Tesamorelin and Ipamorelin Stack: Why the Two Are Paired, How Protocols Time Them, and What a Month Costs

Tesamorelin and ipamorelin are combined for one reason: they act on the pituitary through two different receptors, and the published endocrinology says that when a GHRH-type signal and a ghrelin-type signal arrive together, the growth hormone pulse that results is larger than either produces alone. Tesamorelin is a stabilised analogue of growth hormone-releasing hormone. Ipamorelin is a growth hormone-releasing peptide, a synthetic ghrelin mimetic. Put together they are the same idea as the older CJC-1295 and ipamorelin stack, with the GHRH half swapped for the only GHRH analogue that has been through FDA approval.

This page sets out the published rationale for the pairing, what each compound is expected to do on its own, how research protocols typically time the two, the side-effect profiles that are actually documented, and what a month of the stack costs at the vendors the Bureau scores in September 2026. It describes what researchers do; it does not tell anyone to inject anything.

Why a GHRH analogue plus a GHRP

Growth hormone is released in pulses under two hypothalamic controls: GHRH, which stimulates the somatotroph to release GH, and somatostatin, which inhibits it. A third input, ghrelin, acts through a separate receptor (the GHS-R1a) on both the pituitary and the hypothalamus. The GHRPs, of which ipamorelin is one, are synthetic ligands for that ghrelin receptor.

The synergy claim comes from a specific paper. Bowers and colleagues, writing in the Journal of Clinical Endocrinology and Metabolism in 1990, gave healthy men intravenous GHRP at 0.1, 0.3 and 1.0 micrograms per kilogram, with and without 1 microgram per kilogram of GHRH. Their conclusion, in the abstract's words: "The submaximal dosages of 0.1 and 0.3 microgram/kg GHRP plus 1 microgram/kg GHRH stimulated GH release synergistically." The interpretation was that the two compounds act through independent pathways, so their effects do not simply add; they multiply. Later work in the same literature showed that GHRPs need endogenous GHRH to reach their maximal effect, and that patients whose hypothalamus is disconnected from the pituitary lose both the GHRP response and the synergy, which places much of the GHRP action at the hypothalamic level.

That is the whole rationale. It was established with GHRP-6 and native GHRH, not with ipamorelin and tesamorelin, and it was established with single intravenous doses in a research setting, not with weeks of subcutaneous dosing. Researchers extrapolate from it, and the extrapolation is reasonable, but nobody has published a trial of this specific pair. The tesamorelin guide and ipamorelin guide cover each compound's own literature.

What to expect from tesamorelin

Tesamorelin is the GHRH half and the one with human trial data. It is a 44-amino-acid GHRH analogue with a trans-3-hexenoic acid group on the N-terminus that protects it from the enzyme that degrades native GHRH within minutes. It was approved by the FDA in 2010 as Egrifta, indicated "for the reduction of excess abdominal fat in HIV-infected adult patients with lipodystrophy", and the current EGRIFTA SV label sets the dose at 1.4 mg subcutaneously once daily (the original formulation used 2 mg).

The label's clinical study section is the best published statement of what the compound does. In the two 26-week phase 3 trials, visceral adipose tissue changed by a mean of minus 18% on tesamorelin versus plus 2% on placebo in Study 1, and minus 14% versus minus 2% in Study 2. IGF-1, the downstream marker of GH action, rose by 107 ng/mL in Study 1 and 108 ng/mL in Study 2 on tesamorelin, against minus 15 and plus 3 ng/mL on placebo. Those are large, reproducible effects on the two things a GHRH analogue is supposed to move, in a population with a specific disorder, at a fixed daily dose. Whether the same magnitude appears in a non-HIV adult is not established by the label; the tesamorelin before and after page collects what has been reported outside the trials.

The practical expectation from published data is therefore: a rise in IGF-1 within weeks, a measurable reduction in visceral fat over months, and no direct effect on cortisol or prolactin. Tesamorelin does not raise GH on its own without a functioning pituitary, which is why the label contraindicates it in patients with a disrupted hypothalamic-pituitary axis. The tesamorelin dosage guide goes through the trial dosing in detail.

What to expect from ipamorelin

Ipamorelin is the GHRP half. It is a pentapeptide developed by Novo Nordisk in the 1990s, and its defining paper is Raun and colleagues in the European Journal of Endocrinology, 1998, titled "Ipamorelin, the first selective growth hormone secretagogue". The selectivity is the point. In that work GHRP-6 and GHRP-2 raised ACTH and cortisol alongside GH; ipamorelin "did not release ACTH or cortisol in levels significantly different from those observed following GHRH stimulation", even at doses more than 200 times the effective GH-releasing dose. None of the secretagogues tested affected FSH, LH, prolactin or TSH. The authors called it "the first GHRP-receptor agonist with a selectivity for GH release similar to that displayed by GHRH".

What that means for the stack: ipamorelin supplies the ghrelin-receptor input that the synergy literature says is needed, without the cortisol and prolactin rise that GHRP-6 or GHRP-2 would add, and without the marked hunger that GHRP-6 produces. What it does not supply is a body of human outcome data; ipamorelin was not developed to approval and there are no phase 3 trials to cite. The expected effect is a GH pulse shortly after each dose, of short duration, which is why protocols dose it more than once a day. The ipamorelin vs sermorelin page compares it with the other GHRH analogue researchers pair it with.

How research protocols typically time the two

Because tesamorelin has a labelled daily dose and ipamorelin does not, most reported protocols anchor on the tesamorelin schedule and fit ipamorelin around it. The table describes what is commonly reported, not what anyone should do.

The reconstitution row assumes the 5 mg vials that Ascension and Amino Club sell; Pantheon's tesamorelin page describes the 2 mg and 5 mg vials and states "50 units (1 mg)" for both, which implies 1 mL of water for the 2 mg vial and 2.5 mL for the 5 mg. Use the tesamorelin dosage calculator and the ipamorelin dosage calculator with the vial size you actually have; the arithmetic is different for every combination of milligrams and millilitres. Since the two compounds are in separate vials, researchers either draw them into one syringe or inject them separately at the same time; the synergy data was generated with simultaneous administration.

Side effects: what is documented

Tesamorelin. The EGRIFTA SV label lists the adverse reactions seen in more than 5% of trial patients: "Arthralgia, injection site erythema, injection site pruritus, pain in extremity, peripheral edema, and myalgia." Hypersensitivity reactions occurred in 4% of patients. Two label warnings matter more than the list. Glucose: the label says to "Evaluate glucose prior to and during therapy", and reports the risk of developing diabetes at 3.3 times placebo. IGF-1: "Monitor IGF-1 levels during EGRIFTA SV therapy. Consider discontinuing in patients with persistent elevations." Contraindications are a disrupted hypothalamic-pituitary axis, active malignancy, known hypersensitivity, and pregnancy. Those are the risks of raising GH and IGF-1 for months, and they apply to the stack as a whole.

Ipamorelin. The 1998 data says what it does not do: no cortisol, ACTH or prolactin rise at effective doses. What is reported anecdotally is injection-site redness, transient headache or light-headedness after a dose, and water retention with sustained use, which is a GH effect rather than a peptide-specific one. There is no phase 3 safety dataset. The side effects guide covers the general GH-secretagogue picture.

The stack. Two agents that both raise GH will, if the synergy holds, raise IGF-1 further than either alone. Every risk on the tesamorelin label scales with that. A researcher who would not run tesamorelin without a baseline and follow-up IGF-1 and fasting glucose should not run the stack without them either.

Cost per month at the Bureau's scored vendors (September 2026)

Disclosure. Links in this section may earn the Bureau a commission. Prices are as displayed on each vendor's site in the first week of September 2026; the scorecard weighs documentation, consistency, shipping and price, and the method is on the vendor scorecard page.

The arithmetic below uses one common research pattern: tesamorelin 1 mg once daily on 5 days a week (about 22 mg a month) and ipamorelin 250 mcg twice daily on the same days (about 11 mg a month). At 5 mg per vial that is 5 tesamorelin vials and 3 ipamorelin vials a month, rounding up because a part-vial is still a vial.

Two cautions on the numbers. The pattern above is one of many; halve the tesamorelin frequency and the cost drops by roughly a third. And a "from" price is a floor for the smallest size listed, not a price for 5 mg. The peptide therapy cost page compares these research prices with what compounding pharmacies and clinics charge for the same compounds, where a month of prescribed tesamorelin alone routinely runs to several hundred dollars.

One regulatory note belongs here. On 24 August 2026 the FDA issued a warning letter to NuScience Peptides LLC that named, among other products, a "Tesamorelin Ipamorelin Blend" as an unapproved new drug sold with human-use claims despite research-only labelling; letters the same day to Peak Performance Peptides, Tex Peptides and Peptide Partners each named tesamorelin. The agency is reading tesamorelin listings the way it reads GLP-class listings. None of the Bureau's scored vendors appears in those letters as of the first week of September 2026, and the vendor shutdown tracker keeps the list current.

Where this stack fits, and where it does not

Against CJC-1295 and ipamorelin: tesamorelin brings human trial data on visceral fat and IGF-1 that CJC-1295 (no DAC) does not have, at roughly two to three times the price per milligram at the vendors above; Apollo's CJC-1295/ipamorelin blend at $50 for 5 mg of each is the cheap version of the same mechanism. Against sermorelin and ipamorelin: sermorelin is the shorter, unmodified GHRH fragment with a half-life of minutes, and the sermorelin dosage guide shows why its protocols look different. Against tesamorelin alone: the stack adds the ghrelin-receptor input the synergy data says matters, at the cost of a second compound with no outcome data and two to three more injections a day.

A researcher whose question is visceral fat has a published answer for tesamorelin alone at 1.4 to 2 mg daily over 26 weeks, and no published answer for the stack. A researcher whose question is GH pulse amplitude has the 1990 synergy data and nothing longer-term. That is the honest position, and it is why the Bureau's peptide cycles guide recommends deciding what you are measuring before choosing a stack. Nothing here is medical advice; these are research compounds and the Bureau does not advise anyone on using them.

Check price at Pantheon Peptides

Frequently Asked Questions

Why combine tesamorelin with ipamorelin?

Because they stimulate growth hormone release through two different receptors. Tesamorelin is a GHRH analogue acting on the GHRH receptor; ipamorelin is a ghrelin mimetic acting on the GHS-R1a. Bowers and colleagues showed in 1990 that submaximal doses of a GHRP given with GHRH stimulated GH release synergistically in healthy men, and later work showed GHRPs need endogenous GHRH for their full effect. The pairing applies that finding, though it was established with GHRP-6 and native GHRH by single intravenous dose, not with this pair over weeks of subcutaneous dosing.

How do research protocols time tesamorelin and ipamorelin?

Most reported protocols anchor on tesamorelin's labelled daily dose and add ipamorelin in the same window. The common pattern is 1 mg tesamorelin once daily, before bed or fasted in the morning, with 200 to 300 mcg ipamorelin at the same time and often once or twice more during the day, on five to seven days a week for 8 to 24 weeks. Fasting for around two hours before and 20 to 30 minutes after is usual because glucose blunts GH release. The synergy data was generated with simultaneous administration. This describes practice, not a recommendation.

What does tesamorelin do on its own?

It is the only GHRH analogue with FDA approval, as Egrifta, for reducing excess abdominal fat in HIV-infected adults with lipodystrophy. In two 26-week phase 3 trials visceral adipose tissue fell by a mean of 18% and 14% on tesamorelin against plus 2% and minus 2% on placebo, and IGF-1 rose by about 107 to 108 ng/mL. The current EGRIFTA SV dose is 1.4 mg once daily. Whether the same magnitude occurs in adults without lipodystrophy is not established by the label.

What are the side effects of the tesamorelin ipamorelin stack?

For tesamorelin, the label lists arthralgia, injection-site redness and itching, pain in the extremities, peripheral oedema and myalgia in more than 5% of patients, hypersensitivity in 4%, a 3.3-fold higher risk of developing diabetes than placebo, and a warning to monitor IGF-1. Ipamorelin's 1998 data shows no cortisol, ACTH or prolactin rise at effective doses; anecdotal reports are of transient headache, light-headedness and water retention. Because both raise GH, the stack's IGF-1 and glucose risks are the tesamorelin label's risks, possibly amplified.

How much does a month of tesamorelin and ipamorelin cost?

At the pattern of 1 mg tesamorelin five days a week and 250 mcg ipamorelin twice daily on those days, which is about 22 mg and 11 mg a month or five and three 5 mg vials, Ascension Peptides' September 2026 sale prices of $50 per vial for each come to $400, or $645 at its regular prices. Amino Club's from-prices of $69.99 and $49.99 give about $500 if the from-price is the 5 mg size. Pantheon showed $70 for a 2 mg tesamorelin vial and $40 for ipamorelin. Apollo did not list tesamorelin. Prices are vendor-displayed on the date checked.

Is a tesamorelin ipamorelin blend vial legal to sell?

The FDA's position, stated in a 24 August 2026 warning letter to NuScience Peptides that named a Tesamorelin Ipamorelin Blend among other products, is that such products are unapproved new drugs when the seller's website shows they are intended for human use, regardless of research-only labelling. Letters the same day to three other vendors named tesamorelin. A warning letter is not a finding against every seller, and none of the Bureau's scored vendors was named. It does mean tesamorelin listings are being read by the agency the way GLP-class listings are.

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