Tesamorelin vs sermorelin vs ipamorelin: evidence and legality

The short answer: of the three, only tesamorelin is a currently FDA approved drug with large randomized trials and a lawful prescription path. Sermorelin was approved decades ago for children, has only small human studies, and has no approved product today. Ipamorelin has never been approved and cannot lawfully be compounded. One small human pharmacology study showed a single IV infusion releases growth hormone in healthy men; its only randomized trial (postoperative ileus) was negative; no human trial measured body composition or muscle. [12] All three are prohibited in sport. [11]

People compare them because clinics sell all three for the same goals: fat loss, lean mass, recovery, and sleep. They are not interchangeable. This post puts them in one table, then explains each row and links the three pairwise comparisons. It does not give dosing advice.

Tesamorelin vs sermorelin vs ipamorelin at a glance

Question	Tesamorelin	Sermorelin	Ipamorelin
How it works	Full 44 amino acid GHRH analog	29 amino acid GHRH fragment	Ghrelin receptor agonist
FDA approval	Approved 2010; Egrifta WR current	Geref withdrawn 2009, not for safety	Never approved
Compounding	Not allowed (biologic since 2020)	Unlisted; depends on former approval	No lawful basis
Best human evidence	Phase 3 trials, 806 patients	16 week trial, 19 older adults	One GH pharmacology study; one negative surgical trial
WADA	Prohibited	Prohibited	Prohibited

Sources for the table, in row order: mechanism and approval [1] [4] [6] [7]; compounding [9] [10] [13]; human evidence [2] [5] [8] [12]; sport [11].

For head to head detail, see sermorelin vs tesamorelin, tesamorelin vs ipamorelin, and sermorelin vs ipamorelin.

How do tesamorelin, sermorelin, and ipamorelin work?

All three push the pituitary to release more of the body's own growth hormone, which raises IGF-1. They get there by two different receptors.

• Tesamorelin is a synthetic copy of the full 44 amino acid growth hormone releasing hormone with a hexenoyl group attached to one end. It binds the same receptor with similar potency to the natural hormone. [1]
• Sermorelin is the first 29 amino acids of the same hormone. [4] It works on the same receptor as tesamorelin but lacks tesamorelin's added hexenoyl group and the rest of the full sequence. [1]
• Ipamorelin is a five amino acid peptide that acts on the ghrelin receptor instead. In rats and pigs it released growth hormone about as potently as older secretagogues without raising cortisol or prolactin, which is the basis of its "selective" reputation. [7] That selectivity has not been confirmed in human trials.

Because GHRH analogs and ghrelin agonists act on different receptors, clinics often pair one of each. Pairing is a theory, not a tested treatment: no trial has tested tesamorelin with ipamorelin or sermorelin with ipamorelin. See the tesamorelin and ipamorelin blend page and the sermorelin and ipamorelin blend page.

Which one is FDA approved?

Tesamorelin. FDA first approved it in 2010. The current product, Egrifta WR, is indicated to reduce excess abdominal fat in adults with HIV who have lipodystrophy, and the label says it is not indicated for weight loss. [1]

Sermorelin, formerly. Sermorelin was approved as Geref as a diagnostic and later to treat growth hormone deficiency in children. The sponsor stopped selling it, the approvals were withdrawn, and in 2013 FDA determined in the Federal Register that Geref was not withdrawn for reasons of safety or effectiveness. [6] There is no approved sermorelin product on the market today.

Ipamorelin, never. Its only randomized human trial was a surgical study, and it has no approved use anywhere. [8] [10]

Can each one be prescribed and compounded legally?

This is where the three separate most sharply.

• Tesamorelin has a lawful prescription path, but only as Egrifta WR, which can be prescribed for the approved use or off-label. Tesamorelin is a biologic: Egrifta moved to a biologics license (BLA 022505) on March 23, 2020, and FDA states that biological products are not eligible for the 503A or 503B compounding exemptions, so compounded tesamorelin has no lawful basis. [13] [14] Our tesamorelin prescription guide covers the process.
• Sermorelin sits in a gray zone. It is not on the 503A bulks list and was not placed on the Category 2 list of risky substances. [10] Many 503A pharmacies compound it on the basis of its former approval, and whether that satisfies the component of an approved drug condition depends on how state boards and pharmacies read the statute. [9]
• Ipamorelin has no lawful path. FDA placed it on the 503A Category 2 list in September 2023, the nominations were withdrawn in 2024, and it is now listed as a withdrawn nomination rather than on the bulks list. [10] Clinics still advertising compounded ipamorelin are operating outside FDA's stated categories.

The same readiness applies to the related GHRH analog CJC-1295, which also has no lawful compounding path. Compare it in tesamorelin vs CJC-1295 and read the combination evidence on the CJC-1295 and ipamorelin blend page. State rules are collected on our legality hub.

Which has the best human evidence?

Tesamorelin, by a wide margin. Two double-blind phase 3 trials randomized 806 adults with HIV and excess abdominal fat. At 26 weeks, visceral fat fell by 15.4% relative to placebo, triglycerides fell, and glucose did not meaningfully change. [2] A later 12 month randomized trial in 61 people with HIV and fatty liver cut liver fat by an absolute 4.1 percentage points. [3] The full results timeline is in tesamorelin before and after.

Sermorelin, modest and old. The pediatric program that supported Geref showed faster growth in children with growth hormone deficiency. [4] In adults, the key study gave 19 people aged 55 to 71 a sermorelin analog nightly for 16 weeks. Growth hormone and IGF-1 rose and skin thickened in both sexes, while lean body mass and insulin sensitivity improved in men only; weight, bone density, and sleep quality did not change. [5] No trial has tested sermorelin for fat loss or performance in adults.

Ipamorelin, none for its marketed uses. The only randomized human trial gave intravenous ipamorelin after bowel surgery to 117 adults and found no significant difference from placebo in time to first tolerated meal. [8] No published trial measured growth hormone, IGF-1, muscle, or fat with the injected doses sold today. Its growth hormone data come from animals. [7]

None of the three has a trial showing muscle growth. We cover that question in does tesamorelin build muscle and rank the whole field in peptides for muscle growth.

Which one is right for a given goal?

We do not recommend a product, but the evidence points in clear directions.

• Excess abdominal fat with HIV: tesamorelin is the approved treatment. Start with the HIV lipodystrophy page.
• Diagnosed growth hormone deficiency: diagnosis and treatment belong with an endocrinologist, and none of these three is an approved adult treatment. [1] [6] The growth hormone deficiency page lists the standard of care and grades each option.
• General fat loss, lean mass, or anti-aging: no trial supports any of the three in healthy adults. The fat loss and body composition page lists what does have human evidence.
• Tested athletes: none. All three are on the WADA list. [11]

What do they cost?

Branded Egrifta WR costs thousands of dollars a month at cash prices, and compounded tesamorelin has no lawful price because tesamorelin is a biologic. Compounded sermorelin is priced far lower. Ipamorelin has no lawful price because it has no lawful channel. See the tesamorelin cost page and the sermorelin cost page for dated prices by channel. Status changes are logged on the tesamorelin, sermorelin, and ipamorelin regulatory trackers, and the general route to a lawful prescription is in how to get peptides prescribed. For what clinics mean by the label, see what is peptide therapy.