Tesamorelin reduced the amount of fat in the liver by 37 percent in one year. In a 2019 study, liver fat fell below the fatty liver threshold of 5 percent in 35 percent of treated people, compared with only 4 percent on placebo. The researchers also saw that over a year tesamorelin stopped liver fibrosis from progressing. A 2026 meta-analysis of five trials confirmed a fall in liver fat of 4.28 percentage points on average. All these studies were run in people with HIV, in whom fatty liver is common and takes a more severe course than in others.
What is tesamorelin?
Tesamorelin is an analogue of GHRH, the hormone through which the hypothalamus tells the pituitary to release growth hormone. It is the only peptide in this group approved as a medicine: in the United States under the name Egrifta, to reduce abdominal fat in people with HIV. The history of this approval is described in the guide on why tesamorelin is the only GHRH analogue approved as a medicine.
Tesamorelin acts most strongly on visceral fat, the fat around the organs in the abdomen. How much of it was lost in studies is described in the guide on what studies showed about tesamorelin and belly fat. This guide is about the liver.
What did the first liver study show?
The first study was run at Massachusetts General Hospital in Boston and published in 2014 in JAMA. It included 50 people with HIV and excess abdominal fat. For 6 months they received 2 mg of tesamorelin under the skin once a day or placebo.
| What was measured | Tesamorelin | Placebo |
|---|---|---|
| Visceral fat | minus 34 cm² | plus 8 cm² |
| Liver fat, change in median | minus 2.0 percent | plus 0.9 percent |
| Fasting blood sugar after 6 months | plus 4 mg/dl | plus 2 mg/dl |
The difference in liver fat between the groups was 2.9 percentage points in favour of tesamorelin. Fasting blood sugar rose slightly after 2 weeks, but after 6 months the difference between groups was no longer significant. The authors saw the result as a reason for a longer study.
What did a year of tesamorelin achieve?
The longer study was published in 2019 in Lancet HIV. It included 61 people with HIV whose liver was at least 5 percent fat, which means fatty liver. For 12 months they received 2 mg of tesamorelin a day or placebo, and then everyone received tesamorelin for 6 months.
- Liver fat: a fall 4.1 percentage points greater than on placebo.
- Relative fall: 37 percent from baseline.
- Liver below the fatty liver threshold: 35 percent of treated people versus 4 percent on placebo.
- Blood sugar and glycated haemoglobin: no differences between groups after 12 months.
- Side effects: more frequent discomfort at the injection site, none serious.
One in three treated people therefore ended the year with a liver that no longer met the fatty liver criterion on imaging. The authors of a follow-up paper called tesamorelin the first treatment shown to work for fatty liver in people with HIV.
Does tesamorelin stop liver fibrosis?
Fibrosis is the gradual replacement of healthy liver tissue with scar tissue. In the 2019 study liver biopsies were taken before treatment and after a year. In a follow-up paper in 2020 the researchers concluded that tesamorelin reduced liver fat and prevented fibrosis from progressing over the year.
The same paper examined which genes in the liver changed their activity. Tesamorelin boosted genes linked to cellular respiration in the mitochondria. It dampened genes for inflammation, tissue repair and cell division. These changes went hand in hand with a more favourable score for genes linked to fibrosis.
Do liver tests improve too?
Yes, as an analysis of two phase 3 trials with 806 people with HIV and abdominal obesity showed. The researchers chose people with raised liver enzymes, ALT or AST above 30 units per litre. They compared those in whom tesamorelin cut visceral fat by at least 8 percent with the others.
| Enzyme, change over 26 weeks | Large fall in visceral fat | Small fall |
|---|---|---|
| ALT | minus 8.9 U/l | plus 1.4 U/l |
| AST | minus 3.8 U/l | plus 0.4 U/l |
The improvement in enzymes held for 52 weeks, including in people switched to placebo after 26 weeks. Their visceral fat partly came back, while the enzymes stayed better.
What does the 2026 meta-analysis say?
The meta-analysis gathered five randomised trials comparing tesamorelin with placebo in adults with HIV. This makes it possible to judge the effect in more people than in a single study.
| Result | Mean difference versus placebo |
|---|---|
| Liver fat | minus 4.28 percentage points |
| Visceral fat | minus 27.71 cm² |
| Trunk fat | minus 1.18 kg |
| Waist circumference | minus 1.61 cm |
| Lean mass | plus 1.42 kg |
The authors of the meta-analysis concluded that tesamorelin improves body composition, liver fat and lean mass without serious side effects and without disturbing blood sugar control. They listed joint and muscle pain, tingling and redness at the injection site.
How does tesamorelin compare with GLP-1 drugs?
Semaglutide and tirzepatide also reduce liver fat, and this comes with a clear fall in body weight. Tesamorelin works differently. In the 2026 meta-analysis it did not change body mass index significantly, yet it reduced visceral fat and liver fat. Lean mass rose at the same time, so tesamorelin did not take away muscle.
The results of GLP-1 drugs are described in the guide on what studies showed about semaglutide and tirzepatide for fatty liver. So far tesamorelin has been studied for the liver only in people with HIV. Tesamorelin sold as research material is not the medicine Egrifta.
Where to buy tesamorelin and how much does it cost?
The shop has tesamorelin 10 mg Genheal for 50 EUR, which is 5 EUR per milligram, in stock. The product and the studies are gathered on the tesamorelin page. A comparison with other GHRH analogues is in the guide sermorelin, Mod GRF 1-29, CJC-1295 and tesamorelin in one table. The products in the shop are material for laboratory research, not a medicine.
Frequently asked questions
Does tesamorelin reduce liver fat?
Yes, in a 2019 study tesamorelin reduced liver fat by 37 percent in one year, and in 35 percent of treated people it fell below the fatty liver threshold.
Does tesamorelin act on liver fibrosis?
According to a 2020 paper based on liver biopsies, tesamorelin prevented fibrosis from progressing over a year of treatment.
What dose of tesamorelin was used in the liver studies?
In the 2014 and 2019 studies participants received 2 mg of tesamorelin under the skin once a day, for 6 or 12 months.
Does tesamorelin raise blood sugar?
Fasting blood sugar rose slightly after 2 weeks, but after 6 and 12 months it did not differ from placebo. Glycated haemoglobin did not change either.
How much does tesamorelin cost in the shop?
Tesamorelin 10 mg Genheal costs 50 EUR, which is 5 EUR per milligram, and it is in stock.
Sources
- Stanley TL, Feldpausch MN, Oh J et al. Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation: a randomized clinical trial. JAMA, 2014, 312(4): 380-389. https://doi.org/10.1001/jama.2014.8334
- Stanley TL, Fourman LT, Feldpausch MN et al. Effects of tesamorelin on non-alcoholic fatty liver disease in HIV: a randomised, double-blind, multicentre trial. Lancet HIV, 2019, 6(12): e821-e830. https://doi.org/10.1016/S2352-3018(19)30338-8
- Fourman LT, Billingsley JM, Agyapong G et al. Effects of tesamorelin on hepatic transcriptomic signatures in HIV-associated NAFLD. JCI Insight, 2020, 5(16): e140134. https://doi.org/10.1172/jci.insight.140134
- Fourman LT, Czerwonka N, Feldpausch MN et al. Visceral fat reduction with tesamorelin is associated with improved liver enzymes in HIV. AIDS, 2017, 31(16): 2253-2259. https://doi.org/10.1097/QAD.0000000000001614
- Badran AS, Helal A, Shata KS, Ayesh H. Body composition, hepatic fat, metabolic, and safety outcomes of tesamorelin, a GHRH analogue, in HIV-associated lipodystrophy: a meta-analysis of randomized controlled trials. Obesity Research and Clinical Practice, 2026, 20(1): 2-12. https://doi.org/10.1016/j.orcp.2026.01.002