Tesamorelin protocol

Standard

Weeks 1–16 (legacy)

20u

2 mg · Nightly

Original Egrifta clinical dose (no titration per label). Hold here for the full cycle.

Egrifta WR (2025)

~13u

1.28 mg · Nightly

F8 weekly-reconstitution formulation dose. Same molecule and indication. The ~13u assumes the compounded 10 mg/mL mix; the guide doesn't give the Egrifta WR vial's mixing volume.

Off

4–8 weeks

Pituitary and receptor recovery before re-cycling.

Phase	How often	Dose	Units	Notes
Weeks 1–16 (legacy)	Nightly	2 mg	20u	Original Egrifta clinical dose (no titration per label). Hold here for the full cycle.
Egrifta WR (2025)	Nightly	1.28 mg	~13u	F8 weekly-reconstitution formulation dose. Same molecule and indication. The ~13u assumes the compounded 10 mg/mL mix; the guide doesn't give the Egrifta WR vial's mixing volume.
Off	4–8 weeks	–	–	Pituitary and receptor recovery before re-cycling.

Egrifta WR (F8, 2025): FDA approved a weekly-reconstitution formulation (Mar 2025); an 11.6 mg multi-dose vial reconstituted weekly gives 7 daily doses of 1.28 mg/day. The legacy 2 mg/night is the original Egrifta formulation.

Cycle & timing

Cycle: Ongoing per FDA Egrifta label (continuous nightly for HIV lipodystrophy); off-label use sometimes cycles 12–16 wks on / 4–8 off with IGF-1 recheck.

Timing: Pre-bed nightly, fasted; no food 90 min before / 60 min after (food blunts GH response per label).

Where: Abdomen only. Rotate quadrants.

What to expect

Visceral-fat reduction at 8–12 weeks. Strict night-only injection, food within 90 min blunts GH response significantly. Monitor fasting glucose.

How much to buy

For 16-wk @ 2 mg × 7/wk:

45

× 5mg vials

23

× 10mg vials

12

× 20mg vials

Men & women

Men: Men convert GH to IGF-1 more efficiently and more often overshoot the age ceiling (a higher malignancy signal), aim mid-normal for age, don’t chase the top.

Women: Women make ~3× the GH of men yet have similar IGF-1, they’re less responsive, so often need a higher dose to move IGF-1. Oral estrogen blunts IGF-1 further (read it as running low); a skin patch/gel is more predictable.

Dilution calculator

Set to the guide's typical mix for Tesamorelin. Change anything to see where to draw.

Vial size

BAC water added

Dose you want

Draw to

20u

Volume

0.20 mL

Strength

10 mg/mL

Doses per vial

5

Assumes a U-100 insulin syringe (100 units = 1 mL). Double-check against the compound's page before you draw.

Recommended mixes

Vial	Water	Strength
5 mg	0.5 mL	10 mg/mL
10 mg	1 mL	10 mg/mL
20 mg	2 mL	10 mg/mL

5 mg: 1 unit = 0.10 mg

Storage

PowderFreeze-dried: -4°F.
MixedReconstituted: 36–46°F, up to 28 days with continuous cold chain.

Don't use if: Active malignancy (GH/IGF-1 can promote tumor growth) · Severe diabetic retinopathy · Acute critical illness (per somatropin label) · Pregnancy and lactation

Stop if you notice

Fasting glucose rises >20 mg/dL above baseline
IGF-1 above age-ULN (or >2× ULN)
New persistent joint pain or carpal tunnel
New/enlarging moles
Vision changes
New-onset diabetes
Persistent edema

Side effects

Fluid retention, peripheral oedema, tingling. Glucose intolerance, monitor fasting glucose.

Drug interactions

Glucocorticoids blunt GH response; insulin/antidiabetics, GH worsens insulin resistance; levothyroxine, GH lowers free T4 (recheck TSH/fT4 quarterly); oral estrogens blunt GH-stimulated IGF-1; CYP3A4 narrow-TI substrates, recheck troughs.

Labs

IGF-1 (baseline + Week 8 + end; hold/reduce if IGF-1 >350–400 ng/mL or above age-ULN), Fasting glucose (Week 0/4/8) + HbA1c, Lipid panel (Week 0/12), age-appropriate cancer screening before starting. Out of range? IGF-1 above your age range = too much growth signal (feeds hidden cancer, enlarges organs) → drop the dose; rising glucose/HbA1c = sugar creeping up.

What these labs mean →

Warnings

Glucose intolerance and new-onset T2DM (boxed-equivalent in label); fluid retention with peripheral edema; carpal tunnel with extended use; IGF-1 elevation (theoretical malignancy promotion above physiologic range); pituitary disease (hypopituitarism, post-surgical).

Patient education

GH-axis stimulation is not appropriate during active malignancy or for fertility. Most GH pulses occur during deep sleep, dose pre-bed. Food within 90 min blunts the response. Report new lumps, persistent headaches, or vision changes immediately.

These apply on top of the universal safety rules.