucose normalizes.

Rare but serious side effects include rapid heart rate, elevated blood pressure, or severe headaches. These warrant immediate dose reduction or discontinuation and medical evaluation. Most side effects manage well through dose adjustment, proper hydration, and ensuring injections are truly subcutaneous (not intramuscular).

Combination and Advanced Stacking Protocols

Tesamorelin stacks effectively with several compounds. The most popular combination is tesamorelin (2mg daily) with ipamorelin (100-200mcg daily). These synergistically increase growth hormone through different mechanisms: tesamorelin acts as GHRH while ipamorelin acts as a GHSR agonist. This stack produces superior visceral fat loss and enhanced recovery compared to either peptide alone.

Some advanced users stack tesamorelin with low-dose CJC-1295 (100mcg twice weekly), though this more aggressive combination increases joint pain risk. This triple mechanism—tesamorelin (GHRH), ipamorelin (GHSR), and CJC-1295 (long-acting GHRH)—produces maximal GH elevation for elite athletes, though cost and side effects increase substantially.

Tesamorelin also combines well with joint-supportive peptides like BPC-157 or TB-500 to mitigate joint pain. These can be injected at different sites and times. Some users stack tesamorelin with lower doses of direct IGF-1 peptides (approximately 30-50mcg daily), though this significantly increases cost and requires very careful monitoring.

Results Tracking and Monitoring

Track tesamorelin results through multiple methods. The most practical is weekly waist circumference measurement at your navel level—this correlates closely with visceral fat changes. Most users see 1-2 inch reductions in waist circumference within 8-12 weeks.

The gold standard for measuring visceral fat loss is DEXA scanning (every 12 weeks) or computed tomography (CT) or magnetic resonance imaging (MRI) at the start and end of your cycle. These imaging methods precisely quantify visceral fat volume reduction. DEXA is more accessible and costs $100-200 per scan.

Blood work should include IGF-1 levels every 4-6 weeks (normal ranges 116-358 ng/mL depending on age), fasting glucose, HbA1c (to assess diabetes risk), and lipid panels. Tesamorelin should increase IGF-1 by 25-40% over 8-12 weeks. If IGF-1 doesn't increase after 6 weeks despite proper technique and storage, verify peptide quality or consider dose increases.

Monitor subjective improvements in energy, recovery, sleep quality, and training performance. These often improve within 2-3 weeks even before measurable visceral fat loss becomes apparent. If you notice no visceral fat reduction after 8-12 weeks despite proper dosing and technique, evaluate your diet adherence and exercise consistency, as tesamorelin amplifies results from proper training and nutrition but can't overcome a poor lifestyle.