Recomp stack: Tesamorelin + Ipamorelin
Hold muscle while reducing fat — cutting phases and midlife recomposition.
The recomp stack pairs tesamorelin (1–2 mg daily, subcutaneous, pre-bed) with ipamorelin (200 mcg at the same time), run for about 12 weeks with four weeks off. It is the most clinically grounded protocol here: tesamorelin is an FDA-approved GHRH analog with randomised trial data showing reduced visceral adipose tissue, and ipamorelin is added to deepen the same pulse. It only works as a recomposition tool alongside a modest calorie deficit and heavy resistance training.
Educational only
This page summarizes published research and community protocols. It is not medical advice, and nothing here is a recommendation to use these compounds. Get baseline bloodwork and work with a licensed clinician first. See our medical disclaimer.
The protocol
| Compound | Typical dose | Frequency | Role |
|---|---|---|---|
| Tesamorelin | 1–2 mg | Daily, subcutaneous, pre-bed | FDA-approved GHRH analog with randomised-trial evidence for visceral fat reduction. |
| Ipamorelin | 200 mcg | Daily, subcutaneous, pre-bed alongside tesamorelin | Selective secretagogue; deepens the same GH pulse from the ghrelin-receptor side. |
- Cycle
- 12 weeks on, 4 weeks off
- Timing
- Pre-bed, on an empty stomach
- Route
- Subcutaneous abdominal injection, rotating sites
- Training
- Heavy resistance training 3–4×/week — this is what preserves the muscle
- Diet
- Modest deficit, roughly 300–500 kcal, with protein at 1.6–2.2 g/kg
Who this stack suits
Best for
- Men and women over 40 carrying stubborn visceral fat despite a decent routine
- Cutting phases where holding muscle matters more than the rate of loss
- People who want the option with the strongest published human data
Not for
- Anyone with active malignancy or a disrupted hypothalamic-pituitary axis
- Pregnancy
- Anyone expecting it to replace the deficit — it does not
What the evidence says
Tesamorelin has the trial data
Tesamorelin (marketed as Egrifta) was approved for HIV-associated lipodystrophy on the strength of randomised placebo-controlled trials showing meaningful reductions in visceral adipose tissue over 26 weeks, measured by CT rather than by tape measure. No other compound in this family has evidence of that quality for fat loss.
The approved population is not this population
Those trials studied adults with HIV-associated lipodystrophy. Using tesamorelin for general midlife recomposition is off-label extrapolation — a reasonable one given the mechanism, but the effect size in a healthy 45-year-old lifter has not been measured.
Why add ipamorelin
Tesamorelin works on the GHRH receptor; ipamorelin works on the ghrelin receptor. Combining a GHRH analog with a selective secretagogue produces a larger pulse than either alone, which is the same logic behind the CJC-1295 pairing. The combination itself has not been tested in a trial.
Risks and side effects
- None of these compounds are FDA-approved for muscle building, all are WADA-banned in competition, and research-chemical sourcing means purity is never guaranteed. Tesamorelin itself is FDA-approved, but only for HIV-associated lipodystrophy.
- Injection-site reactions are the most frequently reported effect in the tesamorelin trials.
- Joint pain, swelling in the hands and feet, and carpal-tunnel symptoms signal too much GH.
- Glucose intolerance can develop over a 12-week run — check it rather than assume it.
- Prescription tesamorelin and grey-market 'tesamorelin' are not the same product or the same risk.
Monitoring
Bloodwork to run
- IGF-1, fasting glucose and HbA1c at baseline
- Repeat at week 6 and week 12
- Lipid panel at the start and end — visceral fat loss should move it in the right direction
What to track in DoseRoutine
- Every dose with the time taken
- Waist measurement weekly — the visceral-fat outcome shows up here before the scale
- Strength on two or three main lifts, as the muscle-retention check
Frequently asked
- Does tesamorelin actually reduce belly fat?
- In its approved population, yes, and it was measured properly: randomised placebo-controlled trials in adults with HIV-associated lipodystrophy showed significant reductions in visceral adipose tissue on CT imaging over 26 weeks. Whether the same magnitude applies to a healthy midlife lifter has not been studied, so treat it as promising rather than proven for that use.
- How long does the recomp stack take to work?
- The tesamorelin trials ran 26 weeks to reach their primary endpoint, and the 12-week community cycle is a compressed version of that. Expect waist measurement to move before the scale does, and expect nothing at all if the calorie deficit and resistance training are not in place — the stack amplifies a working setup, it does not create one.
- Can you use this stack while cutting?
- That is the main use case. A modest deficit of roughly 300–500 kcal with protein at 1.6–2.2 g/kg and heavy resistance training three to four times a week is the setup the stack is designed to sit on top of. Aggressive deficits defeat the purpose, because muscle retention is the reason to run it.
- Is tesamorelin legal to buy?
- Prescription tesamorelin (Egrifta) is a legitimate FDA-approved medicine for a specific indication. The vials sold by research-chemical suppliers are a different thing entirely — unverified identity, purity and dose. It is also banned by WADA for athletes at all times.
Compounds in this stack
Full monographs with doses, evidence quality, interactions and sources.
Other stacks
Keep exploring
Last reviewed 2026-09-22.