Tesamorelin

• Reducing excess abdominal (visceral) fat in adults with HIV-associated lipodystrophy

Tesamorelin (Egrifta WR, Egrifta SV) is a lab-made peptide that copies growth hormone-releasing hormone, the brain signal that tells the pituitary gland to release growth hormone. It is FDA-approved for one purpose: reducing excess abdominal fat in adults with HIV who have lipodystrophy, a change in body fat distribution linked to HIV and some older HIV medicines. It is one of the few peptides in this group with full FDA approval, which is why it comes up so often in conversations about peptide therapy.

How Tesamorelin Works

Tesamorelin is a 44-amino-acid analog of human growth hormone-releasing hormone (GHRH) with a small chemical change that makes it last longer in the body. Injected under the skin, it binds GHRH receptors in the pituitary and increases the body's own pulsed release of growth hormone. Growth hormone in turn raises IGF-1, a hormone made mainly by the liver.

Growth hormone shifts the body toward burning stored fat, and visceral fat, the fat packed around the abdominal organs, appears especially responsive. This is the fat most tied to insulin resistance and heart risk, explained in our article on visceral fat. Because tesamorelin works through the pituitary rather than replacing growth hormone directly, the body's normal feedback controls remain partly in place.

FDA Approval and What the Trials Showed

Tesamorelin was first approved in 2010 as Egrifta. Egrifta SV, a version mixed daily, followed, and in March 2025 FDA approved Egrifta WR, a formulation mixed once a week that uses a smaller injection volume.

The approval rested on two randomized trials in adults with HIV and excess abdominal fat. Over 26 weeks, people taking tesamorelin lost about 15 to 18 percent of their visceral fat measured by CT scan, while those taking placebo stayed about the same, as reported in the New England Journal of Medicine. Waist size and triglycerides also improved modestly. Body weight changed little, because the drug targets where fat sits rather than total weight.

The benefit depends on continuing the drug. When participants stopped after 26 weeks, most of the visceral fat returned within months. A later trial in people with HIV and fatty liver found that tesamorelin lowered liver fat, published in The Lancet HIV; that is research, not an approved use.

What Tesamorelin Is Not Approved For

Tesamorelin is not a weight loss drug and is not approved for people without HIV. It has not been shown to improve heart outcomes, and its long-term cardiovascular safety has not been established. It is also not approved for "anti-aging," muscle gain or general body recomposition, which is how clinics and online sellers often market it alongside sermorelin and CJC-1295.

Who Should Not Take Tesamorelin

The label lists several contraindications:

• Disruption of the hypothalamic-pituitary axis, such as pituitary surgery or removal, a pituitary tumor, hypopituitarism, or head radiation or trauma
• Active cancer, either new or recurring, because growth hormone and IGF-1 may stimulate tumor growth
• Pregnancy
• Known allergy to tesamorelin or any ingredient in the product

People with diabetes can use it, but blood sugar must be watched closely, since tesamorelin can raise glucose and worsen glucose tolerance. People with diabetes should keep up their regular eye exams during treatment.

Monitoring and Follow-Up

Before treatment we check fasting glucose or A1c and IGF-1, and update age-appropriate cancer screening. During treatment the label advises periodic glucose checks and IGF-1 monitoring, with consideration of stopping the drug if IGF-1 stays well above the normal range. These are routine blood tests we can draw at our in-office lab.

Judging Whether It Is Working

The FDA label recommends weighing continued use after about 26 weeks. Waist measurement and how clothes fit are practical markers; imaging is not usually needed in everyday care. If there is no clear reduction in abdominal fat by then, the medication is unlikely to be worth the cost and daily injections. Many people need prior authorization from their insurer, which usually asks for documentation of HIV, lipodystrophy and waist measurements.

Side Effects and Safety

The most common side effects in trials were joint pain, injection site reactions, pain in the arms and legs, swelling, and muscle aches. These reflect the effects of higher growth hormone and often ease over time. Fluid retention can cause swelling and hand numbness similar to carpal tunnel syndrome.

Allergic reactions, including rash and hives, have been reported. Injection sites should be rotated within the abdomen and kept away from scars, bruises and the navel. Because both Egrifta formulations differ in strength and preparation, they are not substitutable, and switching requires a new prescription and new instructions.

How Tesamorelin Compares With Other Growth Hormone Peptides

Tesamorelin belongs to the same family as sermorelin and CJC-1295, which all act on the GHRH receptor, and it is often grouped online with ipamorelin and ibutamoren (MK-677), which raise growth hormone through a different receptor. The difference that matters most is regulatory. Tesamorelin went through large randomized trials and FDA review, is made under FDA manufacturing standards, and has a label that spells out its dose, risks and monitoring. CJC-1295 and ipamorelin are not FDA-approved for any use, and ibutamoren remains on FDA's list of substances that may pose significant safety risks in compounding.

That does not make tesamorelin a better choice for general wellness. Its benefits were shown only in adults with HIV-associated lipodystrophy. For people without HIV who want to lose belly fat, weight loss through diet and activity, and when appropriate an FDA-approved GLP-1 medication, have far stronger evidence.

Getting Care in St. Petersburg

Our internists care for adults with long-term conditions, including the metabolic side of HIV care such as blood sugar, cholesterol, metabolic syndrome and fatty liver, in coordination with your HIV specialist. If you are considering tesamorelin, or using a peptide bought outside a pharmacy, our endocrine and hormone care team can review the evidence with you. To talk it through, schedule a visit.