Tesamorelin and other GH Secretagogue dosing protocol

[tubby]

All of the human clinical trials of tesamorelin were done in people with HIV lipodystrophy, and if I am remembering correctly all at 2mg/day. To the best of my knowledge, no studies have ever been done in humans in any other state, so none in any kind of general population. None for obesity either.

So it can be said that it has been shown to reduce visceral fat in persons with HIV lipodystropy, and there did not seem to be any concerning effects on cardiovascular risk markers in that group, apart from blood sugar. This does not mean it is tested or known to be safe in the general population, but has much better evidence than anything else that messes with the GH system. And it can obviously cause GH related side effects like increased sugars and insulin resistance, fluid retention and carpal tunnel syndrome. And may or may not increase cancer risks, and reduce lifespan.

Any claims beyond this by pretty much anyone are bro science, not science. There is no scientific basis for days on /off treatment, but there is no scientific base for its use outside of HIV lipodystropy. As far as I am concerned anyone using the term protocol is making stuff up, I have yet to ever see one that is actually consistent with human trial evidence.

Given there is some evidence at least of being tested in humans, and most people taking it are going to be on GLP's reducing the negative effects on blood sugars, it is probably the safest option, ( if you have to use something that messes with HGH ) but getting sugars, lipids, blood pressure and IGF-1 tested is still a good idea. Just because the studies only used 2mg , does not mean 1mg is a problem. But it is quite a lot more expensive than HGH.

I'd generally agree and well said.

Might be worth adding that tesa isn't the only one that's well studied (sermorelin also gained FDA approval).

I might disagree a bit on the "bro science" angle, but that's more of a subjective difference of opinion. Although not clinically validated, the common protocols are what most others will have tried using and often represent best guesses based on an educated mechanistic understanding. Certainly inferior to a clinically researched approach (if one were available), but more likely to encorporate some degree of trial and error in being arrived at and probably better than reinventing the wheel yourself.

 

[Calm Logic]

An article on GH peptides for older adults, saying it is currently "not warranted" for anti-aging purposes:

Growth Hormone and Aging - Endotext - NCBI Bookshelf

Several short-term studies aiming to increase GH in older adults using a variety of interventions, including exercise, GH administration, or GH secretagogues, have demonstrated consistent effects on body composition but inconsistent effects on physical and cognitive function ...

Long-term studies using hard clinical endpoints, such as falls and fracture rates, functional measures, quality of life, and morbidity and mortality from vascular disease, are needed to establish the potential role, if any, of GH and GHS treatment in normal aging. In the meantime, GH use for anti-aging purposes is not warranted

And even the guys/bros at Meso can't agree that HGH is worthwhile (at least at relatively safe dosages):

https://thinksteroids.com/community/threads/morning-vs-night-hgh-pin.134433988/post-3664416

Honestly, GH is the cherry on top. And if we are being real, it is probably the most overrated thing I have used.

I did not notice a massive difference on GH versus off GH. If anything, I actually felt leaner and better without it.

The typical bro science there:

https://www.thinksteroids.com/community/threads/when-is-gh-detrimental-to-ones-look.134418451/post-3142074

Skin, hair, nails, sleep, body comp, all drastically better.

https://thinksteroids.com/community/threads/loving-my-first-go-at-tesamorelin.134430817/post-3635545

On another note, I just read a medical journal article about the fact “abdominal obesity”, 25% percent of “normal BMI” people have is a major under recognized cardiovascular and all cause mortality risk factor. More men than women have it, and general weight loss isn’t really effective, even with a GLP, because in many cases you’d become underweight everywhere else before the abdomen (and it’s stubborn visceral fat, “dad gut” common as GH levels drop with age) gets to a healthy size.

They mentioned Tesamorelin as a possible way to treat this, since it’s so effective at blasting visceral fat and shrinking the gut, even without weight loss, by redistributing that fat elsewhere, like subQ where it’s essentially harmless. Restoring a “youthful” body composition type and away from middle age “spread”.

ChatGPT to clear up the Meso science:


2002 study cited by ChatGPT (with almost 700 citations at Google Scholar):

Growth Hormone and Sex Steroid Administration in Healthy Aged Women and Men

 

[Habibibi]

Agreed, low igf1 is associated with longevity.

Most of the meso crowd is doing gh at a supra physiological doses anyway, which disqualifies them from the gh for longevity question.

 

[Calm Logic]

Exactly. At Meso, they are arguably working on "brospan" or "hotspan" or something other than health span:

Too well to die; too ill to live: an update on the lifespan versus health span debate - PMC

Since the dawn of human civilisation, the pursuit of immortality has been a perennial quest. Over the past century, unprecedented advancements in medical science, public health initiatives, and social policies have significantly increased the global ...

pmc.ncbi.nlm.nih.gov

"The debate between lifespan (the total number of years a person lives) and health span (the period of life free from chronic disease or disability) has gained considerable attention in both scientific and public discourse, with global focus now gradually shifting from merely living longer to living better."

..."The most well-known framework for describing successful ageing by Rowe and Kahn in 1998, where they included the following three components for a disease-free, healthy ageing [23]:

Avoiding disease.

Maintaining cognitive and physical function.

Preserving engagement."

 

[lessthanhalf]

From the post above by Calm logic

Long-term studies using hard clinical endpoints, such as falls and fracture rates, functional measures, quality of life, and morbidity and mortality from vascular disease, are needed to establish the potential role, if any, of GH and GHS treatment in normal aging. In the meantime, GH use for anti-aging purposes is not warranted.

This unfortunately is the case for GH , secretagogues, androgen treatment and SARMs . There are lots of studies showing some improvement in various different measurable characteristics, like lean mass or muscle mass, or visceral fat but the studies consistently fail to show real world measurable benefits like improved strength or mobility , or less cardiovascular disease which is what matters in the end . It does seem odd that you can get a measured increase in muscle mass, but no actual performance increase, but it has been shown over and over again, in studies of these agents for sarcopenia due to age or cancer or in older persons.

Weirdly GLP's do the opposite, reducing muscle mass, but increasing muscle efficiency , and do produce significant real world gains in mobility and cardiovascular disease risk.

 

[tubby]

This unfortunately is the case for GH , secretagogues, androgen treatment and SARMs . There are lots of studies showing some improvement in various different measurable characteristics, like lean mass or muscle mass, or visceral fat but the studies consistently fail to show real world measurable benefits like improved strength or mobility , or less cardiovascular disease which is what matters in the end . It does seem odd that you can get a measured increase in muscle mass, but no actual performance increase, but it has been shown over and over again, in studies of these agents for sarcopenia due to age or cancer or in older persons.

Weirdly GLP's do the opposite, reducing muscle mass, but increasing muscle efficiency , and do produce significant real world gains in mobility and cardiovascular disease risk.

Agree on GLPs being much more lopsided (at present the pros list seems to greatly outweigh the cons list).

I also agree that we lack hard endpoints data for GH (and related compounds), but that in itself is a fairly weak criticism. Nearly all attempts to expand cardiology and related drugs from secondary prevention to primary prevention are similarly based on drugs and treatments with strong intermediate marker results and with weak endpoint data. A lack of good endpoint data is quite common in pharma overall.

 

[EAM9112]

Why does every protocol that I see for Tesa and other GH secretagogues mention a 5 day on and 2 days off sort of dosing schedule? Would this not be counter productive as boosting your GH production should be everyday? Ive seen many people say this is a myth and your dosing protocol should be tailored to yourself so im wondering if I should just be taking it everyday. Any other thoughts on this?

This is just a cost cutting strategy to save 2 doses per week. Read the FDA guidelines on Tesamorelin. It was administered every day for up to 26 weeks at a dosage of 2mg.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/022505s020lbl.pdf

 

[Commander]

Was that 2mg once a day or was it 1mg twice a day?

 

[wildweasel]

From the post above by Calm logic

...

It does seem odd that you can get a measured increase in muscle mass, but no actual performance increase, but it has been shown over and over again, in studies of these agents for sarcopenia due to age or cancer or in older persons.

honestly makes sense when considered

for strength/performance purposes, neurological recruitment of muscle fibers matters as much or maybe even more than raw muscle mass... same as how body builders or athletes train for max strength vs hypertrophy.. solely training for max strength output results in far less muscular protein accretion than training for muscle hypertrophy, and conversely, training for hypertrophy is not very effective at increases strength, but it does lead to significant increases in overall muscle mass.

GH/GHS/IGF1/etc.. result in new cellular muscle growth, but dont replace the ability to recruit and coordinate muscle fibers effectively through the nervous system.

 

[Ascojoerg]

This is just a cost cutting strategy to save 2 doses per week. Read the FDA guidelines on Tesamorelin. It was administered every day for up to 26 weeks at a dosage of 2mg.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/022505s020lbl.pdf

Thanks for that. Yeah the whole 2 day break just keeps on coming back to bro science. But I guess I am going off of my interpretation of similar studies which in itself would also be my own bro science...

In the end, until a proper peer reviewed, placebo controlled blind test is done, it is all speculation.

 

[tubby]

Thanks for that. Yeah the whole 2 day break just keeps on coming back to bro science. But I guess I am going off of my interpretation of similar studies which in itself would also be my own bro science...

As lessthanhalf laid out upthread, anyone not taking this to offset visceral fat accumulation from HIV meds is already engaging in "bro science," regardless of the number of days a week they're doing it. And the same is true of most of the non-GLP peptides being discussed on this site.

It's all competing "bro science" stories arrived at through N=1 trial and error.

 

[bogardbilla]

Just my 2c:

5 days on, 2 days off.

This is quintessential bro science. The 5 days on 2 days off protocol doesn't make sense for any drug, as drugs are not salaried workers. But people working at medical spas are, which is where this protocol comes from - their offices were simply not open on the weekends, and so their patients couldn't come in to get the peptides administered.

All of the human clinical trials of tesamorelin were done in people with HIV lipodystrophy

There is no such thing as "HIV lipodystrophy." The problem Tesamorelin is solving is HIV patients taking antiretroviral HIV drugs which cause an abnormal rise in visceral fat. The significance of HIV in relation to Tesamorelin is just that the older antiretroviral HIV drugs affect visceral fat, it's not the HIV itself which affects it (other than possibly elevated chronic inflammation.)

 

[Ascojoerg]

But people working at medical spas are, which is where this protocol comes from - their offices were simply not open on the weekends, and so their patients couldn't come in to get the peptides administered.

Wow never thought about that, usually the best answer is the simplest, and this right here might be it.

 

[DustAndDignity]

Thanks for that. Yeah the whole 2 day break just keeps on coming back to bro science. But I guess I am going off of my interpretation of similar studies which in itself would also be my own bro science...

In the end, until a proper peer reviewed, placebo controlled blind test is done, it is all speculation.

You’re spot on, a lot of this is still speculation. I’d just take it one step further.

For anyone running this, I’d recommend they get baseline labs. IGF-1 and Z-score matter. Otherwise we’re all guessing.

From there, test your approach instead of relying on protocol debates.

Some people are running 2mg, 5 days on / 2 off and if that’s the route people choose to emulate, run it and retest. See what your numbers actually do.

I’ve personally adjusted down to 1mg nightly and plan to retest in a couple of weeks. My goal is to simply land in an effective range without overshooting IGF-1 long term.

I’ll come back and share my results so there’s at least one real data point in here.

Also worth noting as mentioned above the 5/2 split is often framed as cost savings. If 1mg daily keeps labs in range, that stretches a kit even further (100 days vs 70 days) while adding a layer of control.

At the end of the day, your labs > others opinions.

 

[swimmer]

I personally love the 5day on 2 day off Tesamoralin schedule. I am quite sensitive to Tesa. After 5 days on 1mg. Tesa I retain on average of 8 lbs water. The 2 days off I piss like crazy!! I don't enjoy the bloated feeling. That's why I take 2 days off. Tessa has been very useful. When I was losing my last 10 lbs on Tirz My muscles were shrinking fast. Tesa 1mg. 5-2 completely reversed that.

I take 300 mcg Ipamorelin with my Tesa but the side effects are from the Tesa. I only use 1mg of Tesa because it raises my resting pulse by 8-10 bpm. at 2mg.

Now that I am at my target weight I use Tesa to counteract Enclomiphene lowering my IGF-1 levels. My labs show 5 on 2 off works great for this too.

Note: I do not have HIV

This is my personal experience with it.

This is anecdotal information. Maybe it is bro science but I doubt it is a placebo effect. There are too many measurable physiological changes.

 

[DustAndDignity]

I personally love the 5day on 2 day off Tesamoralin schedule. I am quite sensitive to Tesa. After 5 days on 1mg. Tesa I retain on average of 8 lbs water. The 2 days off I piss like crazy!! I don't enjoy the bloated feeling. That's why I take 2 days off. Tessa has been very useful. When I was losing my last 10 lbs on Tirz My muscles were shrinking fast. Tesa 1mg. 5-2 completely reversed that.

I take 300 mcg Ipamorelin with my Tesa but the side effects are from the Tesa. I only use 1mg of Tesa because it raises my resting pulse by 8-10 bpm. at 2mg.

Now that I am at my target weight I use Tesa to counteract Enclomiphene lowering my IGF-1 levels. My labs show 5 on 2 off works great for this too.

Note: I do not have HIV

This is my personal experience with it.

This is anecdotal information. Maybe it is bro science but I doubt it is a placebo effect. There are too many measurable physiological changes.

This is great feedback. Thanks for sharing. I feel your pain on the water retention. I stated Tesa two weeks after Tirz and not only did I gain the weight I lost, I also added more weight then where I started with Tirz.

Again, your labs and individual response is greater than any random protocol being pitched online by strangers. I’m glad this is working for you and congratulations on hitting your goal weight.

 

[lessthanhalf]

There is no such thing as "HIV lipodystrophy." The problem Tesamorelin is solving is HIV patients taking antiretroviral HIV drugs which cause an abnormal rise in visceral fat. The significance of HIV in relation to Tesamorelin is just that the older antiretroviral HIV drugs affect visceral fat, it's not the HIV itself which affects it (other than possibly elevated chronic inflammation.)

You had me worried there for a bit thinking my brain must have made the term up, but after looking through about 10 papers on it I did find a recent one that called it HIV lipodystrophy, rather than abnormal visceral and liver fat accumulation in HIV patients, so it might not be the most common term for it but at least I had not misremembered or made it up.

I did find a study of tesamorelin in diabetics that showed no increase in insulin levels or hb1ac, at doses of 1-2mg / day. It directly contradicts what I said about checking blood sugars, but I do not understand why it would not increase sugars and insulin if it acts to increase HGH and IGF-1.

So maybe it does not have adverse effects on sugars, and if this is actually the case then it does make it a safer option than HGH, but as the mechanism makes sense to increase sugars it is still probably not a bad idea to check them. Nearly everyone taking it is likely to be on reta or tirz which have a much stronger effect on lowering blood sugar than hgh does on increasing it, so not sure how much of an issue it really is in practice.

 

[bogardbilla]

It directly contradicts what I said about checking blood sugars, but I do not understand why it would not increase sugars and insulin if it acts to increase HGH and IGF-1.

Maybe because the increase in GH does affect insulin sensitivity negatively, but that might be counteracted by the fact that at the same time Tesamorelin reduces visceral fat which is known to improve insulin sensitivity? Interesting stuff!

 

[bogardbilla]

I did find a recent one that called it HIV lipodystrophy

I stand corrected then. I looked it up and HIV does in fact lower GH levels, which ends up increasing fat accumulation.

 

[IronCircuit]

I personally love the 5day on 2 day off Tesamoralin schedule. I am quite sensitive to Tesa. After 5 days on 1mg. Tesa I retain on average of 8 lbs water. The 2 days off I piss like crazy!! I don't enjoy the bloated feeling. That's why I take 2 days off. Tessa has been very useful. When I was losing my last 10 lbs on Tirz My muscles were shrinking fast. Tesa 1mg. 5-2 completely reversed that.

I take 300 mcg Ipamorelin with my Tesa but the side effects are from the Tesa. I only use 1mg of Tesa because it raises my resting pulse by 8-10 bpm. at 2mg.

Now that I am at my target weight I use Tesa to counteract Enclomiphene lowering my IGF-1 levels. My labs show 5 on 2 off works great for this too.

Note: I do not have HIV

This is my personal experience with it.

This is anecdotal information. Maybe it is bro science but I doubt it is a placebo effect. There are too many measurable physiological changes.

I was going to ask why you weren’t at 2mg, glad you answered it. Sounds like you’re still getting good results at 1mg!