The only FDA-approved peptide specifically designed to melt away stubborn belly fat by telling your brain to release more growth hormone naturally—working with your body's own systems rather than replacing them [6].
Written by Michael Carroll — Owner, Director of Research · Reviewed by the Peptide Initiative Research Team · Editorial standards
Subcutaneous
Route
3 recommended
Sites
Once daily
Frequency
Preparation
Tesamorelin powder vial
Sterile water for injection (provided with prescription products)
Insulin syringes (29-31 gauge, 1/2 inch needle)
Alcohol swabs
Sharps disposal container
Pro tip
Prepare all supplies on a clean surface before you begin. Having everything ready makes the process smoother and more sterile.
Mixing
Example calculation
For Egrifta SV (2mg vial): Add the entire contents of the provided sterile water diluent (0.5 mL) to the vial. This gives you a concentration of 4 mg/mL. The prescribed dose of 1.4 mg = 0.35 mL to inject.
Dose calculation
At 4 mg/mL concentration: 1.4 mg dose = 0.35 mL (35 units on an insulin syringe). Always follow the specific reconstitution instructions for your particular product, as formulations differ.
Location
Site 01
Abdomen
Pinch the skin 2 inches from navel. Avoid the area directly around the belly button. Rotate between left and right sides.
Site 02
Outer Thigh
Middle third of the outer thigh. Keep at least 4 inches above the knee and below the hip. Alternate legs each injection.
Site 03
Rotate sites to prevent lipodystrophy at injection locations
Follow your provider's instructions for this injection site. Rotate sites regularly to prevent tissue damage.
Rotate between 3 sites to prevent tissue buildup and ensure consistent absorption.
Pro tip
Rotate your injection sites with each dose to prevent lipohypertrophy (buildup of fatty tissue). Keep a simple log of where you last injected.
Step by step
Wash hands thoroughly with soap and water
Clean the injection site with an alcohol swab and let dry completely
Pinch a fold of skin between thumb and forefinger
Insert needle at a 45 to 90-degree angle (90 for more tissue, 45 for lean individuals)
Inject slowly and steadily over 5-10 seconds
Wait 5 seconds before withdrawing the needle
Do not rub the injection site afterward
Pro tip
This peptide uses subcutaneous injection (just under the skin into fatty tissue)—this is the only approved administration route. Inject at a 45-90 degree angle into pinched skin. Aspirate before injecting to ensure you haven't hit a blood vessel.
Timing
Optimal timing
Best time
Inject in the morning on an empty stomach, at least 30 minutes before eating. This aligns with your natural cortisol awakening response and may optimize growth hormone release patterns.
With food?
Do NOT inject with food. Tesamorelin should be given on an empty stomach for optimal absorption. Wait at least 30 minutes after injection before eating breakfast.
Stacking notes
If using with other growth hormone secretagogues, separate injections by several hours. Some practitioners alternate between tesamorelin and other GHRH peptides rather than using them the same day. Never combine with exogenous GH—choose one or the other [16].
Sample daily schedule
Morning (before breakfast)
1.4-2 mg depending on formulation injection
Site: Rotate between left and right abdomen
Inject on an empty stomach at least 30 minutes before eating. Consistency is key—try to inject at the same time each day. Morning dosing may align better with natural GH release patterns.
Dosing tiers
Dose
2 mg (1.4 mg with Egrifta SV/WR F8 formulation)
Frequency
Once daily
Duration
26 weeks, continued long-term for sustained effect
FDA-approved dose for HIV-associated lipodystrophy; full dose from day one with no titration [6]. Pivotal phase 3 trials used 2 mg daily [1].
Preservation
Before mixing
Store powder in refrigerator at 36-46°F (2-8°C). Keep in original carton to protect from light. Do not freeze. Check expiration date on package—stable until that date if properly stored.
After mixing
Refrigerate reconstituted solution at 36-46°F (2-8°C). Use within 14 days for Egrifta SV (original Egrifta had shorter stability). Never freeze reconstituted solution. If solution becomes cloudy or contains particles, do not use.
Shelf life after mixing
14 days (Egrifta SV) to 24-48 hours (original formulation)
Signs of degradation
Discard the vial immediately if you notice any of these:
Cloudy or hazy appearance (should be clear and colorless)
Visible particles or floaters
Any color change from clear/colorless
Solution that doesn't dissolve completely during reconstitution
Important
When to stop
Severe allergic reaction occurs—stop immediately and seek emergency care
Visceral fat has not decreased after 3 months of treatment (per FDA guidance) [6]
Blood glucose becomes uncontrolled despite adjustments
Development of new or worsening malignancy [6]
Pregnancy occurs or is planned [6]
Intolerable side effects that don't resolve with dose adjustment
Tesamorelin is an FDA-approved prescription medication that should only be used under physician supervision. Never start, stop, or adjust your dose without consulting your prescribing healthcare provider. This information is educational and does not constitute medical advice.
Clean technique checklist
Wash hands thoroughly with soap and water before handling supplies
Swab vial tops and injection site with alcohol and let dry
Never touch the needle tip or allow it to contact non-sterile surfaces
Use a new syringe and needle for each injection
Dispose of used sharps in a proper sharps container
Store reconstituted peptides according to the storage instructions above
Published research
Falutz J, Mamputu JC, Potvin D, et al. · 2010
In this combined analysis of over 800 HIV patients, tesamorelin reduced visceral fat by an average of 15.4% compared to placebo at 26 weeks. The reduction was maintained at 52 weeks in those who continued treatment. It also improved triglycerides by 12% and significantly improved how patients felt about their belly appearance.
Stanley TL, Falutz J, Marsolais C, et al. · 2012
Patients who achieved at least 8% reduction in visceral fat (called 'responders') experienced significantly greater improvements in triglycerides, glucose control, and adiponectin levels compared to non-responders. This shows that the metabolic benefits directly correlate with how much visceral fat you lose.
Baker LD, Barsness SM, Borson S, et al. · 2012
In a 20-week trial with 152 adults (some with mild cognitive impairment), tesamorelin improved executive function and showed a trend toward better verbal memory. IGF-1 levels increased 117% and body fat decreased 7.4%. This suggests tesamorelin may have brain health benefits beyond just fat reduction.
Stanley TL, Fourman LT, Feldpausch MN, et al. · 2019
In people with HIV and fatty liver disease, tesamorelin reduced liver fat by 37% relative to placebo over 12 months. Remarkably, 35% of tesamorelin patients achieved liver fat levels below 5% (essentially normal) compared to only 4% on placebo. This opens up potential new uses for liver health.
Dhillon S · 2011
This comprehensive review confirmed tesamorelin's effectiveness and safety profile. It noted that while visceral fat reduces significantly, subcutaneous fat stays stable—an important distinction because subcutaneous fat is metabolically healthier. Side effects were manageable and serious events occurred in less than 4% of patients.
Theratechnologies Inc. / U.S. FDA · 2019
Falutz J, Potvin D, Mamputu JC, et al. · 2010
In this 12-month trial of 404 HIV-infected patients, visceral fat fell 10.9% on tesamorelin versus 0.6% on placebo over the first 6 months, and was about 18% below baseline in patients who continued the drug for 12 months. Patients re-randomized from tesamorelin to placebo rapidly lost the visceral fat reduction they had gained. No change in glucose parameters was observed.
Ferdinandi ES, Brazeau P, High K, Procter B, Fennell S, Dubreuil P · 2007
Adding a trans-3-hexenoyl group to the first amino acid of GHRH(1-44) made the peptide resistant to dipeptidyl aminopeptidase-IV breakdown, slowing its degradation in rat, dog and human plasma and prolonging how long it stayed in circulation. The modified peptide still raised growth hormone and IGF-1 in pigs, rats and dogs. Apparent elimination half-life in dogs was 21 to 45 minutes.
Halmos G, Szabo Z, Dobos N, Juhasz E, Schally AV · 2025
This review describes GHRH binding to the pituitary GHRH receptor, a G protein-coupled receptor expressed mainly on somatotroph cells of the pituitary. Receptor activation raises intracellular cAMP, and the resulting signaling phosphorylates CREB, which with its coactivators p300 and CREB-binding protein increases growth hormone gene transcription.
Stanley TL, Grinspoon SK · 2015
This review of human studies reports that GHRH treatment increases the body's own basal and pulsatile growth hormone secretion without changing pulse frequency, and that giving GHRH preserves the normal IGF-1 negative feedback on pituitary GH release, with IGF-1 monitored to keep levels in the physiological range. It also notes that increased visceral fat and reduced GH each contribute independently to dyslipidemia, systemic inflammation, and cardiovascular risk, and that GHRH treatment reduces visceral fat and improves these markers.
Makimura H, Feldpausch MN, Rope AM, Hemphill LC, Torriani M, Lee H, Grinspoon SK · 2012
In obese adults without HIV who had reduced growth hormone secretion, tesamorelin reduced visceral fat (treatment effect -35 cm2) while body weight did not differ significantly from placebo (0.1 kg vs 0.9 kg, P = 0.52). The authors note that weight stayed flat because fat mass fell and lean mass rose by similar amounts.
Neeland IJ, Ross R, Despres JP, et al. · 2019
This joint position statement summarises three decades of epidemiological evidence that visceral adipose tissue, measured by CT or MRI, is an independent risk marker for cardiovascular and metabolic illness and death, and reviews visceral and ectopic fat as risk factors for type 2 diabetes, atherosclerosis, and cardiovascular disease.
Colon G, Saccon T, Schneider A, et al. · 2019
This review of growth hormone and aging states that GH levels fall gradually after puberty, and that after the third decade of life the decrease is about 14% per decade.
Reed ML, Merriam GR, Kargi AY · 2013
This review reports that the most common side effects of growth hormone treatment in adults come from fluid retention, and lists peripheral edema, arthralgia, carpal tunnel syndrome, paresthesias, and worsening glucose tolerance among them. It also notes that these effects became less frequent once dosing moved from high weight-based regimens to low starting doses titrated upward, and that the side effect profile of replacement doses does not apply to supraphysiologic dosing.
Erman A, Veilleux A, Tchernof A, Goodyer CG · 2011
Growth hormone receptor mRNA was measured in omental (visceral) and subcutaneous fat from 55 women across the range of body weight. Receptor expression was 2 to 3 fold lower in obese than lean women in both depots, and in lean women receptor levels were higher in omental than in subcutaneous fat, a depot difference that disappeared with obesity.
Hashimoto Y, Kamioka T, Hosaka M, Mabuchi K, Mizuchi A, Shimazaki Y, Tsunoo M, Tanaka T · 2000
Healthy men were given injections of the 20K isoform of human growth hormone. Their own 22K growth hormone secretion was markedly suppressed in a time-dependent manner, showing that injected growth hormone shuts down the pituitary's own GH release.
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