MOTS-c and Tesamorelin Stack: What Is Studied, Units

MOTS-c with tesamorelin: no study combines them, the tesamorelin label's glucose warning beside MOTS-c's insulin trial, molecules per draw and units.

Medibact Guides · Published 2026-10-29

Illustration: A clear glass vial with pale blue liquid on a white lab bench, softly lit. — Illustration

"MOTS-c and tesamorelin" is searched as a stack: one peptide with an approved label for abdominal fat, and one mitochondrial peptide known from mouse work on obesity and insulin resistance. No study has put them together. This page reports what each record states on its own, where the two records point in different directions, the number of molecules each amount contains, and the syringe arithmetic for each vial. It reports; it recommends no combination and no dose.

The single-compound records are on the MOTS-c dosage page and the tesamorelin dosage page. Tesamorelin's other searched pairings are on the tirzepatide and tesamorelin stack and the CJC-1295 and tesamorelin stack.

The registry, counted

ClinicalTrials.gov returned no study naming both compounds on 2026-10-29. PubMed returned one record for "MOTS-c AND tesamorelin": a 2026 narrative review in Sports Medicine by Mendias and Awan (PMID 41966639) that discusses both among peptides "marketed direct to patients" and concludes that "rigorous human safety data are scarce". It is a review of the category, not a study of the pair. Every statement about what the two do together is therefore unstudied.

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What each record says

	Tesamorelin	MOTS-c
What it is	GHRH analogue, 44 amino acids, 5,135.9 g/mol (PubChem CID 16137828)	16-amino-acid peptide encoded in mitochondrial DNA, 2,174.6 g/mol
Approved product	EGRIFTA SV and EGRIFTA WR (US)	None
Labelled dose	1.4 mg (SV) or 1.28 mg (WR) once daily under the skin	None; 5 mg on a protocol page that states it is unvalidated
Indication	Excess abdominal fat in HIV-infected adults with lipodystrophy	—
Evidence base	Two 26-week placebo-controlled trials per label	Mouse studies; one phase 2a trial recruiting
Glucose	Label warns of glucose intolerance	Studied for improving insulin sensitivity

Tesamorelin label figures from openFDA, both versions effective 2026-07-29. MOTS-c figures from this site's MOTS-c pages and the ClinicalTrials.gov record read 2026-10-29.

Tesamorelin. The EGRIFTA WR label reports two 26-week trials in which visceral fat fell by 27 and 21 cm² on tesamorelin while it changed by +4 and −0 cm² on placebo, mean treatment differences of −31 and −21 cm². Between 84 and 90% of participants were men, mean age 48, all with HIV. The label is explicit about what it does not do: tesamorelin "is not indicated for weight loss management as it has a weight neutral effect". The WR label adds that EGRIFTA WR and EGRIFTA SV "are not substitutable".

MOTS-c. The 2015 Cell Metabolism paper that named it (Lee et al., PMID 25738459) found that MOTS-c "prevented age-dependent and high-fat-diet-induced insulin resistance, as well as diet-induced obesity" in mice, with skeletal muscle as its main target. The one registered human study administering it, NCT07505745 (Hudson Biotech), is a phase 2a placebo-controlled trial in adults with prediabetes and overweight or obesity, recruiting since 2026-02-02 with 120 planned. Its primary outcome is insulin sensitivity (the Matsuda index) at 12 weeks, and its record gives the regimen only as a "fixed dose once daily for 12 weeks", without the amount.

Where the two records point in different directions

The idea behind the stack is two routes to the same end: tesamorelin for visceral fat, MOTS-c for metabolic health. On the one measure both records touch, blood sugar, they point opposite ways.

The tesamorelin label states that treatment "can result in glucose intolerance". In its trials HbA1c reached 6.5% or more by week 26 in 5% of treated patients against 1% on placebo, and the label reports an intent-to-treat odds ratio for developing diabetes of 3.3 (95% CI 1.4 to 9.6). It tells prescribers to check glucose status before starting and to monitor it periodically. MOTS-c, by contrast, is being tested to improve insulin sensitivity; the mouse data point that way, and the human trial has not reported.

Whether MOTS-c would offset, add to or do nothing to tesamorelin's effect on glucose is not known, because no one has measured it. That is the central gap a combination study would have to fill, and none is registered.

Molecules and units per draw

The two amounts are milligram-scale, but MOTS-c is quoted at more than three times the mass of the labelled tesamorelin dose, and its molecule is smaller.

Amount	Source of the figure	Micromoles
Tesamorelin 1.28 mg	EGRIFTA WR label	0.25
Tesamorelin 1.4 mg	EGRIFTA SV label	0.27
MOTS-c 5 mg	Protocol page, unvalidated	2.30
MOTS-c 10 mg	Protocol page, higher tier	4.60

Five milligrams of MOTS-c is about 8.4 times as many molecules as the labelled 1.4 mg of tesamorelin. The arithmetic says nothing about potency; the two act on different targets.

Draw	Vial + water	Concentration	U-100 units
Tesamorelin 1.4 mg	EGRIFTA SV, 2 mg + 0.5 mL (label)	4 mg/mL	35
Tesamorelin 1.28 mg	EGRIFTA WR, 11.6 mg + 1.3 mL (label)	8 mg/mL	16
Tesamorelin 1.4 mg	Research 5 mg + 1 mL	5 mg/mL	28
Tesamorelin 1.4 mg	Research 10 mg + 2 mL	5 mg/mL	28
MOTS-c 5 mg	Research 10 mg + 2 mL	5 mg/mL	100
MOTS-c 5 mg	Research 10 mg + 1 mL	10 mg/mL	50

The two label rows are the labels' own concentrations and volumes; the research rows are arithmetic on vials with no label. At a matching 5 mg/mL, a 5 mg MOTS-c amount fills a whole 1 mL syringe while the labelled tesamorelin amount is just over a quarter of one. Neither label nor any study describes drawing the two into one syringe or mixing them in one vial. The MOTS-c calculator and the tesamorelin calculator work other vials and volumes; the tesamorelin label volumes are explained on the tesamorelin reconstitution page.

What the figures omit

No dose for the combination exists, because no one has studied it. The tesamorelin figures belong to a labelled drug in its labelled population, HIV-associated lipodystrophy, and the label's glucose warning travels with it. The MOTS-c figure is not a dose from any trial. Medibact's MOTS-c guide and Tesamorelin guide cover the compounds. Nothing on this page is an instruction; whether to use either, or both, belongs with a prescriber.

Sources and dates

Opened 2026-10-29: ClinicalTrials.gov API search "tesamorelin AND MOTS-c" (0 records) and record NCT07505745 (last updated 2026-04-01); PubMed search "MOTS-c AND tesamorelin" (1 record) and the abstracts of PMID 41966639 (Mendias and Awan, Sports Med 2026) and PMID 25738459 (Lee et al., Cell Metab 2015); the EGRIFTA SV label (openFDA set id 3d783378-b02d-4f19-99dd-0fc91a042224, effective 2026-07-29) and EGRIFTA WR label (set id 839334d3-8c1d-4c26-9036-2ab524a6ea75, effective 2026-07-29), sections 1, 2, 3, 5 and 14. Carried from this site's pages: the MOTS-c protocol-page figure (2026-09-18) and the PubChem molecular weights. Molar and unit arithmetic by this site. Corrections go to the contact page.

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Medibact Guides facts

No study has given MOTS-c and tesamorelin together: ClinicalTrials.gov returned 0 records for both names on 2026-10-29, and PubMed's one record naming both (Mendias and Awan, Sports Medicine 2026, PMID 41966639) is a narrative review of approved and unapproved peptides, not a study of the pair.
Tesamorelin has two US labels, both effective 2026-07-29 (openFDA): EGRIFTA SV, 1.4 mg (0.35 mL) under the skin once daily, and EGRIFTA WR, 1.28 mg (0.16 mL) once daily, each for excess abdominal fat in HIV-infected adults with lipodystrophy. Both state it 'is not indicated for weight loss management as it has a weight neutral effect'.
In the EGRIFTA WR label's two 26-week trials, visceral fat changed by −27 and −21 cm² on tesamorelin against +4 and −0 cm² on placebo, mean treatment differences of −31 and −21 cm²; 84 to 90% of participants were men.
The same label warns that tesamorelin 'can result in glucose intolerance': HbA1c rose to 6.5% or more in 5% of treated patients against 1% on placebo by week 26, an odds ratio for developing diabetes of 3.3 (95% CI 1.4 to 9.6).
MOTS-c has no label. The mouse study that named it (Lee et al., Cell Metabolism 2015, PMID 25738459) reports that it 'prevented age-dependent and high-fat-diet-induced insulin resistance, as well as diet-induced obesity'; the only registered human study administering it, NCT07505745 (Hudson Biotech, phase 2a, recruiting since 2026-02-02, 120 adults planned), measures insulin sensitivity after 12 weeks and does not state its dose.
At the figures in circulation, 5 mg of MOTS-c (2,174.6 g/mol) is 2.30 micromoles and the labelled 1.4 mg of tesamorelin (5,135.9 g/mol) is 0.27 micromoles, about 8.4 times fewer molecules for the labelled drug; from 5 mg/mL solutions the two are 100 and 28 units on a U-100 syringe (arithmetic by this site).

Frequently asked questions

Can MOTS-c and tesamorelin be taken together?

No study has tested them together, in people or animals, and neither label nor any trial describes the combination. Tesamorelin's label covers it alone; MOTS-c has no label at all. What each does on its own is reported below, and whether to combine them is a question for a prescriber.

Why are MOTS-c and tesamorelin stacked?

Both are discussed for visceral fat and metabolism. Tesamorelin is approved to reduce abdominal fat in HIV-associated lipodystrophy and lowered visceral fat by 21 to 31 cm² against placebo in its trials; MOTS-c reduced diet-induced obesity and insulin resistance in mice. The stack combines a labelled drug with a mouse-stage compound; no study links them.

Does tesamorelin affect blood sugar?

Its label says it can cause glucose intolerance. In the trials HbA1c reached 6.5% or more in 5% of treated patients versus 1% on placebo, and the label advises checking glucose before starting and periodically after. MOTS-c is being tested in the opposite direction, to improve insulin sensitivity, in a trial with no results yet.

How many units are MOTS-c and tesamorelin?

It depends on each vial's concentration. With a 10 mg vial in 2 mL (5 mg/mL), 5 mg of MOTS-c is 100 units, a full 1 mL syringe. With a 5 mg tesamorelin vial in 1 mL (also 5 mg/mL), the labelled 1.4 mg is 28 units. The EGRIFTA SV label's own solution is 4 mg/mL, where 1.4 mg is 35 units.

Is MOTS-c approved?

No. MOTS-c has no approved product or label anywhere; the one registered human study of it as a treatment is a phase 2a trial in prediabetes that began recruiting in February 2026 and has posted no results.