Tesamorelin
Tesamorelin is a stabilised GHRH(1-44) analogue and the only GH-axis secretagogue with a modern FDA approval — for reducing excess visceral (abdominal) fat in HIV-associated lipodystrophy. Multiple phase-3 trials show it selectively lowers visceral adipose tissue while raising GH/IGF-1. It carries the expected GH-axis side effects, chiefly fluid retention and glucose effects.
01 Overview
Tesamorelin (Egrifta) is a synthetic GHRH analogue with a trans-3-hexenoyl group that improves stability. In HIV patients with lipodystrophy, roughly 12 months of daily subcutaneous dosing reduced visceral adipose tissue by around 15-18% versus placebo, with reversal on discontinuation.
It is the best-evidenced compound in this group after somatropin, with randomised controlled trial data for both efficacy and safety. Effects on visceral fat are mediated by restored pulsatile GH secretion; benefits require continued use, and glucose parameters must be monitored given GH's counter-regulatory effect on insulin.
02 Mechanism
Stabilised GHRH(1-44) analogue that binds the pituitary GHRH receptor to restore endogenous pulsatile GH secretion, raising IGF-1 and driving lipolysis preferentially in visceral adipose tissue.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Approved (HIV lipodystrophy) | 2 mg/day | SubQ | 2 mg once daily subcutaneously, the FDA-approved dose. |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Visceral fat reductionSelective reduction of visceral (not subcutaneous) abdominal fat in randomised trials; reverses on stopping. | ~-15 to -18% visceral adipose tissue over ~26-52 weeks | Clinical | |
| Raised GH and IGF-1Restores pulsatile GH secretion and raises IGF-1 in a dose-dependent manner. | Clinical | ||
| Improved triglyceridesModest improvement in triglycerides accompanying visceral-fat loss in trials. | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| Fluid retention / arthralgia and oedemaPeripheral oedema, joint pain and limb swelling, consistent with GH-axis fluid effects. | Moderate | Common in trials | Clinical | |
| Raised glucose / reduced insulin sensitivitySmall rises in glucose and HbA1c from GH's counter-regulatory action. | Moderate | Common, monitor | Clinical | |
| Injection-site reactionsErythema, pruritus, pain or bruising at injection sites. | Mild | Common | Clinical | |
| Carpal tunnel symptomsWrist/hand paraesthesia from fluid retention. | Mild | Uncommon | Clinical |