Run for fat loss

Tirzepatide + Tesamorelin

advanced26 weeks

The same idea as Retatrutide + GH Pulse, built from the two compounds in their classes that actually have FDA labels: weekly tirzepatide for the weight loss, daily tesamorelin for visceral fat and the GH axis. It is the conservative version of the muscle-sparing stack - better documented on both sides, more expensive, and with a clearer glucose problem to watch.

Duration26 wk

Compounds2

Ratio-lockednone

Off standalone rangenone

Also sold as Tirz + Tesa, Mounjaro + Egrifta, Approved-label fat-loss stack.

Cautions — 12 on record

Read before running any of this

Tesamorelin causes glucose intolerance on its own label - HbA1c reaching 6.5% in 5% of treated patients versus 1% on placebo over 26 weeks, with a hazard odds ratio around 3.3 for developing diabetes. Tirzepatide pushes the other way. Nobody has measured what the two do together, so treat this as two active and opposite forces on glycaemia, not as a self-cancelling pair. Check glucose status before starting and periodically after.
If you already have diabetes, tesamorelin raises IGF-1 and the label asks for periodic monitoring for new or worsening retinopathy. That is a specific, labeled harm, not a theoretical one.
Tesamorelin is approved only to reduce excess visceral abdominal fat in HIV-associated lipodystrophy. Using it for general body composition is off-label and unstudied, and any product bought as a research chemical is not the approved product regardless of what the vial says.
Tirzepatide is contraindicated with a personal or family history of medullary thyroid carcinoma or MEN2, and with a history of pancreatitis.
Do not run with an active or recent malignancy. GH and IGF-1 elevation is the clearest contraindication in this class.
Not for use in pregnancy.
Injection site erythema, itching, pain and bruising are the most common reactions on the tesamorelin label, and you are adding a second weekly injection on top. Rotate properly.
Peripheral edema, joint pain and carpal tunnel-type hand symptoms are labeled tesamorelin effects. They are the dose signal - reduce rather than push through.
The Egrifta label directs administration immediately after reconstitution with the supplied diluent. Multi-dose bacteriostatic-water reconstitution of a research vial is not a labeled practice, and the working life of the made-up solution is shorter than people assume.
As with any GLP-1 stack, lean mass is protected by protein and resistance training first. Tesamorelin has never been tested for that purpose in this population.
Start tirzepatide alone and get through at least the first titration step before adding tesamorelin. Nausea from an incretin and malaise from a GH-axis compound are not distinguishable if you start both at once.
Both are banned by WADA.

Components

What is in it, and when

Compound	Dose	Frequency	Time	Notes
Tirzepatide	5 mg2.5 mg–15 mg	Once a week1×/week	Any time	Label titration is 2.5 mg for 4 weeks then 4-week steps to a 15 mg maximum. There is no reason to keep climbing if you are still losing and tolerating the current step - escalate on a plateau, not on a calendar. Same day each week.	Calculator →
Tesamorelin	2 mg1.28 mg–2 mg	Once daily7×/week	Evening	Label dose is 2 mg once daily (Egrifta and Egrifta SV); the reformulated Egrifta WR is 1.28 mg daily, which is why the floor here is 1280 mcg. Unlike CJC-1295, tesamorelin does not need a ghrelin agonist alongside it to be worth injecting - it is the GHRH analogue that was actually taken through phase 3 on its own. Dosed in the evening by convention to sit with the overnight GH pulse; the label does not specify a time. 26 weeks of daily 2 mg dosing is roughly 13 of the 10 mg vials, which is the single biggest practical difference between this stack and the retatrutide version.	Calculator →

Doses are per administration, in the canonical unit. The second line under each dose is the range people run. Each calculator link prefills the reconstitution math for that component.

Delivered dose vs standalone dose

How these doses compare to running each compound alone

Each bar is that compound’s own dose range from its monograph, with a marker where this protocol puts it. A marker outside the band means the protocol is not dosing that compound the way it is dosed on its own — for a fixed-ratio vial that is arithmetic, not a choice.

Tirzepatide

Within standalone range

Standalone 2.5 mg–15 mg (typical 5 mg)This protocol 5 mg

Per dose: 100% of typical
Per week: 5 mg · 100% of standalone
Cycle total: 130 mg · 26 doses

Label titration is 2.5 mg for 4 weeks then 4-week steps to a 15 mg maximum. There is no reason to keep climbing if you are still losing and tolerating the current step - escalate on a plateau, not on a calendar. Same day each week.

Tesamorelin

At the ceiling of the range

Standalone 1.28 mg–2 mg (typical 2 mg)This protocol 2 mg

Per dose: 100% of typical
Per week: 14 mg · 100% of standalone
Cycle total: 364 mg · 182 doses

Label dose is 2 mg once daily (Egrifta and Egrifta SV); the reformulated Egrifta WR is 1.28 mg daily, which is why the floor here is 1280 mcg. Unlike CJC-1295, tesamorelin does not need a ghrelin agonist alongside it to be worth injecting - it is the GHRH analogue that was actually taken through phase 3 on its own. Dosed in the evening by convention to sit with the overnight GH pulse; the label does not specify a time. 26 weeks of daily 2 mg dosing is roughly 13 of the 10 mg vials, which is the single biggest practical difference between this stack and the retatrutide version.

Schedule — 26 weeks

Week by week

Dosing weeks for each component of Tirzepatide + Tesamorelin
Compound	1Week 1	2Week 2	3Week 3	4Week 4	5Week 5	6Week 6	7Week 7	8Week 8	9Week 9	10Week 10	11Week 11	12Week 12	13Week 13	14Week 14	15Week 15	16Week 16	17Week 17	18Week 18	19Week 19	20Week 20	21Week 21	22Week 22	23Week 23	24Week 24	25Week 25	26Week 26	Cycle total
Tirzepatide5 mg · 1×/wk																											130 mg26 doses
Tesamorelin2 mg · 7×/wk																											364 mg182 doses

dosing

Tirzepatide — trial titration ladder

Weeks	Step dose	Note
1–4	2.5 mg	starting dose
5–8	5 mg	—
9–12	7.5 mg	—
13–16	10 mg	—
17–20	12.5 mg	—
21–24	15 mg	maximum

This ladder is the escalation schedule recorded on the Tirzepatide monograph, laid over this protocol’s 26 weeks. It is what the trials stepped through, not what this protocol prescribes — the schedule above holds the dose flat because that is all the protocol data says.

The dataset records one dose per component, so every dosing week is identical. Where a protocol note describes a loading phase followed by maintenance, that phase change is in the note, not in the schedule — read the component notes before assuming the grid is the whole story.

Evidence

What is actually known

HOW THIS DIFFERS FROM RETATRUTIDE + GH PULSE, AND WHICH TO PICK. Pick this one if documentation matters more than magnitude. Tirzepatide is FDA approved with a real label and dosing schedule, and its DXA substudy is the better of the two incretin body-composition datasets - lean soft tissue was about 26% of the weight lost in SURMOUNT-1 versus about 40% for semaglutide in STEP-1, so it starts from a smaller lean mass problem. Tesamorelin is the only compound in the GH secretagogue class with an FDA label and two 26-week phase 3 trials, and it targets visceral fat specifically, which the CJC-1295 / ipamorelin pairing has never been shown to do. Pick the retatrutide stack instead if the goal is the largest available weight-loss effect and you accept an investigational compound to get it, or if cost decides: 100 mcg of CJC-1295 plus 200 mcg of ipamorelin nightly is a fraction of the price of 2 mg of tesamorelin daily, and the nightly pulse is aimed more at sleep and recovery than at visceral fat. There is also a glucose argument for the pulsatile pair: a short GHRH + GHRP pulse is a smaller and briefer GH exposure than continuous daily tesamorelin, and it is tesamorelin that carries the labeled diabetes signal. WHAT NEITHER STACK HAS. No randomized trial has tested any GH secretagogue with any incretin for lean-mass preservation. The claim on the tesamorelin side is stronger than on the CJC/ipamorelin side only because tesamorelin has real trials at all, not because anyone has studied the combination. The only combination therapy with an actual lean-mass result is bimagrumab plus semaglutide (BELIEVE, phase 2b: 2.9% lean mass lost versus 7.4% on semaglutide alone), and bimagrumab is a different class that is not available here. Everything else in this space is mechanism talk.

SourcesDailyMed label FDA Drugs@FDA PubMed ClinicalTrials.gov

Educational information only, not medical advice. Talk to a licensed clinician before starting, changing, or stopping anything.