The Tesamorelin Masterclass | The Complete User's Guide (2026)

0:00 Hey everybody. This is Hunter Williams. I hope you're doing amazing wherever you might be in the world today. Maybe even used it. And today we're going to be doing just going over the masterclass of one, just the background of how it works and everything like that. But then also to the best practices that I would recommend for using it, this is one that definitely I've seen move the needle probably more in people's

0:31 health and fitness journey. than a lot of the other peptides. So we're going to go through all of that, everything you need to know related to Tessamerelin. And so that the end of this video, you can either take this yourself or share it with a friend and family member and basically have all the tools in order to use Tessemereline intelligently to get the results you would want, which is usually obviously better body composition, better sleep, and all other things that we are looking forward to using with peptide. That's what we're going to cover in this one. As always, thank you guys so much for supporting me and being there, whether you're on the email list, using my code at places,

1:03 whatever it is. Thank you, guys, so, much. The link will always be in the description of the videos. There's one link there now that is kind of like a link tree that you can click on and then go use to opt into the e-mail list or join the private group or whatever. So thank, you. guys. so. much and without further ado, I'm going share my screen and today we are going cover Tessamerelin. All right, let's get into it today. I'm going to cover Tessamerelin. This will be the user's guide as it stands today in 2026 as of the filming of this video. So what is Tessa morelin today? We're going cover, uh, Tessemorelin it's the only FDA approved peptide for visceral fat reduction.

1:37 We'll go over the foundations, dosing and cycling protocol stacking, and then also just some troubleshooting and FAQs, because this is one that I would say has a decent amount of side effects or issues that come up when people are using it. Now, testosterone is not growth hormone itself. I personally am a fan of growth hormones, but I am also a big fan testosterone, and I think you can use both of them intelligently in the right protocol. But, Testosterone is a synthetic analog of Growth hormone releasing hormone. It's going to be a very important distinction as you go along on your peptide journey to understand the difference between a GHRH and GHRP,

2:10 which is a growth hormone-releasing peptides. Testimillin sits on the side of a G-HR-R. Now, what does that mean? It is an upstream signal your hypothalamus uses to tell your pituitary to release your own GH and natural pulsatile burst. So what we're doing when we were using Tessamerelin is increasing endogenous growth hormone production. You inject Tassamerelin, your pituitary releases growth hormones, you liver makes IGF-1, and then we get all of these wonderful benefits. And the negative feedback loops that keep the system balance stay intact, unlike introducing exogenous-growth hormone, which can impair that feedback loop

2:45 and have a negative impact on it. Tessa Maryland does not do that, so then when you come off, Basically, we're just right back where we were before and there's no downtime like you would have with HDH. Although I do think that with HGH is overblown, but again, different topic for a different video. Now just to look at the headline numbers. In clinical studies, we see 15% visceral fat reductions. So not just fat reduction, but visceral fat production over 26 weeks. And that was from a 2007 trial, 37% liver fat, reduction over 12 months in a 2019 study.

3:15 That was in HIV patients with fatty liver disease. Then it was approved by the FDA in 2010. This is an FDA approved peptide, meaning that you can get this compounded from compounding pharmacies to use off label from your doctor. Again, a peptide is just a short chain amino acids. Again we all know the popular peptides. Let's look at specifically though the molecular structure of Tesmorelin. Tessa is a 44 amino acid peptid with a sequence identical to native human growth hormone releasing hormone plus one critical addition.

3:45 It has a trans 3-hexanoic acid Moiety on the alpha amino group of the first amino acid, which is tyrosine. Again, don't get confused with that. Just know that this is about as close to native human growth hormone releasing hormone that we can get in the form of a peptide. And what this means is that the modification physically blocks the enzyme DPP4 from cleaving the molecule, extends the half-life from around seven minutes, around 26 to 38 minutes, which is long enough to drive a meaningful GH pulse from a single daily injection.

4:17 And again, when we get that 26 and 38 minute half-life, it's more about the downstream effects of Tessamerelin. So obviously extending it from 7 to 26 minutes has an impact on what it is doing, but it will have a cumulative effect over time. And again, when we look at names, the brand name is Agrifta, or Agrifta SV, Agrafta WR, also has been called Tessmerlin Acetate TH9507 or just mostly Tessa Merlin. There's not a ton of different names around this one. Let's look the growth hormone axis and how it actually works in the body.

4:48 So one, we have the hypothalamus and then that is signaling to the pituitary. and then the pituitary makes growth hormone, and that goes to the liver, which is then metabolized into IGF-1, then we have a feedback loop. So again, think of this as a thermostat, the hypothalamus is the dial, pitutary is a furnace, GH is heat, IG-F1 is room temperature. And so the ultimate goal with all of these is to have the right temperature, right, to create the environment and the body that ends up getting us the fat loss, sleep benefits, everything we had.

5:19 But the hypothalamus, again, is tuning the dial. The pituitary is the actual furnace that is creating the temperature. In this case, it would be the heat if you had a furnace. And then the GH is actual heat. Then ultimately, the IGF-1 is temperature, which is end result. We have a feedback loop to where we can turn that up or down. That's what we're using Tessamereline to do. When we look at clinically important effects, obviously the biggest one is reduction in visceral fat. Growth hormone-driven lipolysis targets the dangerous fat behind the abdominal wall, and that's primarily what people are going to use it for.

5:52 Secondarily, we have a reduction of liver fat, so direct growth hormone effects plus reduced fatty acid delivery from shrinking visceral fat end up in reduced liver We obviously have the increase in IGF-1 which restores levels typical of a healthy young adult, which can be very, very beneficial to someone in their 50s or 60s. Lipids improve so triglycerides fall significantly and then cholesterol modestly improves, but more importantly we get drops in trigliceride which could be huge for someone's metabolic health. that ends up dictating a later risk for cardiovascular disease.

6:23 And then what's cool, I think very few people talk about this and very people realize it, but we actually get improvement in cognition with Tessamrelin that's driven by this increase in GH and IGF-1. Executive function improves in older adults, and that was in a 2012 trial. So very cool things there. Let's look at Tassamrelin comparing it to some of these other GH peptides, because there are many. These are the popular ones. When we look at tessamerelin, it works on the GHRH receptor. Ceramorelin and CJC1295, DAC or no DAC, both work on GHH receptors as well. I would say tessemerein ultimately is probably the superior peptide for most people when it comes to a GHRIH.

6:58 Analog, the half-life is 26 to 38 minutes, whereas with those, it's around 30 minutes. Obviously the CJC with DAC has a half life of six to eight days, which I actually don't like. And I won't talk about that in this video, but I'll cover that and the CJC video. Then we have ipamrelin and MK677. These are ghrelins receptors or GHRP analogs. So they're growth hormone releasing peptide. The halflife can be around two hours to 24 hours. In the case of MK 677, iparlin closer to a two hour half Those are not FDA approved, whereas Tessamerelin is.

7:32 There is visceral fat RCT data around Tessa morelin and not around the other ones. And then is it stackable Tessemorelin? I would recommend people not to stack Ceremoreline and CJC with Tessä moreline, where as you can stack Tessenmereline with Ipamorelin, although I'll talk about this a little bit later when we get into the stacking section, there are times where you may want to do that and there're times when you might not want do to that. Now, who's the peptide for? I think for people in their 40s and 50s that have creeping visceral fat, training and diet is reasonable, but the midsection won't respond. This is the strongest evidence base.

8:03 Obviously for the people with fatty liver and people that had elevated liver enzymes or imaging diagnosis, this is going to work really well for them. And then people who have low to normal IGF-1, which most people after 40 will have, or even people Concussions or brain trauma, the bottom third of age-specific range for people with poor recovery, drifting body composition, testosterone is typically going to raise IGF-1 by 80 to 110% in a lot of cases. So it can be very beneficial to those people that have like an IG-F1 of 150 or under.

8:33 And then for people with cognitive concerns, there are that have word retrieval problems, memory issues, slower executive function. It does show a moderate improvement over a 20 week period for People with Cognitive Issues. So for all the people out there that are trying to do everything they can to stop cognitive decline, Testimony can be a huge, huge player to help improve that. Also for, people, I think, you know, when we look at the GH peptides, younger people stand to benefit really well from them.

9:04 So for the biohacker that's optimized on TRT, I really love the combination of TR T with either growth hormone, testosterone, epinephrine, anything along the growth, hormone axis. You just get this one plus one equals three effect that you cannot get with And I say that to the people, there are so many people out there, you might be one of them watching this, that will take testosterone but you will do nothing about your testosterone levels. And again, it's not to say it is not going to work, but it will be just one those things that ends up not getting the results that you probably want if

9:35 you are not optimizing both of those. So the biohacker on TRT, they are going muscle protein synthesis from the testosterone. Testimone is going to amplify the GH axis and handle visceral fat. And then they're going get two different signals with a clean complimentary effect. Also two for people that are post bariatric surgery or post GLP-1 active phases, whether they are in higher doses of a GLp-2. From those things, they're going to get significant weight loss, but disproportionate visceral fat remains in a lot of cases, and Tessamerelin targets that residual depot specifically once stable on the primary intervention.

10:09 And I always like to remind people, Tesamerelin is a body composition tool, not a direct weight-loss tool. The FDA specifically notes a weight neutral effect in lot people. So if significant reduction is the goal, GLP1s are usually the right tool I love them synergistically together, especially for the muscle muscle maintenance and muscle, uh, just keeping muscle on over time on a GLP one. Everyone's on the GL P one that is struggling with muscle loss. There's no reason they shouldn't be on. Peptide like Tessamerelin.

10:40 And again, there, they're is typically a weight neutral effect, but we do get this reduction in visceral fat. But then you pair that with the GOP, one, and then new pair it with testosterone. It's amazing. So you often hear people talk about TTT. T R T Tessa Maryland answers appetite. You can obviously do TRT. read a TrueTide and you could do test merlin, you can do anything in those category box cakes, but that's just a very, very good stack that a lot of people can use to transform their body pretty rapidly. Who should skip it?

11:10 Anyone with cancer, again, we just don't know when it comes to growth hormone and cancer. So at the end of the day, I could go into different diatribes on both sides of defense when It comes growth, hormone cancer but if you do have an active or recent malignancy, We just think it's probably best at this point to not use it. People that are pregnant or lactating just don't do it. People have had HPA axis disruption, so a pituitary tumor, surgery, irradiation, or hypopituitarism. The signal has no functional target. I want to talk about this for a second because I am someone that has a partially empty cell up, which is most likely come from the fact that I've had a

11:45 lot of concussions in my lifetime from playing football at a very high level for over a long time. When you talk peptides like tessameralin, like epimerelin for people like that. It's not that they won't work. However, a lot of those people, myself, don't get the results that I would get from growth hormone itself because we're relying on that HPA axis, which in a lotta times doesn't that work well because our pituitary doesn' work that well.

12:16 So does it mean it's absolutely worthless? No, but the peptide tends to work better in someone that does not have that. And so for me, the first time I took growth hormone, it was like, one of the best things I had ever experienced for sleep, because even though I'd used Testimonella and Riparillin, and they did make my sleep better, even just one IU of growth hormones was just so far beyond how well I responded to any of peptides. So that's kind of up to you. You have to use your own discretion around those things. But for people that have had head trauma in the past, they tend to do better.

12:46 And then also too, for people with uncontrolled diabetes, you really want to stabilize metabolic foundations first. And the testosterone can mildly worsen glucose tolerance if you're not training, if your hormones are not optimized, and especially if are you not living the proper lifestyle and eating properly and everything like that. For people with uncontrolled diabetes, I like using a GLP-1 first, and then once things get under control, you're just going to be in a better spot to take testosterone. Again, use discretion around that, how severe is the diabetes and how much do you want to use testosterone, but we do know that there can be this mildly

13:19 worsening effect on glucose tolerance, so it's always better to just cover your bases. Let's talk about dosing. I kind of have a three tier dosage ladder. One milligram a day I think is going to be the general optimization sweet spot for a lot of people, especially women. Two milligrams per day is the clinical FDA approved dose. But when we look at dosaging, I don't think a lotta people need to go to two milligrams. one, because you might just get too much water retention. So it just might not be, the best dose for you. but then also two, you're just wasting your money where you are taking double dose and you could get a little of the same results at one milligrams a For

13:52 some women, even a lot of tinier women they even do better on 500 micrograms per day. One milligram is usually safe, but sometimes women just do on half a milligram instead of one milligram. But again, this is a general optimization, cognitive support, sleep and gradual body composition dose. IGF is typically going to raise around 40 to 70% for those people. And then this can be the best starting dose just for people that are looking to optimize. When we talk about the next dose, which is two milligrams per day, this is the FDA approved dose that's used in all the trials. IGF typically raises between 80 to 110 percent.

14:22 And again, that is going to be the workhorse for visceral fat, liver fat and substantive body composition change. I will say this, for someone like me that sits around 10 percent body fat most of the year, I lean towards the one milligram per day because I'm not trying to aggressively change my body composition. And if I go to that two milligram-per-day range, I actually tend to get a lot of water retention, which even though I may be burning fat, it does not look pleasant. So it kind of like blows my face up, makes my midsection look a little bit more bloated than it actually is because of the water attention at that higher dose.

14:55 The same way if would take six I use or eight I used of growth hormone. I know it can rapidly transform my body, but then I'm also going to get this layer of water that just is not for me comfortable to deal with. And even sometimes we'll talk about the side effects later. Sometimes you get carpal tunnel, you got edema in your ankles and everything. When I do those higher doses in 14 days, I look like a water balloon, even though I'd know I am burning fat in the process, which I now is counterintuitive. Contrast that you have a guy that's like 25% body fat or a woman that is 35 or 40% fat.

15:26 When they're doing two milligrams a day, they've really not going to notice in most cases that much more water retention because they are already holding a good amount of fat and more than they probably should. take that person and then put them on two milligrams of testosterone, they don't notice it. And then all of a sudden within 16, 24 weeks they've rapidly transformed their body. They've gotten rid of ton of visceral fat because they may need to lose 50 to 75 pounds. It does really well in those cases. So for someone that is closer to that, like 10% body fat as a man, maybe 15 to 20% as woman, A lot of those people gravitate towards using human growth

15:58 hormone just because there's a little bit more of an aesthetic appeal, really look better. Whereas the person that needs to drop a lot body fat, testosterone is going to do really well for them and they're not going notice that much water retention in a lots of cases because they are already holding on to excess fat. That's how I kind of frame that for people, whether that's right or wrong. I don't know, but it's just my own personal experience. And I know having worked with a lot of people that need to lose a lotta weight, and then people who are optimized to the Hilt, people need a lose-a-lotta-weight tend to do really good at this two-milligram dose, whereas other people are already very fit,

16:28 may already have a six-pack, kind-of that lean-type person, the one-milligram-per-day dose is usually enough for them to get the results they want. And then we look at tier three is two milligrams per day extended, meaning that the established fatty liver or lipo hypertrophy type people, they usually do well on a 12 month continuous course per the 2019 Lancet study on it. And again, we'll get to cycling, but when we talk about this, I think those are the people that need to stay on the extended dose in order to really get those markers, whether it's fatty, liver, or severe visceral fat into the range that they want them to be in.

17:03 Just looking at dosing by purpose, we have longevity and anti-aging, that's one milligram per day, eight to 12 weeks on, four to six weeks off, five days a week at bedtime. For visceral fat reduction, again, for those heavier people, two milligrams a day. Six to nine months on two to three months off. 26 weeks is the minimum for the full response to get that visceral fat production for people that have a lot of viscera fat. In order to get the liver fat reduction for athletic performance, I think you could lean on the one milligram per day, play around with it, maybe even go to one and a half milligrams per.

17:33 Day anchored to a training block. And again, just understand that it's banned by water cognitive support, definitely one milligrams a day air on. The lower side for 20 weeks and you can do bedtime dosing and then post illness recovery just to have an IGF base after a severe chronic illness or something like that, Lyme disease, mold exposure, things like. That one. Milligram per, day for eight to 12 weeks to help there. Let's talk about timing because this is one of the big things that people get hung up on or confused or just there's a lot of information out there.

18:03 Here is, I will give you what the best practices are and then kind of a framework to operate with them. We have standard timing, which is once daily at bedtime, one to two hours after the last meal. This amplifies the natural GH pulse of day, Which occurs during slow wave seat. For almost everyone, this Is going to be the Best thing to do with Tesmaril. Now let's talk about fasting and insulin levels and how that affects. So fasted injection matters, carbohydrates and fat suppress GH release. If you inject on an empty stomach, you're going to get the maximum pulse amplitude.

18:34 Now, if for whatever reason you have to eat at nine o'clock and then go to bed at 9.30, and let say you a 30 minute gap between your eating and when you are taking testosterone, does that mean it's completely worthless? No. I will say, that you will probably impair some of the absorption of it, but it is not completely worth less. But in a perfect world, we will have low insulin levels and normal blood sugar levels, which usually takes about one to two hours after the last meal, because we well want to get the body to where it's more receptive to work and cross the blood brain barrier better and do what it does.

19:07 There's this kind of meme going around about if you're on a GLP, does it matter how long if I think probably, yeah, the longer you give yourself fasting the more effective it's going to be. However, I don't think we have to so anal retentive that you just have say, oh, can only do it four hours after eating, meaning that I have eat at 7 PM

19:37 and then wait till 11 PM to take it. Or if you're going bed before 11PM, wake up and take. I really don' think that matters as much. Obviously, in a perfect world, that's what we do, right? We'd be fasted for 24 hours before we take it just to cover all our bases, but understand that life gets in the way and there are practical considerations. And so I'm not so gung-ho on doing that. Although I do agree that the slowing of gastric emptying with a GLP probably has some effect, how much? Maybe 5%. I don't know.

20:07 Now, let's talk about morning dosing. I think it's acceptable for visceral fat reduction if bedtime interferes with sleep onset, but bedtime is preferred in this case, especially with the testosterone. Always tell people too, sometimes people like breaking it up. So if they're doing two milligrams, they like one milligram in the morning and then one milligrams in evening. I think that's totally fine. Also, some people, you see this less with Tescarella and I would say more with CJC that you'll see, but some actually get their sleep disturbed. And so sometimes it can be too stimulating or too wake promoting or wakefulness promoting.

20:37 So those people just do better in the morning with it. That's fine, although I prefer the nighttime. Let's talk about the 5-on-2-off schedule. This is the most common optimization pattern. It's hard to really say whether this is rooted in science, but practically speaking, I've done 5 days on, 2 days off, and I have done every day. I really like the five days- on-two-days- off. The two-day break gives the GHRH receptor a brief recovery window and reduces cumulative IGF-1 burden across the week. I really like that because it's almost like a mini cycle. And I think it allows you to sustain a longer cumulative cycle by taking those two days off just because you maintain more receptor sensitivity to the peptide.

21:17 Again, whether that's right or not, who knows? Practically speaking, I just respond really well to taking these two, those days often, obviously you could do Monday through Friday, take Saturday, Sunday off, or you can take Monday, Tuesday off and do Wednesday through Sunday, whatever works for you. And again, if doing intermittent fasting, inject at the end of the fasting window before the first meal of eating window, usually within an hour or two before that eating, window if you are doing it in the morning. But again that's going to be more rare that people end up doing that. Let's look at some expectations within 15 to 30 minutes of injecting the peptide.

21:52 GH pulse peaks around 15-30 minutes post injection. Then we look at two to four weeks after cumulative dosing, that five days on, two days off, after two or four week IGF-1 reaches a new steady state. The sleep death usually improves by this point and then mild puffiness is possible, especially in some of those leaner people. Week six to 12, you usually see waist circumference start dropping, recomposition phase begins and the water retention usually settles in. For most people, and again that's where it's weird because it sucks for maybe those first six or 12 weeks that you feel puffy and a lot of times that will

22:22 start to go away as the body acclimates to it. Then we see weeks 16 to 26, this is where we get really the full visceral fat response. So 15 to 18% reduction in phase three trials. Liver fat follows through 12 months. If you get no meaningful change by 16 weeks at two milligrams a day, you are likely a non-responder. In phase 3 trials, around one third of phase-3 patients did not achieve significant visctoral fat reduction. Now, just because you're a non-responder to this doesn't mean it can't work, meaning that there's always the devil's in the details. And we don't know out of those one-third of people, were they exercising?

22:54 Were they hormonally optimized? Probably not. So a lot of times when we look at these clinical trials, people are responding without even doing the foundational things right. Again, when you look one third, I think it's just one of those things, Tessamerelin is not going to be so powerful like a GLP that it is going move beyond or work through those lifestyle things that are not being addressed. And again, just understand that there are people that seem to non-responders in the clinical trials. How to know if it's working, we have subjective markers.

23:24 Is your sleep better? Is you recovery better. Do you have sharper executive function? Do have a drop in waist circumference? do you better training capacity? And do have improved skin quality? Because that will be something that'll happen. Then we can look at objective markers, if you're getting blood work done, you can at IGF-1. That should rise around 50 to 110%, depending on the dose. Usually within 8 to 12 weeks, so you know it is working then. Waist circumferences, people will typically get a 1-3 cm drop at 12-weeks. You can get a dexedine to measure visceral fat specifically. I would do that about 24 weeks out.

23:55 Triglycerides, you can measure on your blood work to see if they improve. And then your ALT and AST liver enzymes, they should modestly improve as well if elevated baseline. Obviously the liver, enzymes can be a little bit more transient. So just take that with a grain of salt. Now, the question is, why cycle at all? So why can't you just stay on Tessamerelin all the time? One, we don't have an evidence gap, or we have evidence gaps beyond 18 months. The longest published continuous use trial is 12 months and there was an open label extension at 18-months. Again, long-term, I just think it's best with peptides, because we don't know what we know, to just always cycle these things because it keeps the body

24:30 in a state where we're not chronically exposed to it. And if there are any issues, not that I worry about that, but if they're already issues we just cycle through. It also allows us to assess real durability. Off-cycle blood work reveals whether gains are durable or entirely peptide driven. Hopefully lifestyle is an adjunct to that. Then more importantly, when we look at cycling, we have this idea of antibody formation. The cool thing about Tessamerelin being FDA approved is that we have this study around antibodies. Anti-Tessamarilin IgG antibodies develop in around 50% of patients after 26 weeks.

25:01 It's not neutralizing trials, but cycling breaks the exposure pattern. Basically what that means is the body is having this immune response to Tessa morelin where it will stop working. basically it's saying, hey, this is being introduced to me. I don't like it anymore. The immune system has a response and it stops working Why do we cycle? Because in a lot of people, one out of two people are going to have that pattern of an immune tolerance buildup to it. Thus, it allows them to decrease those antibodies and then cycle back on. And so that's the real reason. I think we will see that with more and more peptides that become FDA approved.

25:32 that we see this, and that's again why we go back to cycling. Now, I'm all for using it for as long as is needed to get where you want to go, but just understand you may have this immune response, which is why it's smart to cycle. Does that mean you have to cycled off at eight weeks? No, you can use it 16 weeks, 26 weeks. That's been used in clinical trials to the results people have. But I think the more optimized a person is, the they're going to want cycle it because we deal with this antibody buildup, because you might not need to lose 50 pounds of visceral fat, whereas someone that does, It's going to be better for them to stay on it long-term and then

26:05 be less of the mindset of having to cycle very abruptly or very acutely. Whereas the optimized person, they have less visceral fat to lose. They don't need to go as long with cycles. Here's some standard cycling patterns. You can do a short cycle of eight weeks on, four weeks off. Again, general optimization, beginners, this is good for them. We have middle ground, you can 12 weeks, on four, weeks of again, most common general purpose pattern. And again 12, that's three months. Visceral fat protocol, again, 16 to 24 weeks, which is four to six months, and you can take eight to 12 weeks off.

26:37 Again, this is the full visceral viseral fat response from phase three trials. The fatty liver people stayed on for 12 months. And then after that, I would take at least three months off if you were on it for twelve months and then low dose maintenance. You could do one milligram a day continuous. Just kind of assess when you need to, whether 12 weeks, 16 weeks or whatever. But I do think doing the five days on, two days off allows us to sustain some of these longer if you want to. And just as a caveat, continuous use beyond 18 months and optimization context is operating in an evidence-free zone.

27:08 Just take regular breaks until long-term data clarifies the picture, which we'll hint at in a little bit. Now, off-cycle expectations, because everyone is always afraid, what happens when I stop? Obviously, it's a big thing with GLPs, but people love the results they get with testosterone, and then they afraid of what happened when they stop. Let's just look at what's happening first. IGF-1 usually returns a baseline within two to three weeks. Sleep and recovery for a lot of people will begin to regress within a few weeks, then the visceral fat usually holds for four to eight weeks and for lot people, if they don't change their lifestyle, is going to drift back over eight to 16 weeks which again, to go back to that conversation about testosterone and

27:41 a GLP, Those are going to help sustain the momentum that is created by Tessamerelin. And again, the peptide is not a cure. The visceral fat benefit is treatment dependent and the off-cycle period is where lifestyle work matters the most. Again, I cannot stress that enough. I know that's not the sexy thing to talk about all the time, but it's so important when we talk getting to where we want to go just to maintain that momentum. It's huge. Let's look at stacking with some other peptides. I love stacking this with BPC and TB 500. Obviously the BTC and Tb 500 are going to help with growth hormone receptor sensitivity.

28:13 So you even get that much better of a response from Tessamerelin when you're using them. KPV obviously just helping with inflammation. And SS 31 again, to go back to my favorite stack, which is testosterone thyroid, a growth-hormone peptide like Tessemereline. A GLP and a mitochondrial player, I love SS31 with it. Again, completely different systems that really work well. And then we have ipamerelin, which is a different receptor. We get an additive GH release and monitor, we want to monitor glucose more carefully. I will say stacking tessamerelin with ipamerelin is the most powerful peptide stack to increase growth hormone.

28:49 For someone that wants to really put on size, I would say testosterone and eprimelanin are where you want to go. That is the ultimate muscle building, size mass accruing peptide stack when we talk about growth hormone peptides. However, just be aware that because it's so powerful, you will get bigger, meaning that you'll get a lot more water retention. Sometimes to me, when I've stacked those together, it feels like I'm taking almost like five or six I use of growth hormones, which for those of you who don't know, that is a a growth of hormone compared to an optimization dose. Just be cautious when you are doing that.

29:21 You can do that, it's the strongest that we have out there, but you need to know what you're doing and I would always recommend using both of those in isolation. What I recommend not stacking is Tessemerolin or CJC. Again, they compete for the same GHRH receptor, and this can lead to an unpredictable combined signal. I know people do that. companies are making blends. When we're talking about using Tessmerlin for visceral fat, I don't necessarily like stacking HGH with it.

29:52 that is on a maintenance dose of HGH year long. I do like using tessamerelin to just periodically stimulate the pituitary, maybe for eight week cycles, one to two times per year. But when you talk about continuous cycling, always doing tessemereline with HCH, I don't really like that. And I think you end up creating just an excess of growth hormone that probably is doing more harm than good. And also too, I do not like stacking Tessmer Allen with MK 677. It just drives super, super physiologic IGF with amplified side effects.

30:24 And most people, it's just really too much in the case of stacking those two together. I mean, hey, if you were really skinny, you could probably benefit a lot from doing that if need to put on like 30 or 40 pounds. But I would say for most, people I will just avoid doing it. I would say long-term, the reason I put that about the growth hormone on there is long term, I'm not a fan of doing that, but short term you definitely could do it just one to two times per year. But ultimately, just choose between one when you're doing it. Let's look at sequencing. I really like having insulin sensitivity, mitochondrial function, sleep, and hormone status all dialed in.

30:59 Weeks one to eight. So before you even start test Maryland, I really like fixing hormones first. That's always going to be the conversation I have with people is like, Hey, you want to start testing Maryland. But where are our sex hormones? Where are thyroid hormones because those are going be so much more important. What does sleep look like? What is training look? Like what does nutrition look. It's not so like the GLP that you can just take it and it's a miracle cure, right? GLPs are the closest thing. We have a MiracleCure test. Maryland is not that. Then weeks nine through 16, let's run some mitochondria support, kind of use SS 31 to get everything in a good place so that the body responds well.

31:30 And then week 17 through 44, one to two milligrams a day, you choose the dose and then weeks 45 plus maintenance. So if you were looking over the course of a year, I really like that kind. Sequencing is take four months to. Get all of the hormones and mitochondrial dialed in and them bring in testosterone. Cause then it's going to do the work that we really want it to well, Why the reverse order fails, glucose goes the wrong way. If you have an insulin resistant client or you're insulin-resistant, GH axis amplification can push A1C higher rather than producing the expected improvement.

32:01 And again, non-responders in the 2012 study saw worse glucose homeostasis. The side effects can be amplified in those people that are not exercising and dieting. They can get water retention, joint discomfort, and paresthesias in their more prominent clients with poor baseline metabolic health. Then there's no clean diagnostic. Here's a little bit about reconstitution. Super simple. This way I have the peptide cheat sheet, five milligram vial. You put two milliliters of bacteriostatic water. One milligram is going to be 40 units. If you have a 10 milligram bio and you put 2 millileters of bacteria or static water, one milligram it's going be 20 units,

32:33 obviously two milligram would be four units there. You can screenshot that slide there. I always use backwater when I'm doing it. Again, reconstitution, just do everything sterile and clean, add the back water into the vial with a bigger syringe, let it dissolve, label and store it, some people talk about using it within 14 to 28 days. Honestly, I've used it at three months and it's usually fine. But if you're doing the dosing and the bios 10 milligram, you usually going to go through it in 14-20 days Anyway, again, I like sub-Q injections. I will say the one instance into which I don't recommend people have a sub Q injection is if they are having an immune response,

33:09 meaning they're getting welts or hives from the injection, sometimes injecting into the muscle intramuscular because there are less I meant to say mass cells, not MCAS, but unless there are fewer mass-cells in the muscle, they can inject into the muscles and not have as bad of a response. Personally, I don't keep Tessmerlin at room temperature. I know the clinical guidelines for the pharmaceutical version say to keep it at a room-temperature, but I've always refrigerated my Tesseron.

33:43 Now, if you keep really, really cold, basically so cold that it's not freezing, like as close to freezing as you can get, sometimes that results in it gelling. But I have always refridgerated mine and it has always done well for me and I knew it was Tessa Merlin and knew that wasn't another peptide because I had it tested. Again, there's a bait about there out that. Hey, if you want to keep it at room temperature, by all means, go do it. I personally just decided to just keep mine refrigerated and I've never had issues with mine gelling. Some people have though, and if that's you, hey, do room-temperature to each their own.

34:14 What to track biomarkers. I like IGF-1 fasting glucose, fasting insulin, your HOMA IR, A1C, lipid panel, HSCRP, ALT, EST, and TSH. Body composition, I liked getting a DEXA or a bod pod in body. If that's what you can do, you get a fiber scan to detect liver fat and then your waist circumference. And then performance definitely look at HRV, deep sleep percentage, REM sleep, resting heart rate, grip strength. and how ready you feel. I will say over time, most people have an improvement in HRV and resting heart rate.

34:45 You may have a transient increase in resting heartbeat and decrease in a HRB when you first start, but usually that normalizes and then it improves over the time. And again, just rate your sleep depth, morning energy, cognitive sharpness, joint discomfort, things like that. Then labs, you could get labs done every three to six months and just see how you are doing. When we look at stacking, I think testosterone is the first and most important thing when we talk about it. It's the foundational pairing when you stack testosterone with a GH modifier like tessameralin. TRT again drives muscle protein synthesis, tessemeraline handles visceral fat and recovery, and we can usually run those for pretty long periods of time

35:21 and get amazing results. Then throw a GLP like Truzepatide or Retatrutide on top of it. The GLPs will drive overall weight loss. And then Tesameralin is going to target visceral fat specifically. Again, just make sure you're monitoring your glucose, but usually it works really well alongside of Tesimeraline because it's modulating glucose and improving insulin levels. Again, BPC-157-TB500 helps with injury recovery and repair. And then also too, we're going to get a really good anabolic effect. So if you are weight training, you will have much better muscle maintenance and muscle recovery, and potentially muscle growth when you use B.P.C.

35:55 and TB 500 with the Tessamerelin. Then like I always say, SS 31 is amazing. Complementary accesses. SS-31 stabilizes mitochondrial membrane function and then Tessemereline working on growth hormone. Again there's a very synergistic combo there. Some additional stacking notes, again, just make sure you're not stacking with Sarah Merlin CJC or MK 677. I do like it with KPV, I like with NAD and NNAD precursors or 5-Amino, with Hepatolin and Thymolin, especially for people that do not sleep well,

36:27 that usually is a really good stack. And again it can pair well with Hypermerlin because of the mechanisms, they're complimentary, but just know this is going to have the highest IGF elevation, which can increase the side effect burden, so just making sure that you are managing that pretty well. I think for people, I didn't say this earlier. For people that are stacking them together, i like cutting the dose down of tessameralin. So I would do closer to like a 600 micrograms of Tessamarolin with 200 micro grams of ipamerelin, rather than the full one milligram dose of testamarolin and 300 micro gram dose, dose All right, let's do some troubleshooting.

37:00 What about for the people that I don't feel anything? We all know these, if you work with clients, that people, nothing works for them. They're the, it doesn't work for me type people. One, Let's look at some of these things. We have timeline, the effects emerge over four to 16 weeks. Nothing is going to happen day one. The dose could be too low. So for some people, especially if they have a lot of fat to lose, one milligram might not be enough with them. You could titrate that up to two milligrams within that initial period. Could be a source quality thing. If you want to cover your bases, you can get it from a 503A pharmacy or just have legitimate source that you're getting it.

37:35 Again, foundation could missing, so they could have broken sleep, poor nutrition, undressed testosterone deficiency. And again, testosterone can potentially amplify a very bad baseline. And then again, there's those non-responders for the people. Again, how much of that is lifestyle and diet? We don't know, but we do know in trials that there was a significant cohort of people that just didn't respond. When we look at side effect management, injection site reactions, again this can be ongoing. Rotate sites, that typically helps with the immune buildup in the site. So make sure that you're rotating the sites.

38:05 Skip reactive spots in week one. You could also potentially inject intramuscularly if it doesn't work sub-Q but always default to injecting sub Q. I will say I have seen people that take Tessamerelin for six months a year. They do totally fine on it. Then one day out of the blue, they inject and they have an anaphylactic shock reaction to it and have to go to the emergency room or get an EpiPen. I don't know what's going on there. Obviously, it's probably some sort of immune modulated or immune mediated thing. But I would tell those people, please just avoid Testimonella in the future if that's you.

38:36 And again, I think that goes back to cycling because the people that I've seen do that in almost all cases, there were people they were on it for a very long period of time without coming off. Then we talk about those anti-drug, antibody buildups. Is that person's immune system interacting with those ADAs to potentially have that issue? Maybe, maybe not. But again that is why I that it's very important to cycle. Water retention and puffiness usually resolves by week 12. Again, if you are getting that, you can go down on the dose. Joint discomfort and stiffness can improve as the system stabilizes.

39:09 People that get tingling, again, this is probably from their IGF levels being too high. You could bring down the dos, but it usually will go away. and then mild glucose elevation, just monitor it and make sure you're doing everything. I would say for everyone that lives a healthy lifestyle and is hormonally optimized, they almost never have issues with glucose. It's usually just people that have very low testosterone and are sedentary that will get issues from the testosterone. And then sleep onset interference, this usually goes away within the first one to two weeks, but you can always move it to the morning time if that is an issue.

39:39 or just move it up. When to discontinue? Obviously, if you have a malignancy or cancer diagnosis, If you're pregnant, you can have one of those immune reactions like I talked about just a second ago. And if your liver enzymes are extremely elevated, I would probably not be the first thing that I'd use. If your IGFC score is above two standard deviations despite dose reduction. Strong reconsideration signals if A1c rises more than half a percent without body composition response. Persistent, worsening edema and swelling, persistent neuropathic symptoms with the tingling, and then 16 weeks with no measurable response at two milligrams

40:14 a day. I would just say maybe switch to something else and get on a GLP. Let's look at some FAQs. Can you take it orally or intranasally? No, I know there are people that sell this, but I have not seen. Testimonellin. in an oral formulation or a nasal formulation. Will it make me gain weight? No, there's a net neutral effect on weight in clinical studies. There could be a transient one to three pound water retention in those first six weeks, but it usually resolves. Does it affect ketosis? Not directly. GH drives lipolysis, which complements a ketogenic diet, if that's for you.

40:46 Although I think it would be smarter to use carbs. Does it interact with TRT, metformin, or other type of medications? There are no clinically significant interactions with any of these, no dose adjustment needed, but monitor glucose when adding Tessamrelin to met formin. Should you use Tessa with CJC plus Hippomerelin? I would say no. And then I'd say Tesseron has the strongest evidence cleaner mechanisms and best for visceral fat. CJ and Hippa are going to be better for just overall anti-aging, milder side effects, lower costs. For visceral fat specifically, Tessemerellin is going be What happens when you stop?

41:19 We talked about that. IGF-1 usually returns within two to three weeks. Visceral fat drifts back over eight to 24 weeks without other interventions. Again, it is not a panacea or cure-all. What about cancer history? I think it's just one of those things. Air on the side of caution. If you have a history or act of cancer, would not be the first thing that I add in. And then how much does it cost typically if you're getting compounded or research grade somewhere between 50 to 100 or maybe even on the higher end $500 per month. I do know if you get the brand name Agrifta as a prescription, it can be up to $2,500 to 5,000 per months.

41:53 Let's look at future outlooks. So there are active programs. We have this one trial that is looking at non-HIV fatty liver. It was last updated September, 2024. Primary results are pending as of today in 2026. Positive results would significantly expand the off-label rationale. We do have a 10-year malignancy cohort being studied. There's an FDA-mandated post-marketing study. The results are not yet published, but hopefully this substantially clarifies the long-term question around cancer. And then there is a Cognition Trial Register but no primary publication yet.

42:24 When we look at where it's heading, TESMRELM remains the FDA approved GHRH analog of choice. I would say as far as that goes right now, it is the gold standard for FDA approve things. It's increasingly a complimentary tool layered onto GLP-1 protocols. I hope in the future that test morelin becomes very, very commonly prescribed off-label with a GLp-one to help with muscle maintenance and visceral fat reduction for someone on GL p-One and also to preserve lean mass. This will be kind of the advanced body composition protocol, obviously with HRT going forward. And there are oral GHRH receptor agonists in early research, none in clinical trials as of mid-2026 in humans.

43:00 But again, we have a very strong evidence base just to sum up 15 to 18% visceral fat reduction in 26 weeks, 37% liver fat, reduction, in 12 months, 80 to 110% increase in IGF-1 elevation at two milligrams per day. And we had a substantial executive function improvement in older adults. Where are some of the gaps? We have nothing longer than 12 to 18 months. The non-HIV fatty liver cohort hasn't been reported. We don't know about the cancer question, at least from a clinical data standpoint. And again, the cognitive evidence isn't overwhelming, but it's still there.

43:32 Again, no RCT data in long COVID or chronic fatigue syndrome in those cohorts. But for the right client, I think Test from Rellon can be the best tool. It works best when foundation work is done first, the dose is matched to the goal, cycling is doing intelligently like we've talked about today, and monitoring is honest. And for right indications, for those people that get their DEXA scan done and they have a dangerous level of visceral fat, Test can very superior to every other intervention, except a GLP, meaning that it's going to be better than IPA.

44:04 It's gonna be other than growth hormone. And it is going be the best thing for those people with lots of visceral fat. Then just understand that is not a panacea, it not weight loss drug, is a continuous intervention requiring monitoring and cycling. Although you can use it in perpetuity, you could use in in-perpetuity when you're cycling on and off. Would not be something that I say on five days on two days off for perpetually without cycling And then just some takeaways. It's the only FDA approved peptide for visceral fat. Upstream, it's going to work in a pulsatile fashion that mimics our body's natural GH pulsing.

44:36 Foundations are so important before starting this peptides, much more so than even things like a GLP or testosterone or SS31. And again, just be smart when you talk about cycling. There's a lot of different use cases and you have to use your own discretion for those. It's not a magic wand, but done right in the right client for the person is one of the most useful peptides that we have available today, particularly among the cohort of growth hormone peptide. And that is it for slides. That is my masterclass for Tessa Morellen. I did my best job to cover everything I could, whether it's from the clinical literature, just to the coaching that I do and hearing all the different

45:11 feedback things from people. I will say this would be probably, if I was ranking peptides just overall, this will be in my top 10. I wouldn't say top five, but definitely top ten because of the visceral fat and just what getting visceral fat off of a body does for so many people when we talk about long-term health, long term cardio metabolic outcomes, and longterm brain health and those things. Again, when I talk long terms, I am still a fan of growth hormone itself, But I do think Tessamrelin in the right instance can be superior to growth hormones.

45:41 Long-term, with someone that's completely optimized, I think one to two I use of growth hormone are perfect, but I will say testosterone can be used in the right situation to get superior results to growth hormones. One thing I didn't mention in these slides, and I did want to say before I close down the video, is that the older someone is, the better they respond to their growth. because of this feedback loop that we talked about today, it just doesn't seem to work as well as we get older. However, I think if you had some guy or some woman that was 65 and they had 70 pounds of visceral fat to lose, Contrast that if you have a 65 year old

46:22 guy that's a bodybuilder and his 10% body fat and trains five days a week and is really healthy. I think long-term he's going to do better with one to two, I use a growth hormone and maybe you can use Tessamrelin just to get some pituitary stimulation here or there a couple of times per year. But I know that that is kind of one of the questions people have and ultimately there's no right answer. It depends on the person, but that being said, i still love Tassamrelin and it does so many amazing things and I still use it personally in those one-to-two cycles per alongside my growth hormone just to maintain some pituitary function because we do have that.

46:52 I kind of think about testum relin is like the HCG to my testosterone as it would be to growth from own, meaning that the same way we'd use HCT with testosterone, I like using testamerelin occasionally with my Growth Hormone just, uh, to have some, but to her stimulation of that, that feedback loop. But that's it for this one. I would love to hear your feedback on this, whether it was helpful or there was anything that I left out that, I could cover in future videos. That's also very helpful to me too. But just in closing, always like to say I have the best audience in the world.

47:22 Thank you guys so much for the amazing support that you send to, me whether, it's using my code at places, sharing this with friends and family, being on the email list, or now using the AI chat just because that helps build the database of questions that need to be answered the most. So thank you guys so much for all of the amazing support that you have sent me. I love you, guys. This is a dream come true that I get to do this. And I just always want to close out to make sure that, you know that because it's very important to me that reciprocate the same amazing love and support, that uh, I received from you.

47:53 Thank you so, much looking forward to the next one and I will talk to you later. Peace.