Tesamorelin
The GHRH analogue specifically effective in reducing visceral fat
Definition
Tesamorelin is a synthetic 44-amino-acid analogue of growth hormone-releasing hormone (GHRH) modified with a trans-3-hexenoic acid residue that increases its stability and half-life. It is the only GH secretagogue FDA-approved (2010) — for reduction of abdominal lipodystrophy in HIV patients. Its unique clinical profile is the very potent and specific reduction of abdominal visceral fat, with documented efficacy of 15-20% VAT reduction in clinical trials.
Detailed explanation
Mechanism: Tesamorelin stimulates pulsatile endogenous GH release from the pituitary, physiologically raising IGF-1. The preserved pulsatility protects sensitivity of peripheral GH receptors. The preferential effect on visceral fat (vs subcutaneous) is due to the greater density of GH receptors in visceral adipose tissue.
Clinical evidence: HIV lipodystrophy: pivotal trials (Falutz 2007, Stanley 2014) showed VAT reduction of 15-18% at 26 weeks with 2 mg/day subcutaneous, with improvement of lipid profile and triglycerides. Fatty liver (NAFLD/MAFLD): trials in patients with hepatic steatosis show significant reduction of liver fat fraction measured by MRS and H1-MRS. General lipohypertrophy: potent effects on visceral fat redistribution in non-diabetic metabolic obesity. Cognitive function: preliminary studies suggest improvements in mild cognitive impairment (IGF-1 effect on neuroplasticity). Body composition in longevity: growing off-label application in metabolic biohacking of those over 50 with elevated VAT.
Dose: 1-2 mg/day subcutaneous in abdomen, rotating sites. Preferential night-time application (aligns with natural GH release during sleep). Prolonged treatment: typically 6-12 months for optimal VAT results.
Monitoring: IGF-1 (target within physiological range, not supratherapeutic), fasting glucose, HbA1c (watch elevation), lipid profile. Contraindications: active or recent cancer, pregnancy, breastfeeding, poorly controlled diabetes.
Availability: approved in US as Egrifta. In Spain and EU restricted access — compassionate use or specific protocols in specialised clinics.
Scientific sources
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