Tesamorelin

Egrifta · B-tier (Dr. Alex Tatem) · Strong evidence

The only GH-releasing peptide with FDA approval and strong trial data. It specifically targets deep abdominal (visceral) fat.

Dr. Tatem’s take

B-tier: potent, legitimate and commercially available, but pharmaceutical-grade product is expensive. On Diary of a CEO he called it “uniquely good at stripping abdominal fat”, adding that the fat returns when you stop unless your lifestyle changes.

In Dr. Tatem’s tier list

• A direct GHRH analog — it mimics growth-hormone-releasing hormone, the brain’s signal to release GH. Sermorelin is a similar, milder compound.
• Unlike most secretagogues it’s a commercial product, approved for patients on older HIV medications who developed lipodystrophy (abnormal fat deposits).
• “Tesamorelin actually really does work”: it raises GH enough to strip midsection fat.
• No trials in healthy people using it cosmetically, but many anecdotes. The drawback is price — pharma-grade tesamorelin costs far more than gray-market growth hormone.
• Verdict: B tier — “much better than most of its peers.”

History & background

Tesamorelin was developed by Theratechnologies (Montreal) as a stabilized version of human GHRH. Phase 3 trials published in 2007–2010 showed it reduced visceral fat in HIV-associated lipodystrophy, and FDA approved it as Egrifta in November 2010.

Lipodystrophy was a common side effect of older HIV drugs (especially 1990s–2000s protease inhibitors and thymidine analogs), which created the need. A once-weekly-reconstituted version, Egrifta WR, was approved in 2025.

Benefits

• Cut visceral fat by 15% in 26 weeks, while it rose 5% on placebo.
• Reduced liver fat in a 12-month trial.
• Raises your own GH and IGF-1 rather than replacing them.

Risks

• Raised IGF-1: 47% went above the normal range at 26 weeks.
• Higher blood sugar or glucose intolerance.
• Fluid retention, joint pain, carpal tunnel.
• Don’t use with active cancer, pituitary disorders or pregnancy.

Dosing protocols (informational, labeled by evidence)

• Clinical trial / label: FDA label – Egrifta SV — 1.4 mg (0.35 mL of 2 mg vial reconstituted with 0.5 mL), SubQ (abdomen), Once daily, Chronic; reassess response
• Clinical trial / label: FDA label – Egrifta WR — 1.28 mg, SubQ, Once daily, Chronic
• Clinical trial / label: Pivotal trials (original Egrifta) — 2 mg, SubQ, Daily, 26 wk

Status: FDA-approved (Egrifta, Egrifta WR) to reduce excess abdominal fat in adults with HIV-associated lipodystrophy.

Grade and commentary: Dr. Alex Tatem. Watch: The Truth About Popular Peptides (What Works, What’s Overhyped) | Peptide Tier List pt.1, Peptide Expert: What Do Peptides Actually Do? (EXPLAINED) - Dr Alex Tatem. Subscribe: @DrAlexTatem.