ASCEND Blend (CJC-1295 / Ipamorelin / Tesamorelin / IGF-1 LR3): What It Is, Where to Get It Prescribed, and What It Costs

ASCEND is not a single molecule. It is four independently studied peptides dissolved together in one sterile multi-dose vial by a compounding pharmacy. Three of them prompt the pituitary to release the body's own growth hormone; the fourth is a modified version of the growth factor that growth hormone works through. Each has its own research literature, its own described mechanism and its own regulatory file at the FDA. The name is a brand name for the combination; it does not appear in any journal. That shapes everything on this page: "does ASCEND work" has to be broken into four questions, because the combination itself has never been studied as a combination.

The pituitary releases growth hormone in pulses when it receives two signals at once: GHRH, and a ghrelin-receptor signal. CJC-1295 and tesamorelin both supply the first; ipamorelin supplies the second. Growth hormone does most of its work by prompting the liver to make IGF-1; IGF-1 LR3 is meant to add a small amount of that downstream signal directly. The rationale is to act at three points on one axis with a single bedtime injection.

The proportions matter. Ipamorelin is 12 of the 29 mg in the vial, tesamorelin 10, CJC-1295 6 and IGF-1 LR3 1 mg — about three percent by mass. At the standard 0.25 mL dose that is 0.6 mg ipamorelin, 0.5 mg tesamorelin, 0.3 mg CJC-1295 and 0.05 mg IGF-1 LR3. By mass ASCEND is a secretagogue preparation with a small direct-IGF-1 component. The ratio is fixed by the pharmacy's formulation and cannot be adjusted per component, which matters here because the four have very different amounts of human data behind them.

It is not growth hormone: nothing in the vial is somatropin, and three of the four components only work if your own pituitary responds. It is not a weight-loss medication; the one component with human trials, tesamorelin, carries a label statement that its effect on body weight is neutral. It is not an anabolic steroid. And it is not a substitute for training, sleep or protein intake — every component is described as amplifying signals the body already sends.

CJC-1295 is a 29-amino-acid analogue of growth-hormone-releasing hormone with four substitutions that protect it from dipeptidyl peptidase-IV, the enzyme that clears sermorelin and native GHRH within minutes. It binds the GHRH receptor on pituitary somatotroph cells and drives both release of stored growth hormone and synthesis of more. The form in ASCEND is CJC-1295 without the drug affinity complex, so it is dosed nightly. A 2006 paper in the Journal of Clinical Endocrinology and Metabolism sampled blood every ten minutes in healthy adults given the DAC form and reported that the pituitary's pulsatile pattern was preserved, with more growth hormone per pulse rather than a flat elevation — the basis for describing secretagogues as working with the axis rather than overriding it. A fuller treatment is on the CJC-1295 / Ipamorelin page.

Ipamorelin is a pentapeptide that binds the growth hormone secretagogue receptor, GHS-R1a, on pituitary cells and in the hypothalamus. It triggers growth hormone release directly and is described as reducing somatostatin, the brake signal on the pituitary. The 1998 characterisation paper in the European Journal of Endocrinology reported that in animal models it released growth hormone with potency similar to GHRP-6 but, unlike GHRP-6 and GHRP-2, did not raise ACTH, cortisol or prolactin at doses well above the releasing dose. That selectivity is why it is the ghrelin-receptor agonist in prescribing blends, and why it is paired with a GHRH analogue: two different signals converging on the same pulse. Its own page is ipamorelin.

Tesamorelin is a 44-amino-acid GHRH analogue with a trans-3-hexenoic acid group on the N-terminus that stabilises it against enzymatic breakdown. It binds the same pituitary receptor as CJC-1295 and triggers a pulsatile growth hormone release that remains subject to somatostatin. In the 2007 New England Journal of Medicine trial, IGF-1 rose by 81 percent over 26 weeks. Growth hormone is lipolytic, and visceral fat carries a higher density of the relevant receptors than subcutaneous fat, which is the mechanistic reason every tesamorelin trial has reported the same pattern: a measurable reduction in visceral fat on CT with no significant change in subcutaneous fat. In ASCEND it supplies a second GHRH signal alongside CJC-1295; the two act on the same receptor, so the pairing is about dose and duration rather than a new mechanism. See tesamorelin.

IGF-1 LR3 is native IGF-1 with an arginine substituted at position 3 and a 13-amino-acid extension on the N-terminus. A 1992 paper in the Journal of Molecular Endocrinology reported that those changes sharply reduce binding to the IGF binding proteins that carry more than 99 percent of circulating IGF-1, and that binding-protein escape, not receptor affinity, accounts for the analogue's higher potency in cell assays. It acts at the IGF-1 receptor, activating the PI3K–Akt cascade that drives protein synthesis. Two consequences follow. IGF-1 at high concentrations also activates the insulin receptor and lowers blood glucose, and the binding proteins are the buffer against that; an analogue built to escape them bypasses the buffer. And IGF-1 is the signal the pituitary reads to set growth hormone output, so supplying it from outside turns that output down: a 1995 paper in the Journal of Endocrinology infused LR3 IGF-1 into guinea pigs and reported that the animals' own IGF-1, IGF-2 and binding proteins fell while organs grew. In ASCEND it is dosed at 0.05 mg per injection. The full picture is on the IGF-1 LR3 page.

The axis map below is the clinical rationale for the blend. It is a rationale, not a finding — no study has confirmed that the four act as described when injected together, and none has measured what adding IGF-1 LR3 to three secretagogues does to the feedback loop they depend on.

The human evidence is two 2006 studies in the Journal of Clinical Endocrinology and Metabolism, both of the DAC form in healthy adults. The first reported dose-dependent increases in growth hormone and IGF-1 that persisted for days after a single injection and were described as well tolerated; the second is the pulsatility study above. In mice engineered to lack GHRH, a 2006 study in the American Journal of Physiology reported that once-daily CJC-1295 normalised growth. None of this measured body composition, recovery or sleep, and none used the non-DAC form at a nightly dose.

A 1999 paper in Pharmaceutical Research modelled the growth hormone response to intravenous ipamorelin in human volunteers and reported dose-dependent release with a half-life measured in hours. Animal work reports increased longitudinal bone growth and bone mineral content in rats. A 2014 randomised, placebo-controlled phase 2 study of intravenous ipamorelin for post-operative ileus did not show a significant difference from placebo — the largest human study of ipamorelin, at a different route, dose and population from anything on this page.

This is the component with real human trials. The 2007 New England Journal of Medicine trial randomised 412 people with HIV and abdominal fat accumulation to daily tesamorelin 2 mg or placebo for 26 weeks: visceral fat on CT fell 15.2 percent on treatment and rose 5.0 percent on placebo, triglycerides fell, and glycaemic measures did not differ. A 2010 pooled analysis in the Journal of Clinical Endocrinology and Metabolism covered 806 randomised patients across two phase 3 trials, reporting a treatment effect of −15.4 percent on visceral fat, no significant change in subcutaneous fat, and visceral fat returning toward baseline in those switched to placebo. Outside HIV, a 2012 trial in the same journal randomised 60 abdominally obese adults with reduced growth hormone secretion to tesamorelin 2 mg or placebo for 12 months and reported a reduction in visceral fat with no change in glucose measures. Every trial used a fixed daily dose of 1 or 2 mg; none used the 0.5 mg five nights a week delivered by ASCEND, and none combined it with other peptides.

The classic studies are from the early 1990s in rats made catabolic with dexamethasone: a 1992 paper in the Biochemical Journal reported that IGF-1 and, more so, its modified variants including LR3 improved nitrogen balance and body-weight gain in those animals. The 1995 guinea pig study reported organ growth alongside suppression of the animals' own IGF-1. Native IGF-1 has human data as mecasermin in children with severe IGF-1 deficiency, and a 1987 New England Journal of Medicine study reported that recombinant native IGF-1 given to healthy adults produced hypoglycaemia. None of that transfers directly to the analogue. There are essentially no published human clinical studies of IGF-1 LR3.

The rationale is physiological: the largest growth hormone pulse of the day occurs during slow-wave sleep, and a 2000 study in JAMA found slow-wave sleep and growth hormone secretion declining together in healthy men from early adulthood. Patients frequently report deeper sleep on secretagogues, but no published trial of any component, let alone the blend, has sleep or recovery as an endpoint.

This is the honest part, and the part worth understanding before starting.

There are no randomised controlled trials of ASCEND, or of any four-peptide combination of these components, in humans. The blend has never been studied as a blend. Evidence is per component, and it is uneven:

• Tesamorelin has randomised, double-blind, placebo-controlled trials, including two phase 3 trials that supported an FDA approval and one 12-month trial in abdominal obesity without HIV. Roughly 1,100 people have been randomised to it or placebo — a materially stronger base than any other compounded growth hormone secretagogue.
• CJC-1295 has small studies in healthy adults, of the DAC form, showing it raises growth hormone and IGF-1. No trial has measured a clinical outcome.
• Ipamorelin has pharmacokinetic work in volunteers and one randomised phase 2 trial, for post-operative ileus, that did not meet its endpoints.
• IGF-1 LR3 has no randomised human trials and essentially no human clinical studies of any kind.

Much of medicine rests on mechanism plus clinical experience, and that is the basis physicians prescribe ASCEND on. But the accurate framing is "three components known to raise growth hormone or IGF-1 in humans, one studied only in animals, combined on a physiological rationale," not "proven for body composition or recovery."

• That four peptides together do more than any one alone. No study has compared the blend with its components.
• An effect on muscle size, strength or scale weight in humans. Tesamorelin's trials measured visceral fat on CT and its label calls it weight-neutral; the muscle findings for IGF-1 are animal.
• Results at ASCEND's doses. The tesamorelin data is at 1–2 mg daily; 0.5 mg five nights a week is a physician's extrapolation.
• A timeline in humans. Timelines given by prescribers are clinical experience, not trial endpoints.
• Long-term safety over years of continuous use, which is why IGF-1 and fasting glucose are monitored.
• Efficacy for any condition as an FDA-approved treatment. ASCEND is not approved for anything; tesamorelin's approval belongs to a different product at a different dose for a specific population.

Both were placed in Category 2 of the FDA's interim 503A bulk drug substances list in September 2023, the category for substances flagged as raising significant safety concerns, and both were then taken through the FDA's Pharmacy Compounding Advisory Committee in full.

On 29 October 2024 the committee considered ipamorelin, evaluated for growth hormone deficiency and post-operative ileus, and voted 0 yes, 12 no, 1 abstain against recommending both the free base and the acetate for the 503A Bulks List, citing a lack of information supporting safety and efficacy for those two uses. On 4 December 2024 the committee considered the CJC-1295 family, evaluated for growth hormone deficiency, and voted 0–13 against CJC-1295 free base and 1–12 against CJC-1295 acetate; the three DAC forms were voted against 0–13 each.

Both have since left the 503A Category 2 list. The list as updated 14 May 2026 has six substances in Category 2, and neither CJC-1295 nor ipamorelin appears in Category 1, 2 or 3. The FDA's safety-risks page, current as of 22 April 2026, lists CJC-1295 among substances "nominated but withdrawn," with the agency's stated concern being immunogenicity risk for certain routes and peptide-related impurities; ipamorelin acetate is listed as withdrawn for 503A pharmacies but remains in Category 2 for 503B outsourcing facilities. Neither was on the agenda of the 23–24 July 2026 committee meeting.

The committee evaluates a substance for the specific uses in its nomination against the FDA-approved drugs that already exist for them; a vote against is not a finding that the peptide is unsafe at prescribed doses, and it is not a ban. The FDA has not issued a final determination on either. Both are prescribed by physicians and compounded by licensed 503A pharmacies to those prescriptions.

Egrifta (tesamorelin acetate) was approved on 10 November 2010 under NDA 022505 for the reduction of excess abdominal fat in HIV-infected adults with lipodystrophy, and on 23 March 2020 that approval was deemed a biologics licence in the transition that moved protein products onto the Purple Book. The current formulation, Egrifta WR, is dosed at 1.28 mg once daily; its label, revised March 2025, carries three limitations of use — long-term cardiovascular safety has not been established, it is not indicated for weight-loss management because its effect on weight is neutral, and there is no evidence it improves antiretroviral adherence — and is contraindicated in active malignancy, pregnancy and disruption of the hypothalamic-pituitary axis.

Because it is the active ingredient of an approved product, tesamorelin was never nominated for the 503A bulks list, is not in any category, and did not move in the 2026 changes. Compounded tesamorelin is not Egrifta: it has not been reviewed by the FDA for safety, effectiveness or manufacturing quality as a finished product, and the trial data belongs to the approved product at its approved doses. Prescribing it for anything other than HIV-associated lipodystrophy is off-label, which is a physician's decision and common across medicine, but should be understood as such.

IGF-1 LR3 does not appear in Category 1, 2 or 3 of the 14 May 2026 list, is not on the safety-risks page as a current or withdrawn Category 2 substance, and was not on the July 2026 committee agenda. The FDA has published no position on it, for or against. Native IGF-1, as mecasermin, is the active ingredient of the approved biologic Increlex, deemed a biologics licence on the same date as Egrifta; IGF-1 LR3 is a research analogue and is not a component of any approved product.

None of the four components is currently in 503A Category 2. Two were recommended against by the advisory committee in late 2024 for the specific uses in their nominations, with no final FDA rule issued. One is the active ingredient of an approved biologic, prescribed off-label in this blend. One has never been evaluated by the FDA at all. ASCEND itself is not an FDA-approved drug product, and compounded medications never are. See are peptides FDA approved.

Most of what is reported early is about sleep: some people describe falling asleep faster or sleeping more deeply within the first few nights of bedtime dosing, consistent with the timing of the growth hormone pulse but not measured in any trial. Injection-site tenderness, hunger after the dose and a brief flush are the other early observations. Noticing nothing in this window is normal.

This is where prescribers describe recovery between training sessions feeling shorter and morning stiffness easing, where it happens. It is also the window in which the follow-up IGF-1 measurement tells your physician whether the pituitary is responding and whether the dose is right — the number, rather than how you feel, is what the dose is titrated against.

Visceral fat change in the tesamorelin trials was measured at 26 weeks. Prescribers who use ASCEND with body composition as a goal describe it as a months-long proposition alongside training and diet. Nothing produces visible body-composition change in two weeks.

No withdrawal is described for any component. Because the three secretagogues work through your own pituitary, output returns to its baseline pattern when they stop; the tesamorelin extension data, in which visceral fat returned toward baseline on placebo, is the clearest demonstration that the measured effect does not persist on its own.

The directions are written in millilitres and in insulin-syringe units because that is what you can actually read off the barrel. 0.25 mL is 25 units on a U-100 syringe. You are not calculating anything — the number is printed on your medication. Because the four are in fixed proportion, every dose delivers the same split; you cannot take more of one and less of another. If your directions and syringe markings appear to disagree, ask before dosing.

Subcutaneous means into the fat layer, not the muscle. Abdomen and thigh are the usual sites, rotated so the same spot is not used repeatedly. Bedtime is specified because the body's largest growth hormone pulse occurs in the first hours of sleep and the secretagogues are meant to reinforce it. Prescribers generally direct that the dose be taken away from food, because a rise in blood glucose and insulin blunts growth hormone release; the IGF-1 LR3 component is the reason a physician may qualify that if you have any tendency to low blood sugar. Your directions will say.

20 doses at five per week is four weeks of weekday dosing, which is why refills run on a monthly cycle. Weekends off is part of the schedule, not a missed dose. One vial per fill, always — not a stockpile.

Refrigerated, and it ships that way in insulated packaging with ice packs. Beyond-use dating runs from first puncture and is on the label; a four-peptide vial is not something to keep past it.

The two-peptide CJC-1295 / Ipamorelin blend is the secretagogue core of ASCEND without tesamorelin or IGF-1 LR3. It is the more common starting prescription for sleep and recovery and carries none of the IGF-1 LR3 cautions. ASCEND adds a second GHRH analogue with human trial data behind it and a small direct growth-factor component; whether that addition is wanted is a physician's judgement about the goal.

Tesamorelin on its own delivers the one component with phase 3 evidence, at a dose per injection higher than ASCEND's 0.5 mg and with a simpler safety file. If the goal is specifically visceral fat, it is the more evidence-based prescription. ASCEND spreads a smaller amount of tesamorelin across a broader stimulus; it is aimed at the whole axis rather than at one endpoint.

The TITAN blend shares three components and swaps IGF-1 LR3 for BPC-157, trading a growth factor for a repair peptide and dropping the blood-sugar and growth-signalling questions that come with IGF-1. The PHYSIQ blend keeps tesamorelin and ipamorelin but pairs them with AOD-9604 and MOTS-c, aiming at fat metabolism rather than the axis as a whole. ASCEND is the one with a direct IGF-1 signal, which is its distinguishing feature and its main caution. It is supplied as a vial and syringe only; there is no Pen cartridge for this blend.