Tesamorelin Dosage: 1mg/Day, 5 On/2 Off Protocol (2026)

Tesamorelin is a synthetic GHRH analog that stimulates endogenous growth hormone production. It is the only FDA-approved treatment for reducing visceral fat in HIV-associated lipodystrophy, with Phase III trial data showing both visceral fat reduction and increased lean body mass.

Research-context information only. Tesamorelin is the active ingredient in an FDA-approved product for HIV-associated lipodystrophy; research-peptide and compounded forms are not FDA-approved and are sold for research purposes only. Protocols, doses, and reactions reported below come from published clinical trials and self-reported community sources. This article reports what has been documented, not what should be done. Consult a licensed physician for personal medical decisions.

FDA-approved for HIV lipodystrophy. Off-label community use is growing but lacks equivalent clinical evidence. This is not medical advice.

Tesamorelin Dosing Table

Match your vial size below — reconstitution and dose math update automatically.

1 mg

40 units

0.4 mL

Daily SubQ (5-on/2-off)Community

2 mg

80 units

0.8 mL

Daily SubQFDA-approved dose

Math assumes U-100 insulin syringes (1 mL = 100 units). Verify your syringe matches before injecting. Round half-units to the nearest visible mark.

20 units

0.2 mL

10 units

0.1 mL

Daily SubQ (5-on/2-off)

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Quick Reference: Standard Protocol

Dose

1 mg (20 units on insulin syringe)

Route

Subcutaneous injection

Timing

AM or PM

Frequency

5 days on, 2 days off

Cycle

8 weeks on, 8 weeks off

Vial size

10 mg

Reconstitution

2 mL bacteriostatic water → 5 mg/mL

Draw amount

20 units on insulin syringe

Storage

Refrigerate, use within 28 days

Standard protocol: 1 mg subcutaneous, 5 days on / 2 days off, for 8 weeks on / 8 weeks off. For the full tesamorelin profile, vendor pricing, and stacking options, see our tesamorelin peptide page.

Cycling Details

The 5on/2off schedule gives receptors periodic rest while maintaining consistent GH stimulation throughout the work week. The 8-week cycle length balances efficacy with cost management and receptor sensitivity.

Community protocols describe morning or evening dosing interchangeably; consistent timing is the documented standard approach. Fasted injection is commonly described in community sources as slightly optimizing GH response. Tesamorelin does not use a loading phase; documented protocols describe a direct 1 mg starting dose with no loading phase.

Continuous use versus cycling: what the trials documented

The community 8-on/8-off pattern is one approach; the clinical record describes another. In the Phase 3 program, tesamorelin was dosed at 2 mg subcutaneously every day for 52 continuous weeks with no scheduled breaks. IGF-1 reached its elevated plateau by week 26 and was maintained at that level through week 52, and visceral-fat reduction was sustained across the full year — the trials documented no tachyphylaxis (no loss of response over time) on continuous daily dosing (Falutz et al., 2007; 52-week extension, 2010). Trial data also documented that visceral fat re-accumulated after dosing stopped.

Community sources therefore describe two documented paths. Cycled use (commonly 8 weeks on, 8 weeks off) is typically described in the context of cost management and letting IGF-1 normalize between blocks. Continuous use mirrors the FDA-approved protocol, where the trial evidence for a sustained, non-attenuating response is strongest. In the trials, IGF-1 was monitored against the laboratory reference range, and published protocols described dose reduction when IGF-1 rose above it.

Enhanced Protocol (Clinical/FDA)

Note: The standard protocol above reflects the common community protocol at 1 mg. The FDA-approved protocol below uses the higher clinical dose.

2 mg daily

Every day (continuous)

Continuous under medical supervision

Indication

HIV-associated lipodystrophy

Evidence

Phase III RCT: 18% visceral fat reduction at 26 weeks

The FDA protocol runs continuously at 2 mg/day. Community protocols use 1 mg with cycling to manage cost and receptor sensitivity while still achieving meaningful GH elevation. Discontinuation leads to visceral fat regain regardless of dose. To estimate your total spend per cycle, see our tesamorelin cycle cost calculator. When you're ready to source, the tesamorelin buying guide covers which 4 of 7 vendors publish COA with mass spec verifying the 5,196 Da identity, plus vial-size selection (5mg vs 10mg).

Routes of Administration

Subcutaneous (only route): Trial protocols and FDA labeling describe rotating injection sites between left and right abdomen, with documented avoidance of scar tissue and the navel area. Community reconstitution guides note 27–30 gauge, ½ inch needle use.

Reconstitution Quick Reference

2 mL

5 mg/mL

10 mg vial + 2 mL BAC water = 5 mg/mL. At that dilution, a 1 mg dose corresponds to 20 units on an insulin syringe. One vial lasts 10 doses.

Community protocols describe gentle swirling — not shaking — to avoid degradation, with storage at 2–8°C and use within 28 days.

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