Tesamorelin: The HIV Peptide for Extreme Fat Loss
By Jay Campbell
December 10th, 2020
Since my first book on testosterone replacement therapy was published in 2015, I have ALWAYS recommended the peptide Tesamorelin as one of the best fat loss agents in existence.
Not only is Tesamorelin an essential part of my daily supplement stack, but I have gone out of my way to mention it in every single book I’ve published:
But I have yet to give Tesamorelin the full “Jay Campbell” treatment:
A definitive guide telling you what Tesamorelin is, how it works, what it can do for you, and the BEST way to use it for extreme fat loss.
Keep reading and you’ll discover you will ever need to know about this Golden Age therapeutic peptide.
What is Tesamorelin?
Tesamorelin is a 44-amino-acid long peptide that was created as a synthetic analog of growth hormone-releasing hormone (GHRH), which is normally produced in the hypothalamus.
It stimulates the pituitary gland in your brain to increase your body’s natural production of growth hormone (GH).
Ben Greenfield does a great job of showing how Tesamorelin is different from other synthetic GHRH analogs:
“As you can see [from the above picture], it’s the same sequence as our own GHRH (in red all the way to the left), but with a leading tail having an attached trans-3-hexanoic acid.
In other words, tesamorelin is the 44 amino acid peptide GHRH, but with a slight chemical modification added to the start of the peptide… this modification was made to reduce the natural and rapid degradation of the peptides by enzymes [such as dipeptidyl aminopeptidase] in our bodies”
So what we have in effect is a GHRH analog that is more metabolically stable and potent than naturally-produced GHRH itself.
Tesamorelin is owned by Canadian pharmaceutical company Theratechnologies and was approved by the FDA in 2010 for the treatment of lipodystrophy (i.e. unusual body fat distribution) in HIV patients under the name “EGRIFTA”:
“This medication is used to reduce excess fat in the stomach area (abdomen) in people with HIV infection who have changes in the way their body fat is distributed.
Some HIV drugs may cause this side effect (increased fat in the upper back and stomach areas, decreased fat in the arms and legs)”
(Fun fact: In 2019, the FDA approved an “enhanced” version of EGRIFTA that requires a five-fold lower injection volume and remains stable at room temperature)
Believe it or not, lipodystrophy was one of the unwanted side effects that had arisen from the first line of HIV treatments developed in the 1990s:
“Since it first became available in the mid-1990s, highly active antiretroviral therapy (HAART) has saved lives and improved health and quality of life for countless people living with HIV — but the drugs are not without their downsides.
One of these became clear within a few years after HAART was introduced, when people taking the new drugs began to experience dramatic and disturbing body shape changes caused by shifts in where fat accumulates.”
And it was a SPECIFIC type of body fat being accumulated – visceral adipose tissue, to be exact:
“The associated gain in abdominal fat is largely attributed to visceral adipose tissue (VAT). This type of fat is deep in the abdomen and surrounds the organs, hence “visceral”.
This is different than subcutaneous fat which can be thought of as the “jiggly” fat underneath the skin. VAT is associated with numerous disease states such as insulin resistance (leading to Type 2 diabetes), hypertriglyceridemia (high trigylcerides), metabolic syndrome and heart disease.”
Typical pharmaceutical industry shenanigans – develop a treatment to treat one condition, and then develop a second treatment to treat the side effects of the first treatment!
And remember what we know about visceral body fat, the most inflammatory substance naturally produced in the human body.
And seeing as HIV patients were unable to lose this additional fat through conventional means such as diet and exercise, this accident resulted in the development of an exceptionally powerful fat loss agent.
Tesamorelin’s Mechanism of Action
Since I’ve written so prolifically about Tesamorelin, I’ll refer to The TOT Bible to summarize how Tesamorelin works:
“…increases IGF-1 levels in men. It binds and stimulates to GHRH receptors just as well as endogenous GHRH (i.e. GHRHs that naturally exist in the body).
“… exhibits interaction with the growth hormone releasing hormone (GHRH) receptor and ghrelin receptor and does not induce insulin resistance”
As you’ll see later, Tesamorelin’s mechanism of action is very similar to that of Ipamorelin.
But let’s dive deeper into why the inner workings of Tesamorelin are so effective for fat loss, which involves a deeper understanding of growth hormone:
“[Human growth hormone] is a hormone that the pituitary gland secretes. It can help enhance muscle growth and promote the loss of body fat.
It does so, in part, by stimulating the liver to release insulin-like growth factor-1 (IGF-1). In turn, IGF-1 triggers muscle protein production and muscle growth. It also appears to indirectly promote the breakdown of body fat”
Once growth hormone is secreted by Tesamorelin, the fat loss starts to happen:
“The released [growth hormone] then binds with the receptors present on various body organs and regulates the body composition. This regulation is mainly because of the combination of anabolic and lipolytic mechanisms.
However, it has been found that the main mechanisms by which Tesamorelin reduces body fat mass are lipolysis followed by reduction in triglycerides level”
(NOTE: Lipolysis is the process in which fat loss takes place via the break down of lipids and triglycerides)
And according to the official product monograph for Tesamorelin:
“No clinically significant changes in the levels of other pituitary hormones, including thyroid-stimulating hormone (TSH), luteinizing hormone (LH), adrenocorticotropic hormone (ACTH) and prolactin, were observed in patients receiving EGRIFTA in clinical trials. “
Tesamorelin is also a very fast-acting peptide with a half-life of just 8 minutes, so it will go to work immediately after you inject it into your body.
Top 7 Health Benefits of Tesamorelin
Although Tesamorelin is approved for treating lipodystrophy in HIV patients, 85 published studies on PubMed since 2003 indicate that it might be useful for a lot more than mere fat loss.
There are NUMEROUS benefits to using Tesamorelin for fully optimized health, and you’ll discover all of them if you keep on reading…
Tesamorelin is Supremely Effective For Fat Loss
No matter which way you look at it, Tesamorelin consistently shows amazing fat loss results in large-scale clinical trials:
“In placebo-controlled studies with more than 800 HIV-positive volunteers that lasted six months, daily injections (2 mg) of tesamorelin resulted in decreased visceral fat, reduced belly size and sometimes reduced levels of triglycerides in the blood”
Another review of three randomized controlled trials dives further into the specific of these results:
“The relative reduction in [visceral adipose tissue] (−12% to −20% across studies) and the absolute reduction in waist circumference (−1.3 to −1.8 cm) associated with tesamorelin treatment versus placebo exceeded the thresholds of 8% and 1 cm, respectively, that Health Canada considered to be minimal acceptable decreases that reflect clinical benefit.”
Ask any competitive bodybuilder who knows their stuff about peptides, and they’ll be the first to tell you that Tesamorelin = abs!
If you’re looking to target visceral fat in the trunk region (i.e. belly fat around the abdominal area), Tesamorelin is especially rapid in shredding fat when used in conjunction with any dieting approach involving long intervals of fasting.
It’s rather unfortunate that Tesamorelin is “not indicated for weight loss management (weight neutral effect)” by the FDA, as it would singlehandedly disrupt the multi-billion dollar weight loss industry!
Tesamorelin Can Be Used to Treat Poor Liver Health
In the past two years, a lot of data has come out about the therapeutic use of Tesamorelin to treat liver issues such as non-alcoholic fatty liver disease (NAFLD):
“One of the known comorbidities of HIV is non-alcoholic fatty liver disease (NAFLD), a condition characterized by excess liver fat in the absence of any significant alcohol consumption.
People with NAFLD often suffer from liver fibrosis, or scar tissue, which can impede liver function and lead to liver failure.
Antiretroviral therapy (ART) to treat HIV has been implicated in the development of excess abdominal fat, or lipodystrophy, which itself is a risk factor for NAFLD.”
It appears as if Theratechologies may have another medical condition where Tesamorelin could be worthy of FDA approval, according to the results of a randomized double-blind trial published in 2019:
“Results showed that after 1 year, participants receiving tesamorelin experienced better liver health than the placebo group.
According to the study, 35% of patients in the tesamorelin group achieved normal hepatic fat fraction compared with 4% in the in the placebo group. Grinspoon and colleagued reported that tesamorelin was well tolerated, reduced patients’ hepatic fat fraction and reduced odds of onset or worsening fibrosis.
Additionally, blood markers associated with inflammation and liver damage decreased among participants in the tesamorelin group.”
A review of two Phase III clinical trials conducted in 2018 also found that Tesamorelin led to significant reductions in alanine aminotransferase (ALT) levels, which are elevated when the liver is damaged.
And get this: Even when patients were switched to placebo after 26 weeks of using Tesamorelin, the positive changes lasted over an ADDITIONAL 26 weeks!
Tesamorelin May Enhance Cognition
For the older adults reading this article, frequent Tesamorelin use may lead to a boost in brain function.
This was confirmed in a 2008 randomized controlled trial examining the use of Tesamorelin in healthy older adults and those suffering from mild cognitive impairment (MCI):
“Both for healthy older adults and adults with MCI, tesamorelin improved performance on executive function tests of response inhibition and set-shifting, and a statistical trend also suggested tesamorelin-related improvements in working memory. On tests of memory, tesamorelin significantly improved delayed verbal recall for adults with MCI but not for healthy older adults.
This study is the first to demonstrate that short-term tesamorelin administration improves executive function for healthy and memory-impaired older adults, and has a favorable effect on verbal memory for adults with MCI who are at high risk of progression to Alzheimer’s dementia.”
The finding was confirmed in another controlled trial performed in 2012.
And just one year later, it became more apparent why Tesamorelin positively affects cognition:
“Twenty weeks of GHRH administration increased GABA levels in all 3 brain regions, increased [N-acetylaspartylglutamate] levels in the frontal cortex, and decreased [myo-inositol] levels in the posterior cingulate.
To our knowledge, this is the first evidence that 20 weeks of somatotropic supplementation modulates inhibitory neurotransmitter and brain metabolite levels in a clinical trial, and it provides preliminary support for one possible mechanism to explain favorable GHRH effects on cognition in adults with MCI and in healthy older adults.”
Unfortunately, I can’t provide any further comment on whether the same effects will be observed in healthy young adults between the ages of 25 and 45.
Tesamorelin Lowers Triglyceride Levels
If you want to live a long and happy life, it is imperative to keep your triglyceride levels under control:
“Triglycerides are a type of fat found in your blood. After you eat, your body converts the calories that you don’t need into triglycerides and stores them in your fat cells to be used for energy later.
While you do need triglycerides to supply your body with energy, having too many triglycerides in your blood can increase your risk of heart disease.
About 25% of adults in the US have elevated blood triglycerides, which is classified as having levels over 200 mg/dL (2.26 mmol/L). Obesity, uncontrolled diabetes, regular alcohol use and a high-calorie diet can all contribute to high blood triglyceride levels.”
Tesamorelin can help you lower your triglycerides to a healthy level of ~150 mg/dL, according to physicians at John Hopkins Medicine:
“Tesamorelin decreases abdominal fat by a modest 14-18% and significantly reduces triglycerides and non-HDL cholesterol in HIV+ pts with lipodystrophy. White patients and those with metabolic syndrome and triglycerides >150 mg/dL are more likely to respond.”
As you’ll see in the next benefit, there is another way in which Tesamorelin can be help improve your cardiovascular health.
Tesamorelin Shows Potential for Improving Heart Health
I highly doubt that Tesamorelin will ever be used for directly lowering one’s risk of cardiovascular disease (CVD), yet a small piece of information from one randomized clinical trial shows some hope:
In this trial, Tesamorelin reduced the thickness of the left carotid intima artery, which is important when you consider that a thicker artery is one of the earliest biomarkers of CVD:
“The amount of lesion in the common carotid artery (CCA) has been reported to correlate to the extent of atherosclerotic lesions elsewhere in the body.
Over more than two decades, [carotid intima–media thickness] has been extensively researched and explored for its medical and clinical viability, and available in clinically since 2002.
Several large, research-based cohort studies have clearly indicated a relationship between [carotid intima–media thickness] and [cardiovascular] events and emphasized its use.”
Makes perfect sense – an obese person who loses a significant amount of fat and weight ALWAYS sees improved heart health!
Tesamorelin Might be Useful for Peripheral Nerve Damage
For those of you who don’t understand how debilitating peripheral nerve damage can be, allow me to bring you up to speed:
“Peripheral neuropathy, a result of damage to the nerves outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body.
Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins. One of the most common causes is diabetes.
People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy.”
Tesamorelin has never been directly studied for this purpose, but research into therapies based on growth hormone indicate it might be useful:
“Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) have been shown to accelerate axonal regeneration, maintain proliferating Schwann cells, reduce muscle atrophy and thereby improve motor and sensory functional recovery following peripheral nerve injury in a number of studies.
Tesamorelin is a recently developed long-acting growth hormone releasing hormone (GHRH) analogue that may be an ideal therapeutic alternative.”
But as it stands now, there is no further interest in investigating Tesamorelin for the treatment of nerve damage.
Tesamorelin Leads to a Slight Increase in Muscle Mass
Although bodybuilders do not use Tesamorelin for muscle gain, some evidence suggests that Tesamorelin may increase skeletal muscle mass.
This was confirmed in an analysis of two randomized controlled trials in HIV patients (spanning 341 participants in total) who used Tesamorelin for 26 weeks:
“In models adjusted for baseline differences and treatment arm, tesamorelin was associated with significantly greater increases in density of four truncal muscle groups (coefficient 1.56-4.86 Hounsfield units; all p<0.005), and the lean anterolateral/abdominal and rectus muscles (1.39 and 1.78 Hounsfield units; both p<0.005) compared to placebo.
Significant increases were also seen in total area of the rectus and psoas muscles (0.44 and 0.46 centimeters2; p<0.005), and in the lean muscle area of all four truncal muscle groups (0.64-1.08 centimeters2; p<0.005).”
In plain English, Tesamorelin could be helpful in increasing both the amount of muscle and the density of muscle on your frame.
This makes sense when you consider that increasing growth hormone production leads to increased muscle mass, a phenomenon well-established by scientists for decades.
I have also noticed this myself when using Tesamorelin – on top of gaining muscular size, I also noticed my physique becoming bigger, “harder” and more vascular.
The Best Tesamorelin Dose For Shredding Stubborn Body Fat
Having used Tesamorelin myself to maintain single-digit body fat levels year-round, and recommended its use to thousands of private coaching clients, I have precise recommendations for dosing Tesamorelin.
The optimal dose of Tesamorelin for fat loss has previously been described in my book Guaranteed Shredded:
1 mg injected subcutaneously at night before bed (but at least 90 minutes after your last meal), and 1 mg injected subcutaneously upon waking up in the morning (ideally before fasted cardio or exercising).
If you’re going to inject Tesamorelin only once per day, inject it at night as recommended above.
With my female clients, a once-a-day injection of 1 mg of Tesamorelin works wonders for improving polyphasic sleep and night-time growth hormone production.
Ben Greenfield likes to use Tesamorelin on a “five day on, two days off” cycle and injects 1 mg subcutaneously in the morning while fasted before cardio.
I personally recommend people use Tesamorelin for no longer than 60 days in a row before taking a week-long break to cycle off.
And with respect to expectations, it takes roughly 4-6 weeks for noticeable changes in body composition (i.e. increase in lean muscle mass, decrease in visceral body fat, etc.).
If you are a person who is 20% body fat or higher, your results will not be as noticeable as someone who significantly less body fat upon initiation of Tesamorelin.
Combining Tesamorelin and Ipamorelin For Extreme Fat Loss
It is possible to use Tesamorelin and Ipamorelin together for fat loss?
The answer to that question is a resounding YES!
Both of them stimulate the release of growth hormone from the pituitary gland, albeit in slightly different ways.
The real difference between the two is that Ipamorelin is a growth hormone-releasing peptide (GHRP), whereas Tesamorelin is a modified version of growth hormone-releasing hormone (GHRH).
I talk more about the fundamental differences between Ipamorelin and Tesamorelin in the video below:
As for how to combine the two together to accelerate fat loss even further, one of the most common protocols can be found below:
- 100 mcg Ipamorelin in the morning and 1 mg of Tesamorelin before bed
- Cycle within the week for 5 days on and 2 days off (i.e. use both peptides from Monday to Friday)
- Follow the weekly cycle for 60 days before taking a month off
Personally, I could recommend taking Ipamorelin before working out to increase the release of growth hormone during your training session.
However, there are MANY more advanced strategies for using Tesamorelin and Ipamorelin at the same time.
All of them are discussed in this old TOT Revolution podcast with world-renowned peptide physician Dr. William Seeds:
Take from that what you will!
Tesamorelin’s Side Effects and Safety Profile
Since Tesamorelin is a drug officially approved by the FDA, it’s been thoroughly studied for its safety and any possible side effects that might arise from using it.
Even before Tesamorelin got the green light from the FDA in 2010, its long-term safety and effectiveness were well-established:
“Treatment with tesamorelin was generally well tolerated and resulted in sustained decreases in VAT and triglycerides over 52 weeks without aggravating glucose.
Though effects on VAT are sustained during treatment for 52 weeks, these effects do not last beyond the duration of treatment.”
Three clinical trials that took place before 2010 arrived at the same conclusion regarding the once-a-day use of 2 mg of Tesamorelin:
“The three randomized-controlled trials have proven that Tesamorelin is a safe and effective treatment for lipodystrophy in HIV patients.
It is because of these clinical trials that Tesamorelin was approved by the FDA on November 10, 2010 and it is currently the only alternative treatment for lipodystrophy in HIV patients besides surgery or diet and exercise”
And in cases where side effects do arise, they happen in less than 4% of HIV patients who were using Tesamorelin properly and consistently:
“Tesamorelin was generally well tolerated, with treatment-emergent serious adverse events occurring in <4% of patients during 26 weeks of therapy.
Most of these events were injection-site reactions or events known to be associated with growth hormone therapy (e.g. arthralgia, headache and peripheral oedema).”
These side effects are both rare in frequency and mild in their nature, with the most common ones being the following:
- Slight difficulty with falling asleep
- Night sweats
- Redness and itching at the site of injection
- Muscle aches
Overall… Tesamorelin is one of the safest therapeutic peptides in existence and you have absolutely nothing to worry about!
The #1 Source For Pharmaceutical-Grade Tesamorelin
As I mentioned earlier in this article, Tesamorelin is a prescription-only peptide that is given to HIV patients suffering from lipodystrophy.
Even if you were prescribed pharmaceutical-grade Tesamorelin in the form of the commercially available EGRFITA, you’re looking at a MINIMUM of $3,000/month.
I’ve even heard stories of EGRIFTA costing as much as $4,000 to $5,000 per month!
Our only hope for the price going lower is Theratechnologies’ patent on EGRIFTA expiring, which would allow for a generic version to be created for easier access and greater affordability to non-HIV patients.
However, that won’t happen until May 2023.
To make matters worse, recall that Tesamorelin is a 44-amino acid long peptide.
Since the FDA prohibits the compounding of “biologics” (i.e. anything longer than 40 amino acids), the purchase of Tesamorelin will be heavily restricted.
Until we arrive at the day where generic EGRIFTA is available for off-label prescription by health optimization doctors, or hosted by a legitimate peptides vendor, your only remaining option is the black market (and that’s not a route I advise going down).
So for the time being… you’re better off purchasing Ipamorelin from Limitless Life Nootropics.
(Use code JAY15 to get 15% off your order)
Additional Reading Resources For Tesamorelin
There’s not much else that can be said about Tesamorelin – everything you need to know about using the peptide for enhanced fat loss can be found in this article.
I did this video for everybody as a compendium to this article(for folks who refuse to read).
But if you’re truly interested in learning more about the many ways in which Tesamorelin can radically transform your physique and optimize your health, here are some helpful resources…
Dr. Rob Kominiarek, one of the world’s leading hormone optimization physicians, has been on my podcast to talk exclusively about how he uses Tesamorelin to help patients suffering from metabolic disorders (in combination with testosterone).
This podcast provides a good overview of Tesamorelin and compares it to other fat loss peptides:
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