Cagrilintide (amylin analogue) layered onto a GLP-1 is the CagriSema thesis — additive satiety, Phase 3 readouts ~25% loss at the combined high end. Tesamorelin adds a daily GHRH pulse that reduces visceral fat specifically (FDA-approved for HIV-related lipodystrophy on this exact mechanism). Three different fat-loss levers, three trial histories.

Who it's for

Someone 12+ weeks into a GLP-1, tolerating it well, hit a plateau, and ready to commit to daily injection on top of two weekly. Visceral-fat-specific goal is the right context for Tesamorelin.

Red flags

·Three injections per week minimum. Daily Tesamorelin on top. Journaling burden triples.
·Cagrilintide is RUO until Novo's CagriSema approval lands. Sourcing risk is real.

You don't need this if

·You haven't plateaued on a single GLP-1 yet.
·You can't journal three separate injection days reliably.
·You're chasing the last 5 lbs of vanity, not a real metabolic load.

Considered and rejected

What we left out, and why.

Every peptide on the shortlist we read for this goal. The ones below didn’t make the stack — and the one-liner is the reason.

×AOD-9604Failed its Phase 2b efficacy endpoint in 2007 (Calzada / Metabolic Pharmaceuticals). Now mostly a cosmetic-clinic marketing peptide. Skip.
×MOTS-cMitochondrial-derived peptide, metabolic improvement claims. Mostly rodent data, a few early human trials. Interesting bonus, not foundational.
×RetatrutideTriple agonist (GLP-1 / GIP / glucagon). Would replace Tirzepatide, not stack with it. Wait for FDA filing.
×Liraglutide (Saxenda)Older GLP-1. Inferior efficacy to Tirz and Sema. No reason to pick it.

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