Tesamorelin + Ipamorelin: What It Is, Where to Get It Prescribed, and What It Costs

Tesamorelin + Ipamorelin is not a single molecule. It is two independently studied growth-hormone secretagogues — compounds that prompt the pituitary to release growth hormone the body makes itself — dissolved together in one sterile multi-dose vial by a compounding pharmacy. Each has its own research literature, its own described mechanism and its own, very different, regulatory file at the FDA. The combination has no name in any journal, and it has never been studied as a combination. That shapes everything on this page: "does it work" has to be broken into two questions.

Neither contains growth hormone. Both deliver an instruction; the pituitary decides how much to release, and the body's feedback loops — somatostatin, IGF-1 — still apply. That is the central difference from injected growth hormone, which bypasses the gland altogether.

The pituitary listens to two separate inputs for growth hormone. Growth-hormone-releasing hormone from the hypothalamus acts on one receptor; ghrelin-type signals, originally from the gut, act on another. Tesamorelin supplies the first signal and ipamorelin the second. Because the two receptors sit on the same cells and are described as acting additively, the prescriber's rationale is that one bedtime injection of both produces a fuller pulse than either alone, on top of the pulse slow-wave sleep already produces.

The ratio is worth noticing. In the standard strength tesamorelin is 10 of the 15 mg in the vial, so by mass this is mostly a tesamorelin preparation with ipamorelin as the smaller component. The proportion is set by the pharmacy's formulation and differs between the three strengths; within any one vial it cannot be adjusted per component, which is the genuine trade-off of any blend.

It is not growth hormone, and it cannot substitute for it in someone whose pituitary cannot respond — the approved tesamorelin product is contraindicated where the hypothalamic–pituitary axis is disrupted for exactly that reason. It is not a weight-loss medication: the approved tesamorelin label states it is not indicated for weight-loss management because its effect on scale weight is neutral, and the mouse work on ipamorelin points, if anywhere, the other way. It is not an anabolic steroid; neither component binds the androgen receptor or suppresses testosterone. And it is not a treatment for any diagnosed disease as supplied here — no regulator has reviewed this combination for anything.

Native growth-hormone-releasing hormone is cut apart in the bloodstream within minutes by the enzyme DPP-4. Tesamorelin is that same 44-residue sequence with a trans-3-hexenoic acid group on one end that protects the cleavage site, so a subcutaneous dose survives long enough to reach the pituitary. There it binds the GHRH receptor on somatotroph cells and triggers a growth hormone pulse. Because the release is pulsatile and remains subject to somatostatin, the pattern is described as an amplified version of normal physiology rather than a flat, sustained elevation.

Growth hormone released in the pulse acts on the liver to produce IGF-1, which carries most of the signal to tissue. In the 2007 New England Journal of Medicine trial of tesamorelin in people with HIV, IGF-1 rose substantially over 26 weeks. The size of that rise is why IGF-1 monitoring is written into the approved product's label, and why it is the marker your physician tracks rather than growth hormone itself, which is pulsatile and hard to interpret from a single draw.

Growth hormone is lipolytic — it signals fat cells to release stored triglyceride — and visceral fat, the fat around the organs, carries a higher density of the relevant receptors than the fat under the skin. That explains the pattern every tesamorelin trial has reported: a measurable reduction in visceral fat on CT with no significant change in subcutaneous fat. It is also why the trial evidence is specific to visceral fat and says nothing about general weight, a distinction that is frequently lost in marketing.

Ipamorelin is a pentapeptide developed at Novo Nordisk in the 1990s. It binds the growth hormone secretagogue receptor, GHS-R1a — the receptor ghrelin uses — and not the GHRH receptor; the founding paper in the European Journal of Endocrinology in 1998 used receptor antagonists to show that. The same paper called it "the first selective growth hormone secretagogue" because in pigs it released growth hormone at potency comparable to the older peptides GHRP-2 and GHRP-6 without raising ACTH or cortisol above what GHRH itself produced, and without affecting prolactin. That selectivity is the reason it, rather than an older GHRP, is the ghrelin-side component in a preparation taken nightly for weeks. In humans, selectivity is inferred from the animal work rather than measured directly.

The rationale is one pulse, two signals. A GHRH analogue asks the pituitary to release; a ghrelin-receptor agonist asks through a second door on the same cell, and is also described as easing the somatostatin brake. The largest natural growth hormone pulse occurs in the first hours of slow-wave sleep, so a bedtime dose is intended to land on top of a pulse the body is already producing rather than creating one at a time the system would normally be quiet. Two points of precision: the additive effect has been described for the classes, not measured for this pairing; and the pairing is a clinical rationale, not a finding.

This is tesamorelin's evidence, and it is the strongest evidence for any component of any growth-hormone secretagogue prescribed as a compounded peptide. The first phase 3 trial, in the New England Journal of Medicine in 2007, randomised 412 people with HIV and abdominal fat accumulation to daily tesamorelin 2 mg or placebo for 26 weeks and reported a 15.2% fall in visceral fat on CT against a 5.0% rise on placebo, with a fall in triglycerides and no group difference in glycaemic measures. A pooled analysis of both phase 3 trials in the Journal of Clinical Endocrinology and Metabolism in 2010 covered 806 randomised patients with a 26-week safety extension; visceral fat fell on treatment and rose on placebo, subcutaneous fat did not change significantly, and in patients switched to placebo after 26 weeks the reduction drifted back toward baseline. That last point matters before you start: the effect is described as maintained while the signal is present.

One randomised trial has tested tesamorelin outside HIV, in the Journal of Clinical Endocrinology and Metabolism in 2012: 60 abdominally obese adults with reduced growth hormone secretion, tesamorelin 2 mg or placebo for 12 months. It reported a reduction in visceral fat versus an increase on placebo, with improvements in triglycerides and C-reactive protein, no change in subcutaneous fat and no change in glucose measures. It is one trial of 60 people selected for low growth hormone secretion, but it is the most direct evidence that the visceral-fat finding is a property of the molecule rather than of HIV. Smaller randomised trials of tesamorelin in liver fat and in cognition in older adults are covered on the tesamorelin page.

Established in every species tested. In humans, a dose-escalation study in Pharmaceutical Research in 1999 gave healthy male volunteers intravenous ipamorelin at five dose levels and reported dose-proportional pharmacokinetics, a roughly two-hour half-life and a single, sharp episode of growth hormone release at every dose. That study is the human pharmacology anchor for ipamorelin. It measured growth hormone only — not sleep, body composition, strength or recovery — and it did not use the subcutaneous route.

A 2001 paper in Biochemical and Biophysical Research Communications runs against how ipamorelin is often marketed. In mice, twice-daily ipamorelin increased body weight, fat-pad weight, leptin and food intake, and the authors concluded that secretagogues of this class increase adiposity by growth-hormone-independent mechanisms that likely include feeding. This does not mean ipamorelin makes people fatter; it means the animal evidence does not support fat loss as an effect of ipamorelin, and nobody should tell you it does. In this blend the body-composition case rests on tesamorelin.

Ipamorelin was taken into human trials by Helsinn for return of bowel function after surgery, because ghrelin receptors also sit on the nerves that drive gut movement. A phase 2, multicentre, double-blind, placebo-controlled study in the International Journal of Colorectal Disease in 2014 randomised 114 adults undergoing bowel resection to intravenous ipamorelin or placebo twice daily for up to seven days. Time to tolerating a solid meal did not differ significantly from placebo, no secondary endpoint separated, and the programme was discontinued. It is the only randomised trial of ipamorelin in patients ever published, for a surgical indication by intravenous infusion.

There are no randomised controlled trials of Tesamorelin + Ipamorelin, or of any tesamorelin-plus-ipamorelin combination, in humans. The blend has never been studied as a blend. Evidence is per component, and it is sharply uneven:

• Tesamorelin has randomised, double-blind, placebo-controlled human trials, including two phase 3 trials that supported an FDA approval, with more than 800 people randomised in the pooled phase 3 analysis alone. Every trial used a fixed daily dose of 1 mg or 2 mg, most were in people with HIV, and the longest ran 12 months. None used the weekday-night schedule or the doses on this page.
• Ipamorelin has one pharmacokinetic study in healthy volunteers confirming that intravenous ipamorelin releases growth hormone in people, and one randomised phase 2 trial in bowel-resection patients that did not meet its endpoints. There are no randomised human trials of ipamorelin for sleep, recovery, body composition or any wellness use, and no human data for the subcutaneous route at all — the FDA's 2024 review looked and found none.

Much of medicine rests on mechanism plus clinical experience, and that is the basis on which physicians prescribe this blend. But the accurate framing is "one component with trial evidence for one endpoint, one component with pharmacology and prescribing experience, combined on a rationale," not "proven in people."

• That the two together do more than tesamorelin alone. No study has compared the blend with its components.
• An effect on scale weight. The approved tesamorelin label calls the drug weight-neutral; the trials measured visceral fat on CT, not kilograms.
• An effect on subcutaneous fat. Every tesamorelin trial that measured it reported no significant change.
• Results at the compounded doses or schedule. The human data is at 1–2 mg tesamorelin daily; five nights a week at the doses on this page is a physician's extrapolation.
• Any effect of ipamorelin on sleep, recovery or body composition in adults. No trial has measured it.
• Long-term safety of the combination. The approved tesamorelin label says long-term cardiovascular safety has not been established; the longest human exposure to ipamorelin on record is seven days.
• Efficacy for any condition as an FDA-approved treatment. Neither the blend nor compounded versions of its components are approved for anything.

An FDA-approved tesamorelin product exists. Egrifta (tesamorelin acetate), from Theratechnologies, was approved on 10 November 2010 for the reduction of excess abdominal fat in HIV-infected adult patients with lipodystrophy. On 23 March 2020 that approval was deemed a biologics licence under the Public Health Service Act, in the transition that moved protein products onto the biologics framework; the FDA's own record now describes it as BLA 022505. The current formulation, Egrifta WR, is dosed at 1.28 mg once daily, with labelling revised in March 2025. Its label 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 are no data to support improved antiretroviral adherence. It is contraindicated in disruption of the hypothalamic–pituitary axis, active malignancy, known hypersensitivity and pregnancy.

Tesamorelin is not on the FDA's 503A bulk drug substances category list and never was, because that list is for nominated substances that are not components of approved drugs; on the version updated 14 May 2026 it appears in no category. It was not among the peptides removed from Category 2 on 15 April 2026 and was not on the Pharmacy Compounding Advisory Committee's July 2026 agenda.

Compounded tesamorelin is not Egrifta. It is prepared by a state-licensed pharmacy to an individual physician's prescription. It has not been reviewed by the FDA for safety, effectiveness or manufacturing quality as a finished product, and the trial data above 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 it should be understood as such.

Ipamorelin acetate was placed in Category 2 of the FDA's interim 503A and 503B lists — the category for nominated substances the agency has flagged as presenting significant safety risks — on 29 September 2023. The concern the FDA recorded was immunogenicity risk from aggregation or peptide-related impurities for certain routes, the characterisation complexity of its unnatural amino acids, and the limited safety data from the intravenous hospital trials, which are not the outpatient subcutaneous use prescribed here. The 503A nomination was later withdrawn by the nominator, and the FDA's page on those listings, current as of 22 April 2026, now records ipamorelin acetate under withdrawn 503A nominations while noting that the agency "has not identified safety-related information regarding ipamorelin acetate via certain other injectable routes of administration" and "lacks sufficient information to know whether the drug would cause harm if administered to humans via those routes." The same page still lists ipamorelin acetate in Category 2 for 503B outsourcing facilities.

On 29 October 2024 the FDA's Pharmacy Compounding Advisory Committee voted 0 in favour, 12 against, with 1 abstention, on adding ipamorelin (free base) and ipamorelin acetate to the 503A Bulks List. The uses evaluated were growth hormone deficiency and postoperative ileus — not the uses it is actually prescribed for — and the committee's stated reason was a lack of information supporting safety and efficacy in the available data for those uses; one member remarked that frequent prescribing does not by itself mean a drug is safe and effective.

A committee vote is an advisory recommendation, not a rule. On the FDA's 503A category list updated 14 May 2026, ipamorelin appears in no category and no final determination has been issued; it is not on the July 2026 advisory docket. The pharmacies that compound this blend are state-licensed 503A pharmacies preparing it to an individual prescription; the 503B Category 2 listing governs outsourcing facilities, which is a different channel.

One component is the active ingredient of an approved biologic, prescribed here off-label in a compounded form. The other has a withdrawn 503A nomination, an advisory vote against it for two clinical uses that are not the ones prescribed, and no final FDA rule. Both are legal to prescribe and dispense with a valid prescription. Neither the blend nor compounded versions of its components is an FDA-approved drug product, and compounded medications never are — they are prepared by a licensed pharmacy to a physician's prescription, not approved as manufactured products.

The pharmacology says what happens on night one: a growth hormone pulse within the hour, gone by morning. What people describe first is sleep — often deeper, sometimes with more vivid dreams — which fits a bedtime dose landing on the slow-wave pulse. Some report a brief headache, flushing, hunger or light-headedness after the injection; some early fluid retention, joint stiffness or hand tingling can appear, which the tesamorelin trials recorded as the commonest non-injection-site effects. Nobody should expect a visible change in the abdomen in two weeks, and noticing nothing is normal.

IGF-1 has risen and settled. This is the window in which prescribers describe recovery between training sessions and, where diet and training are in place, the first body-composition changes. The follow-up IGF-1 and fasting glucose draw usually falls here and decides whether the dose and strength stay where they are.

The tesamorelin trials measured their primary endpoint at six months. If visceral fat is the goal, this is the horizon on which to judge it — by waist measurement or imaging rather than the scale, which the evidence says will not move much. The approved label advises weighing the case for continuing in anyone who has not had a reduction in visceral fat, and that is a reasonable conversation to have with your physician.

No withdrawal is described for either component; because both ask the pituitary for a pulse rather than replacing growth hormone, the gland's own output is not suppressed. What the tesamorelin extension data does describe is visceral fat drifting back toward baseline over the six months after switching to placebo — the pattern of most metabolic therapies, where the effect is maintained while the signal is present.

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 two peptides are in fixed proportion within a vial, every dose delivers the same split; you cannot take more of one and less of the other. If your directions and syringe markings appear to disagree, ask before dosing.

Subcutaneous means into the fat layer, not the muscle. The abdomen is the usual site, rotated so the same spot is not used repeatedly. The dose is taken shortly before sleep, on an empty stomach where possible, so the pulse it triggers lands on top of the one slow-wave sleep already produces; a meal shortly before is described as blunting the response. The weekday-only schedule is a prescriber convention that gives the axis two nights without a signal each week; it is not trial-derived, and your physician may direct otherwise.

20 doses at five nights a week is exactly four weeks, which is why refills run on a 28-day cycle. Weekends off is part of the schedule, not a missed dose. One vial per fill, always — not a stockpile.

IGF-1 is the practical dosing guide, because it is the mediator of growth hormone effect and the aim is a physiological range rather than the highest achievable. Fasting glucose matters because growth hormone reduces insulin sensitivity. Lipids and thyroid are commonly checked alongside because both interact with the same axis. At-home blood testing covers these without a lab visit; a provider prescribing a GH-axis blend with no labs at all is not monitoring you.

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

The same idea — a GHRH analogue plus a ghrelin-receptor agonist in one vial — with a different GHRH half. CJC-1295 / Ipamorelin uses a modified 29-amino-acid GHRH fragment and is the most commonly prescribed GH-axis combination for a general recovery and body-composition brief. This blend uses the full 44-residue sequence with the phase 3 trial record for visceral fat. Prescribers reach for it when visceral fat is the specific goal and for CJC-1295 / Ipamorelin when it is not.

Tesamorelin on its own is the component carrying the human trial evidence, at the same per-injection tesamorelin dose in the matching strength. Adding ipamorelin adds the second pituitary signal on a rationale, not on a trial. A physician who wants to see how a patient responds to the GHRH signal alone, or who wants the cleaner evidence base, starts with the single agent; one who wants the fuller pulse chooses the blend.

The PHYSIQ blend contains the same two peptides plus AOD-9604 and MOTS-c, in equal parts. It is the broader body-composition formula; this blend is the narrower one, with more tesamorelin by proportion and nothing acting outside the growth hormone axis. If a physician's aim is a GH-axis prescription and nothing else, this is the more targeted of the two.