Tesamorelin Before and After: Results at 4, 8, 12 and 26 Weeks From the Trial Data

Tesamorelin is the one growth-hormone secretagogue with a proper "after" on record, because it is also a licensed drug. As EGRIFTA it went through two placebo-controlled phase 3 trials totalling 806 patients, a 26-week extension in which some patients were switched to placebo, and a 12-month trial in obese adults without HIV.^1,5,9 That means the question "what does tesamorelin before and after actually look like" can be answered with CT scans, waist tapes and blood panels rather than with somebody's bathroom mirror.

This page does not carry photos or testimonials. It sets out what the published data say happens week by week, what a researcher should record before starting so that the "after" means something, how big the realistic change is, what is noise, and what disappears when the compound is stopped. The Bureau's tesamorelin guide covers the pharmacology; this page is only about the timeline.

Results at a glance: 4, 8, 12, 26 and 52 weeks

Every cell below is a published measurement with its source; where no trial measured anything at a timepoint, the cell says so rather than filling the gap with an estimate. All figures are group averages in the trial populations (mostly men in their forties with excess visceral fat), on 2 mg a day.

Where the before-and-after data come from

Four bodies of evidence do most of the work here. First, the 12-week dose-ranging study (61 HIV-positive patients with abdominal fat accumulation, 1 mg or 2 mg daily against placebo), the earliest fat measurement in the literature.⁴ Second, the two 26-week phase 3 trials, pooled as 543 patients on 2 mg tesamorelin against 263 on placebo, with a 26-week extension in which everyone who completed the first 26 weeks on tesamorelin was re-randomised to keep going or to switch to placebo.^1,5 Third, a 12-month trial of 60 abdominally obese adults without HIV and with reduced growth hormone secretion.⁹ Fourth, a six-month trial of 50 patients that added liver-fat imaging and a two-week glucose check.⁸

Two caveats before the numbers. The phase 3 trials measured visceral adipose tissue (VAT) by CT at the L4 to L5 level, in square centimetres of cross-sectional area, not by tape or scale. And the trial populations were mostly men in their forties with a specific pattern of central fat, selected by waist size and waist to hip ratio; the size of the effect in a lean person with a normal growth hormone axis is not established anywhere.

The week-by-week timeline

Read the last row carefully. The VAT curve is not linear for a year. The pooled analysis shows most of the visceral loss is in by week 26 and the second 26 weeks add a few percentage points. Anyone expecting the six-month result to double by twelve months is expecting something the trials did not find.

Why there are no before and after pictures here, and how to take useful ones

Searches for tesamorelin before and after pictures outnumber searches for the data, and the pictures are the least informative evidence available. The compound's measured effect is on visceral fat, the depot behind the abdominal wall that a CT scan sees and a camera does not. Subcutaneous abdominal fat, the layer that changes a photograph, did not move in any trial (2 cm² down against 2 cm² up in the pooled data). A set of photographs showing a dramatic change over a few months on tesamorelin alone is therefore showing something else as well: a diet, a GLP-1 compound, a lighting change, or a different person.

If you want photographs that mean something, treat them as one instrument among several and control them like one: the same room, the same light source, the same lens distance and height, the same time of day, fasted, weekly, front and side. Pair them with the waist tape and the bloodwork listed below, and expect the tape and the triglyceride panel to move before the pictures do. The honest visual change at six months in the trial population was a flatter upper abdomen and a looser waistband, which is exactly what a 3 cm waist reduction looks like.

What to record before the first dose

The trials used CT scans. Most researchers will not. That makes the baseline log more important, not less, because the effect is specifically visceral and the ordinary measures (scale, mirror) are poor at seeing visceral change. The Bureau suggests the following minimum, recorded on the same day of the week, in the morning, fasted.

• Waist circumference at the navel, same tape, same tension, three readings averaged. This is the one cheap measurement that tracked VAT in the trials (a 2 cm placebo-adjusted change at 26 weeks).
• Scale weight as a 7-day rolling average, because tesamorelin barely moves total weight (trunk fat -1.0 kg over 26 weeks) and a single reading is dominated by water.
• Fasting glucose and HbA1c. The label records an HbA1c of 6.5% or above in 4.5% of tesamorelin patients versus 1.3% on placebo at 26 weeks, and a hazard ratio of 3.3 for developing diabetes. If you do not know your starting glucose, you cannot see the signal.
• IGF-1, because 47.4% of patients on 26 weeks of treatment had IGF-1 more than 2 standard deviations above normal and 35.6% were above 3. The label says to consider stopping when it stays elevated. A baseline value is the only way to interpret a follow-up.
• Fasting triglycerides and the cholesterol to HDL ratio, which fell in the HIV trials (in the obese non-HIV trial triglycerides fell but total, HDL and LDL cholesterol did not change).^3,4,9
• Front and side photographs in the same room, same light, same lens distance, same time of day, weekly. Note that subcutaneous fat did not change in any trial, so the photographs may look unremarkable even when the CT would not.
• A symptom log for joint pain, hand tingling, ankle swelling and injection-site reactions, which are the side effects that decided most discontinuations.

If you are also running a DEXA or a CT, book the baseline scan before the first dose rather than in week two, so the "before" really is before.

Women, and anyone outside the trial population

The phase 3 trials enrolled mostly men, which reflects the HIV lipodystrophy population they studied rather than any decision to exclude women, and no trial reported a separate effect size for women. The licensed product's label sets the same dose regardless of sex.¹ The 12-month study in obese adults without HIV did include women; it selected people with reduced growth hormone secretion and found a placebo-adjusted visceral fat reduction of 35 cm², as large as in the HIV trials.⁹ No trial studied people with a normal growth hormone axis and a small visceral depot, so there is no basis for expecting the headline numbers in that group.

Pregnancy is a contraindication on the licensed label, as are active malignancy and any disruption of the hypothalamic-pituitary axis such as a pituitary tumour, pituitary surgery or head irradiation. Those exclusions apply to research use with at least the same force.

Realistic magnitude, and what is noise

Within the treated groups, visceral fat area fell about 11 to 18 percent at 26 weeks, a placebo-adjusted effect of 15.4 percent in the pooled analysis.^3,10,1,5 In absolute terms that was 21 to 27 cm² in the phase 3 studies and 34 cm² in the six-month liver-fat trial.^1,8 It is a real change, and it came with lower triglycerides in the HIV trials and less liver fat in the follow-on studies.^3,8,11 It is not a transformation. The people in these trials lost about a kilo of trunk fat, 2 to 3 cm of waist and essentially no scale weight.¹

Noise, by contrast, is large relative to that. A waist tape moves with meals and water from one day to the next, easily by as much as the 26-week placebo-adjusted effect, and scale weight swings more over a week than tesamorelin moved it in six months. The 12-week VAT change, although minus 15.7 percent on 2 mg, was not statistically distinguishable from placebo with 61 people, which tells you how wide the individual spread is.⁴ And the placebo groups themselves moved: 1 cm off the waist and, in one study, 2 percent off VAT, presumably from being weighed and watched.¹ A researcher with no control arm is comparing against their own memory.

The IGF-1 response is the one place the magnitude is large: an 81 percent rise at 26 weeks in the NEJM trial and a mean increase of 108 ng/mL in the pooled analysis.^3,5 That number is why the label asks for monitoring.

What reverses on stopping

This is the clearest part of the tesamorelin record, and the part most before-and-after pages leave out. In the 26-week extension, everyone who had completed the first 26 weeks on tesamorelin was re-randomised to continue or to switch to placebo.¹ Those kept on tesamorelin held their result (VAT changed by +3 cm² and -11 cm² in the two studies over the second 26 weeks). Those switched to placebo regained 25 and 24 cm², essentially the whole 26-week loss, in the same 26 weeks it took to lose it; their trunk fat rose 1.4 and 1.09 kg and IGF-1 fell by about 135 ng/mL.¹ The 2008 paper summarised it plainly: "Upon discontinuation of tesamorelin, VAT reaccumulated."⁷

The pharmacology fits. Tesamorelin is a GHRH analogue that raises the body's own growth hormone pulses while it is present; in healthy men IGF-1 was no longer different from baseline two weeks after stopping.¹² There is no published evidence of a lasting reset once it is withdrawn, and the licensed product is used as continuing therapy. The Bureau's peptide cycles page discusses how researchers handle compounds whose effect is entirely on-treatment.

Where people misattribute results

Scale weight as fat loss. Tesamorelin does not move the scale much; if the scale drops several kilos, something else (diet, a GLP compound, illness) did it. If the scale rises early on, the label's fluid retention and the trials' small lean-mass gain are both more likely than fat.

A softer or flatter stomach as "the tesamorelin working". Subcutaneous abdominal fat, the layer you can pinch, did not change in any trial (-2 cm² versus +2 cm² in the pooled data). Visceral fat sits behind the abdominal wall. A pinch test measures the wrong depot.

Stack effects. Tesamorelin is routinely paired with ipamorelin or CJC-1295 in research protocols. If the "after" came from a stack, the trial numbers on this page no longer apply, and the extra GH pulse from a GHRP will add its own water and appetite effects. See the tesamorelin and ipamorelin stack page for what is and is not known about the combination.

Population. The headline numbers come from HIV-positive patients with excess abdominal fat and from obese adults selected for reduced growth hormone secretion. The obese non-HIV trial found a placebo-adjusted VAT reduction of 35 cm² (minus 16 against plus 19 cm² on placebo), similar to the HIV trials.⁹ No trial studied a young person with a normal IGF-1 and little visceral fat, so nothing on this page tells that person what to expect.

Lipids and liver enzymes as proof of fat loss. These improved in the trials, but they also respond to diet within days. A triglyceride drop in week 2 is not visceral fat; it is last week's meals.

Joint pain as "growth". Arthralgia occurred in 13.3% of treated patients versus 11.0% on placebo. It is a GH-related fluid effect, not a sign that anything is being rebuilt.

Sourcing and dosing notes

The trials used 2 mg once daily; the current EGRIFTA SV label uses 1.4 mg of a more concentrated formulation. Research protocols generally mirror the 1 to 2 mg range, and the tesamorelin dosage guide walks through the reconstitution arithmetic. To convert a vial size and bacteriostatic water volume into syringe units, use the tesamorelin dosage calculator.

On sourcing: tesamorelin is a peptide that degrades if handled badly, and the trial-sized effect depends on a full daily dose for six months, so a vendor with per-batch lab results matters more than a few dollars per vial. The Editor's Pick on the Bureau's Vendor Scorecard is Amino Club, which publishes a batch COA on every product page; the Amino Club review sets out how the scorecard treats it, and best peptides for fat loss puts tesamorelin next to the GLP class for anyone whose goal is scale weight rather than visceral area.

Tesamorelin is a research compound. The numbers above describe licensed-drug trials in specific patient populations; nothing here is medical advice, and the Bureau does not advise anyone on using research compounds.

Frequently Asked Questions

What does tesamorelin before and after look like at 4 weeks?

Nothing measurable in fat, because no trial measured fat, waist or weight at four weeks. What is documented at one month is that IGF-1 is significantly raised, with no difference in glucose at the early timepoints in obese adults without HIV. The growth hormone fluid effects on the label (oedema, joint ache, tingling) can appear during treatment, but the label does not time them by week. Anyone reporting visible fat loss at week four on tesamorelin alone is reporting something the data do not support.

What results does tesamorelin give at 8 and 12 weeks?

No trial reports any measurement at eight weeks. At twelve weeks the dose-ranging study found trunk fat 9.2 percent down by DEXA and visceral fat 15.7 percent down by CT on 2 mg, the latter not statistically significant in 61 people, with IGF-1 65 percent above placebo. Twelve weeks is the first point with published data to compare a scan against; 26 weeks is the fair before-and-after.

Are there tesamorelin before and after pictures?

Not on this page, deliberately. Tesamorelin's measured effect is on visceral fat behind the abdominal wall, which a photograph cannot see, and subcutaneous fat did not change in any trial. Pictures that show a dramatic change usually show diet, a GLP-1 compound or different conditions as well. If you want your own useful record, standardise the room, light, distance and time of day, shoot weekly, and read the photographs alongside a waist tape and bloodwork.

Do women get the same tesamorelin results?

Unknown. The phase 3 trials enrolled mostly men and reported no separate female effect size, and the licensed label uses the same dose for everyone. The 12-month study in obese adults without HIV included women and found a placebo-adjusted visceral fat reduction of 35 cm squared, similar to the HIV trials, but it only enrolled people with reduced growth hormone secretion. Pregnancy is a contraindication and the compound stops there.

How long does tesamorelin take to show results?

IGF-1 is significantly up by week two, the first measurement, but fat change is not measured until week twelve, where the 2 mg group showed trunk fat down 9.2 percent by DEXA and visceral fat down 15.7 percent by CT, the latter not statistically significant in a 61-patient study. The fair before-and-after point is 26 weeks, where visceral fat fell about 11 to 18 percent within the treated groups, a placebo-adjusted 15.4 percent in the pooled analysis. Expect nothing visible in the first month.

How much visceral fat does tesamorelin remove?

About 11 to 18 percent of visceral adipose tissue area at 26 weeks within the treated groups of the phase 3 trials, a placebo-adjusted 15.4 percent pooled, which was 21 to 27 cm squared by CT, and 17.5 percent from baseline at 52 weeks in patients who stayed on treatment. The 12-month trial in obese adults without HIV found a 35 cm squared treatment effect. Subcutaneous abdominal fat did not change significantly. Total body weight did not differ from placebo; trunk fat fell about 1 kg over 26 weeks while lean mass rose about 1.2 to 1.3 kg, and waist circumference dropped 2 to 3 cm.

Does tesamorelin fat loss come back after stopping?

Yes, in the only controlled data available. In the extension, everyone who completed 26 weeks on tesamorelin was re-randomised; those switched to placebo regained 24 to 25 cm squared of visceral fat over the next 26 weeks, essentially the whole loss, and their trunk fat rose by over a kilo, while those who continued held their result. In healthy men IGF-1 was back near baseline two weeks after stopping. There is no published evidence of a lasting effect once it is withdrawn.

What should I measure before starting tesamorelin?

At minimum: waist circumference at the navel averaged over three readings, a seven-day rolling scale weight, fasting glucose and HbA1c, IGF-1, fasting triglycerides, and standardised photographs in the same light. The glucose and IGF-1 baselines matter most, because the label reports IGF-1 above 2 standard deviations in 47 percent of treated patients and HbA1c reaching 6.5 percent in 4.5 percent against 1.3 percent on placebo. If you plan a DEXA or CT, book the baseline before the first dose.

Why has my weight gone up on tesamorelin?

The trials found no meaningful change in total body weight over 26 weeks: trunk fat fell by about 1 kg while lean body mass rose about 1.2 to 1.3 kg. The label also lists fluid retention as a growth hormone effect, with peripheral oedema in 6.1 percent of patients against 2.3 percent on placebo. A small scale gain is consistent with either, and the label does not say which week it appears; a large gain is not explained by the trial data and is worth a clinician's look.

Is tesamorelin worth it for someone who is already lean?

The published evidence cannot answer that. The phase 3 trials enrolled HIV-positive people with excess abdominal fat, selected by waist size, and the obese non-HIV trial enrolled people with reduced growth hormone secretion. No trial studied a lean person with a normal IGF-1, so that person is outside the data, and the visceral fat numbers on this page do not apply to them.

Research use only. The compounds discussed are sold as research chemicals and are not approved for human use. Nothing here is medical advice.

Sources

1. EGRIFTA SV (tesamorelin for injection) prescribing information, DailyMed. dailymed.nlm.nih.gov
2. EGRIFTA (tesamorelin for injection) prescribing information, 2010. accessdata.fda.gov
3. Falutz J, et al. Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med. 2007. PubMed 18057338
4. Falutz J, et al. A placebo-controlled, dose-ranging study of a growth hormone releasing factor in HIV-infected patients with abdominal fat accumulation. AIDS. 2005. PubMed 16052083
5. Falutz J, et al. Effects of tesamorelin (TH9507) in HIV-infected patients with excess abdominal fat: a pooled analysis of two phase 3 trials with safety extension data. J Clin Endocrinol Metab. 2010. PubMed 20554713
6. Stanley TL, et al. Reduction in visceral adiposity is associated with an improved metabolic profile in HIV-infected patients receiving tesamorelin. Clin Infect Dis. 2012. PMC3348954
7. Falutz J, et al. Long-term safety and effects of tesamorelin, a growth hormone-releasing factor analogue, in HIV patients with abdominal fat accumulation. AIDS. 2008. PubMed 18690162
8. Stanley TL, et al. Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation: a randomized clinical trial. JAMA. 2014. PMC4363137
9. Makimura H, et al. Metabolic effects of a growth hormone-releasing factor in obese subjects with reduced growth hormone secretion: a randomized controlled trial. J Clin Endocrinol Metab. 2012. PMC3513535
10. Falutz J, et al. Effects of tesamorelin in HIV-infected patients with abdominal fat accumulation: a randomized placebo-controlled trial with a safety extension. J Acquir Immune Defic Syndr. 2010. PubMed 20101189
11. Stanley TL, et al. Effects of tesamorelin on non-alcoholic fatty liver disease in HIV: a randomised, double-blind, multicentre trial. Lancet HIV. 2019. PMC6981288
12. Stanley TL, et al. Effects of a growth hormone-releasing hormone analog on endogenous GH pulsatility and insulin sensitivity in healthy men. J Clin Endocrinol Metab. 2011. PMC3038486

Every figure above was checked against the linked source on 4 October 2026. "No published measurement" means the Bureau searched these trials and found none at that timepoint.