Tesamorelin has the strongest visceral-fat data in the GH-secretagogue class, paired with ipamorelin’s clean GH pulse. Worth knowing up front: the combination has never been trialled as a stack, so the “most potent protocol” framing is inference, not a finding.
A combined GHRH + GHRP protocol that pairs tesamorelin (the FDA-approved GHRH analog originally used for HIV lipodystrophy visceral fat) with ipamorelin (the selective GHRP with no cortisol or prolactin side effects).
It is often described as a "premium CJC-1295 + Ipamorelin." Two things are worth separating there. Tesamorelin genuinely has what CJC-1295 lacks — FDA approval and randomised trials with imaging endpoints — and those trials show a real preferential effect on visceral fat. But the claim that it produces a stronger GH pulse than CJC-1295 has never been tested head-to-head, and neither has this stack as a stack. The trade-off in cost and reconstituted shelf life is real.
One qualifier that follows the visceral-fat and liver-fat numbers on this page: those trials were run in people with HIV, most with treatment-associated lipodystrophy. That is the approved indication, and how those effect sizes transfer to a healthy adult with ordinary visceral fat is unknown.
Tesamorelin has been studied outside HIV, though, and this guide previously said otherwise. Baker 2012 (Arch Neurol, PMID 22869065) randomised 152 adults aged 55–87 — 76 healthy, 66 with mild cognitive impairment — to tesamorelin 1 mg/day subcutaneously or placebo for 20 weeks, with cognitive testing at weeks 10, 20 and after a 10-week washout. Note the dose: 1 mg/day, half the 2 mg used in the HIV lipodystrophy trials and at the bottom of the range this page lists.
That cognitive result did not hold up when it was tested again. Ellis 2025 (J Infect Dis, PMID 39813152) randomised 73 people with HIV and abdominal obesity and found waist circumference fell significantly while the cognitive difference between groups did not reach significance — and the IGF-1 rise showed no correlation with cognitive change. Two trials, opposite directions, and the larger, more recent one is the null. Treat cognition as unresolved rather than as a benefit of this stack.
The strongest tier of evidence now sits above any single trial: Badran 2026 (Obes Res Clin Pract, PMID 41545261) pooled five randomised controlled trials and found visceral adipose tissue down 27.71 cm², trunk fat down 1.18 kg, lean body mass up 1.42 kg and hepatic fat down 4.28% — with adverse events limited to arthralgia, myalgia, paraesthesia and injection-site reactions, and no disturbance of glucose metabolism. The earlier evidence it pools includes Stanley 2014 (JAMA, PMID 25038357; net −16.6% visceral fat in 50 patients) and the 12-month safety extension of the pivotal trial (Falutz 2010, JAIDS, PMID 20101189), where continuing users reached roughly 18% visceral-fat reduction. Every one of these was run in people with HIV-associated lipodystrophy, so the population caveat above still applies to all of it.
Tesamorelin is FDA approved (Egrifta) for HIV lipodystrophy; ipamorelin is not FDA approved. Both WADA prohibited (S2). The stack is used off-label; available as separate peptides or pre-mixed blend.
Potent GHRH analog with higher pituitary binding affinity and longer half-life than CJC-1295 no-DAC. Drives a larger, more reliable GH pulse. Strong preferential effect on visceral (deep belly) fat reduction via IGF-1-mediated lipolysis.
Selectively activates GHS-R without the cortisol/prolactin/aldosterone side effects of older GHRPs. Amplifies the GH pulse from tesamorelin without adding side-effect baggage.
Like CJC+Ipa, the combination produces a larger GH pulse than either component alone. With tesamorelin as the base, the pulse is noticeably stronger — reflected in both IGF-1 elevation and clinical visceral fat outcomes.
| Benefit | Evidence |
|---|---|
| Visceral fat loss | Solid — for tesamorelin alone, in a specific population. Falutz 2007 (NEJM, PMID 18057338) — note this is Falutz, not Grunfeld, who is sometimes credited for it — 26 weeks of daily tesamorelin cut visceral adipose tissue 15.2% while placebo rose 5.0% (p < 0.001), in HIV patients with treatment-associated central fat accumulation. The "stack amplifies via ipamorelin" half is an inference — no trial has tested the combination |
| Sleep quality | Pre-bed pulse restores slow-wave sleep reliably |
| Body composition | Lean-mass preservation is consistent with GH physiology, but "stronger than CJC+Ipa per dose" is not something anyone has measured — no head-to-head trial of the two stacks exists |
| Liver fat / NAFLD | Real, and narrower than "~40%." Stanley 2019 (Lancet HIV, PMID 31611038) randomised 61 people with HIV-associated NAFLD: hepatic fat fraction fell 4.1 percentage points absolute, a 37% relative reduction (p = 0.016), with 35% vs 4% reaching a fat fraction under 5%. Fasting glucose and HbA1c did not differ. The authors call for further study of long-term liver histology |
| Recovery | Faster soft-tissue recovery between training sessions |
| Skin quality | Increased collagen synthesis; thicker, healthier skin over 8–12 weeks |
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Start Tracking FreeNot medical advice. These figures describe what is reported in the literature and what practitioners and communities do — not a recommendation, and for most compounds here no human dose-finding study exists. Talk to a qualified healthcare provider.
Begin at 1 mg tesamorelin + 100 mcg ipamorelin for 2–4 weeks to assess water retention, glucose response, and overall tolerance. Titrate to 2 mg tesa if tolerated.
IGF-1 — note the trial figure is higher than the ~50% this guide used to quote: in Falutz 2007 (PMID 18057338) IGF-1 rose 81% on tesamorelin while falling 5% on placebo. Also fasting glucose, HbA1c, lipids. Measure at baseline and every 3 months. DEXA or waist circumference at baseline and 12 weeks to track visceral fat change.
Not medical advice. These figures describe what is reported in the literature and what practitioners and communities do — not a recommendation, and for most compounds here no human dose-finding study exists. Talk to a qualified healthcare provider.
Commonly supplied as a pre-mixed blend (e.g. 5 mg tesamorelin + 5 mg ipamorelin in one vial). Can also be reconstituted separately.
10 mg tesa + 3 mg ipa blend + 2 mL BAC water = 5 mg/mL tesa + 1.5 mg/mL ipa
| Target (Tesa + Ipa) | Volume | Syringe Units |
|---|---|---|
| 1 mg + 300 mcg | 0.20 mL | 20 units |
| 1.5 mg + 450 mcg | 0.30 mL | 30 units |
| 2 mg + 600 mcg | 0.40 mL | 40 units |
Vial ratios vary by vendor — check your label. If your blend isn’t 10/3 or you want a different tesa:ipa ratio, reconstitute the two peptides separately instead.
There is genuine disagreement on whether reconstituted tesamorelin should be refrigerated, and this guide is not going to pretend otherwise.
Do not refrigerate — the branded product labelling. Reconstituted Egrifta SV is use-immediately, not refrigerated or frozen; Egrifta WR is stable up to 7 days at room temperature and also not refrigerated. Some practitioner guidance for the blend agrees.
Refrigerate — much research-grade vendor stability documentation, which commonly specifies refrigeration with use inside about 7 days. That is also what many suppliers of the pre-mixed blend state.
These may not actually be in conflict: branded and compounded formulations differ, and the guidance could simply be product-specific rather than one side being wrong. We have not found data that settles it for research-grade vials. Follow the documentation for the exact product you hold, and if it is silent, ask your supplier for their stability data rather than defaulting either way.
Powder storage varies by product too — Egrifta SV powder is controlled room temperature, the original F1 formulation was refrigerated. Check your label.
Pre-filled with a typical Tesamorelin + Ipamorelin setup. Edit any field — the draw updates live.
Insulin syringe — 100 units = 1 mL
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Elevated GH/IGF-1 may promote existing tumor growth. Avoid with any malignancy history.
Tesamorelin + Ipamorelin is sold for research use only. If you are sourcing it for research, we recommend Lyvn — every batch third-party tested with the full laboratory panel published on the product page.
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For research use only. Not for human consumption. 21+.
Build your protocol, log every dose, monitor your body's response, and get reminders so you never miss a dose.
Start Tracking FreeIt is a combined GHRH + GHRP protocol. Tesamorelin is a potent GHRH analog with higher pituitary binding affinity and longer half-life than CJC-1295 no-DAC, driving a larger, more reliable GH pulse with a strong preferential effect on visceral fat. Ipamorelin selectively activates the ghrelin receptor (GHS-R) without the cortisol, prolactin, or aldosterone side effects of older GHRPs. Like CJC + Ipa, the combination produces a larger GH pulse than either component alone, but with tesamorelin as the base the pulse is noticeably stronger.
Tesamorelin is FDA approved as Egrifta for HIV lipodystrophy (excess visceral fat in HIV patients). Ipamorelin is not FDA approved. The combined stack is used off-label and is available as separate peptides or as a pre-mixed blend. Both components are WADA prohibited under S2 (Peptide Hormones, Growth Factors).
The standard community stack is 1 to 2 mg tesamorelin plus 100 to 300 mcg ipamorelin once daily pre-bed (with an optional second morning pulse), SubQ on an empty stomach (more than 2 hours post-meal), cycled 3 to 6 months on with a 1 to 2 month break. A conservative start is 1 mg tesamorelin + 100 mcg ipamorelin for 2 to 4 weeks to assess water retention, glucose response, and overall tolerance before titrating up to 2 mg tesa.
Once daily pre-bed is the standard timing, with an optional second morning pulse. Injections should be SubQ in a fasted state, more than 2 hours after a meal, because food (especially carbohydrates and fats) blunts the GH pulse. Pre-bed dosing reliably restores slow-wave sleep, and vivid dreams from the pre-bed dose are a common reported effect.
Track IGF-1 (the trials showed an 81% rise, not the ~50% commonly quoted), fasting glucose, HbA1c, and lipids at baseline and every 3 months. DEXA or waist circumference at baseline and 12 weeks tracks visceral fat change. Tesamorelin trials in HIV lipodystrophy showed a 15.2% VAT reduction at 26 weeks versus a 5.0% rise on placebo (PMID 18057338), and a 37% relative reduction in hepatic fat in HIV-associated NAFLD (PMID 31611038), so liver imaging may be relevant if NAFLD is the target. Note IGF-1 rose 81% in that first trial, not the ~50% often quoted, and that every tesamorelin trial was run in people with HIV.
Common effects include injection site reactions (tesamorelin can sting), arthralgia or joint discomfort, water retention or edema, numbness, tingling, or mild carpal tunnel symptoms, vivid dreams from pre-bed dosing, and short-lived facial flushing. Less common effects include mild fasting glucose elevation, headache, and mild nausea. Tesamorelin is also fragile to reconstitute: water down the wall slowly, gently roll the vial, and use the reconstituted product within 7 days (tesamorelin limits the shelf life).
Do not use with active or prior cancer, pituitary tumor, active retinopathy, pregnancy or breastfeeding, or under age 25. Use caution with diabetes, insulin resistance, thyroid disorders, cardiovascular disease, and carpal tunnel. Elevated GH/IGF-1 may promote existing tumor growth, so avoid with any malignancy history. WADA prohibits the stack at all times.
Disclaimer: This guide is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. The compounds discussed are not FDA approved for human use. Always consult a qualified healthcare provider before starting any new supplement or peptide protocol. StackTrax does not sell peptides or supplements directly — purchase links go to third-party vendors. StackTrax is not responsible for the products, quality, or business practices of any third-party vendor.
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StackTrax guides cover peptides and compounds that are not FDA-approved for the uses discussed. The dosing, reconstitution, and safety information is compiled from published research and community protocols for educational purposes only.
Before using any compound mentioned here, consult a qualified healthcare provider. StackTrax does not sell, prescribe, or recommend these substances for personal use.