CommunityDosing & Titration

Recommendations on Tesamorelin starting dose?

27 replies12 peopleJul 24, 2026☆ Follow
Summary

What starting dose of tesamorelin makes sense for someone already on reta who wants to regain lean muscle?

Users report starting anywhere from 0.5 mg to 2 mg nightly, with several finding 1 mg effective for muscle retention while avoiding sides. Common issues at 2 mg include fluid retention, joint stiffness, elevated blood sugar, appetite increase, and sleep disruption; some switched to sermorelin after those effects appeared. Injection timing varies, with some preferring morning fasted and others bedtime, and a few note better tolerance by titrating up slowly or taking weekends off.

What this discussion establishesWhere people disagree

Whether side effects at 2 mg would resolve with continued use or if they justify dropping the dose or switching compounds

Still open

Whether daily dosing is necessary versus 5-on/2-off, and how long any gains in lean mass persist after stopping

Nothing here is advice.

27 replies · 12 people
SharpKettle23archiveopening postJul 24

I'm a 53-year-old guy currently on SS31 and a maintenance dose of Reta after reaching my target weight. Planning to start tesa to recover some lean muscle. Does beginning at 2 mg nightly seem reasonable or should I begin lower? Appreciate any feedback.

KeenCompass55archiveJul 24

Just use 2 mg at night, two to three hours after your last meal. That matches the official prescription amount for the version we get, and once mixed the vial only stays good for about five days so a 10 mg vial works out perfectly that way.

BrightSignal52archiveJul 24

I'd begin at 0.5 mg and monitor how it goes. Tesa carries a risk of allergic reaction so the lowest effective amount is worth trying. It's also expensive. I started at 0.5 mg, moved to 1 mg nightly, then tried 2 mg but disliked the fluid retention and joint stiffness so dropped back to 1 mg where it still worked without sides. I eventually quit because of the impact on appetite and blood sugar and now prefer sermorelin for fewer effects on those areas.

WarmSparrow60archiveJul 24

I used 2 mg in the morning while fasted and it worked better for me because of slower gastric emptying from tirz. You could begin at 1 or 1.5 mg to gauge your response before going to 2 mg. I completed two cycles, one 30 days and one 50 days, and saw IGF and Z score rise sharply on the second one. It worked well but now I just use HGH at 3 IU.

SharpKettle23archiveJul 24
↳ replying to @BrightSignal52

This is helpful. Thank you. What effects did you notice?

BrightSignal52archiveJul 24
↳ replying to @SharpKettle23

Fluid retention and joint stiffness or pain stood out at the 2 mg dose. Dropping back to 1 mg made the side effects disappear.

KeenCompass55archiveJul 24
↳ replying to @BrightSignal52

Those would have faded even if you had stayed at 2 mg.

BrightSignal52archiveJul 24
↳ replying to @KeenCompass55

Not worth the risk. I tried two weeks at 2 mg and it made my morning runs difficult. The joint stiffness and higher blood sugar were deal breakers, so I'm now a sermorelin user with none of those issues.

KeenMeadow61archiveJul 24
↳ replying to @BrightSignal52

Curious whether you run it by itself without ipa and what dose you use either way. Thanks.

BrightSignal52archiveJul 24
↳ replying to @KeenMeadow61

Just tesa alone while on a glp-1. I began dosing before bed but it hurt my sleep quality. Started at 0.5 mg with good sleep, went to 1 mg after a week, then to 2 mg after another week but only lasted two weeks there before joint pain sent me back to 1 mg daily. Stayed at that level for a couple months until my A1c rose from 5.4 to 5.8, so I stopped with two vials left. I had tried sermorelin a few months earlier without the sides or blood sugar rise and it even helped my sleep. Earlier cjc/ipa caused flushing that felt like anaphylaxis after three days.

KeenMeadow61archiveJul 24
↳ replying to @BrightSignal52

Sorry I wasn't clear earlier. I'm wondering what your sermorelin dose is and if you run it by itself.

ClearWillow37archiveJul 24
↳ replying to @BrightSignal52

This. I'm also a fan of the minimum effective dose with any supplement or medication to avoid building tolerance short or long term. Start at 0.5 mg, then 1 mg, then 2 mg only if needed. I only required 1 mg to keep lean mass while cutting. However that same 1 mg recently sent me to the ER with anaphylaxis after using it successfully for months, stopping for a couple months, then taking it again three weeks ago. I won't touch it now and will always recommend hGH over any secretagogue for that reason.

BrightSignal52archiveJul 24
↳ replying to @KeenMeadow61

Sermorelin at 0.3 mg nightly by itself. I had none of the sides I got from tesa such as blood sugar elevation, sleeplessness, water retention, or joint stiffness. It also didn't increase appetite the way tesa did.

BrightHarbour31archiveJul 26
↳ replying to @ClearWillow37

Oh wow, do you have major allergies to other things?

ClearWillow37archiveJul 26
↳ replying to @BrightHarbour31

No, not really. I only get slight immune responses from mast cells when exposed to certain edibles and pollutants around me. That compound tends to trigger the body to produce antibodies against it. One particular research paper showed this happening to half the participants, and a single person had a stronger full-body issue mentioned in the middle of the document in the section about sticking to the protocol and side effects.

BrightHarbour31archiveJul 26
↳ replying to @ClearWillow37

Interesting. Did the hospital treat the allergy or just observe and let it pass?

IronThistle53archiveJul 27
↳ replying to @ClearWillow37

Hey, off topic but I love your username, that's clever.

ClearWillow37archiveJul 27
↳ replying to @BrightHarbour31

They just observed after I had already treated it myself before arriving.

BrightHarbour31archiveJul 27
↳ replying to @ClearWillow37

Might be smart to keep an epi pen handy. Off to indiamart.

BrightBramble77archiveJul 27

I began tesa a week ago. Started low at 500 mcg, then 750 mcg the next day, then 1 mg. The only things I've noticed are weight gain on reta plus tesa, up 2 kg from my lowest point despite a 750 kcal daily deficit, and noticeable water retention. Today I'll try 2 mg. The plan was to stay on tesa for 8 to 12 weeks to target visceral fat.

AmberMarble85archiveAug 6

Anyone tried pinning weekly? The prescribed dose for Egrifta WR is 11 mg weekly.

CopperQuill51archiveAug 7

I started two weeks ago with 1 mg in the morning and have had no side effects so far. I'm starting to think the half life claim of a week might hold because a reconstituted 10 mg vial stung less on the second week, suggesting potency dropped.

BrightBramble77archiveAug 7
↳ replying to @AmberMarble85

What do you mean by 11 mg weekly? One single pin of 11 mg? That would be extreme, especially given the roughly half-hour half life of Egrifta, or even shorter for the newer versions. It wouldn't work. I'm currently at 2 mg on a 5/2 schedule and it still stings from the acid component for about twenty minutes at the site. Can't imagine what 11 mg would feel like even with 2 ml of water.

WarmSparrow60archiveAug 7

Best spot for tesa is upper glutes if you get injection site reactions. All the spicy ones go to the cheeks, especially in pool season when less visible lumps are better. Some people end up with golf-ball-sized welts.

BlueCompass61archiveAug 7
↳ replying to @SharpKettle23 (opening post)

Based on what I've come across, beginning with half a milligram looks like the way to go. Mind sharing how much you stay on for ongoing use of this? I took it not long ago to drop thirty pounds, ending up five over my target, and now I'm scaling back from the peak of four milligrams on a repeating six-day schedule. I meant to quit altogether, yet lately I've been wondering if holding at some steady lower level could work out.

SharpKettle23archiveAug 9
↳ replying to @BlueCompass61

Sure. I'm splitting 1 mg weekly with 0.5 mg Monday and 0.5 mg Friday.

SharpKettle23archiveAug 9
↳ replying to @WarmSparrow60

Yeah, I'm seeing that too. Reta and ss31 never gave me much trouble in the belly or thighs, but with tesa, now in week three at 1 mg daily, my abdomen looks like a mine field.

BrightBramble77archiveAug 10

Honestly it feels wrong to go straight to the full 2 mg with tesa. Painful injections, water retention, and possible allergy risk are all concerns, and there's no clear guidance on titrating. For example 500 mcg first, then 750 mcg, 1 mg, 1.5 mg, finally 2 mg. Research also suggests daily pinning may not be ideal because receptors need recovery time, so I pin Monday through Friday and take weekends off.

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Recommendations on Tesamorelin starting dose? · ZyraTrack Community