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GLP-1 Support Stack: Tesamorelin, Tesa/Ipa, MOTS-c and NAD+ With a GLP-1 Drug

A weekly GLP-1 shot with growth-hormone or "energy" peptides added on top: every blend name you will see, how the separate protocols fit around the weekly injection, where the risks add up, and why no trial has tested any of it together.

Community combination, not studied together

No human trial has given semaglutide, tirzepatide or retatrutide together with tesamorelin, ipamorelin, CJC-1295, MOTS-c, SS-31 or NAD+. The closest study, in rats, found growth hormone added nothing to liraglutide's effects on diabetes. [7]

  • Semaglutide

    Anchor (one GLP-1 drug, never two). A weekly GLP-1 medicine sold as Wegovy and Ozempic. [8]

    Evidence
    Large trials: 14.9% average weight loss at 68 weeks in STEP 1
    Status
    Approved prescription medicine
  • Tirzepatide

    Anchor. A weekly GIP and GLP-1 medicine sold as Zepbound and Mounjaro. [9]

    Evidence
    Large trials: 20.9% average weight loss at 72 weeks in SURMOUNT-1
    Status
    Approved prescription medicine
  • Retatrutide

    Anchor. An experimental weekly drug acting on GIP, GLP-1 and glucagon receptors. [10] Often the anchor in community education groups.

    Evidence
    Large trials, mostly company announcements so far
    Status
    Experimental; approved nowhere
  • Tesamorelin

    Add-on for belly fat and, people hope, muscle. A copy of the hormone that tells the pituitary to release growth hormone. [1]

    Evidence
    Two trials in people with HIV; not tested with a GLP-1
    Status
    Approved only for HIV-related belly fat (EGRIFTA)
  • Ipamorelin

    Add-on for muscle and sleep, usually in a blend with tesamorelin (Tesa/Ipa) or CJC-1295 (CJC/Ipa). [3]

    Evidence
    Three small human studies, none of the injections people use
    Status
    Never approved
  • MOTS-c

    Add-on for tiredness on a GLP-1 drug and "metabolism". A small peptide made from a mitochondrial gene. [4]

    Evidence
    Mouse and cell studies; one short trial of a modified version
    Status
    Research compound, not approved
  • SS-31

    Add-on for energy. Elamipretide, a peptide designed to reach mitochondria. [11]

    Evidence
    Daily-use trials missed their main goals
    Status
    Approved only for Barth syndrome (Forzinity)
  • NAD+

    Add-on for energy; sometimes compounded into the same vial as the GLP-1 drug. A coenzyme, not a peptide. [6], [12]

    Evidence
    About a dozen small studies; none for energy or weight
    Status
    Not approved in the United States

Why people combine them: Keeping muscle, losing more belly fat and easing tiredness while a weekly GLP-1 drug drives weight loss. The reasoning comes from each part's separate research, not from tests of the combination.

Also called: Tesa/Ipa, Hulk, CJC/Ipa, Compounded semaglutide or tirzepatide with NAD+, B12, B6 or niacinamide, Kali, FUSION, Reta and tesa, Reta and MOTS-c

Injections per week for each part of the GLP-1 support stack, from each part's own most common protocol. The GLP-1 drug, semaglutide, tirzepatide or retatrutide, one only: once a week. Tesamorelin: 5 to 7 times a week, daily or 5 days on and 2 off. Ipamorelin: 1 to 3 times a day, so 7 to 21 times a week. MOTS-c: 2 to 3 times a week. SS-31 research vials: once a day, 7 times a week. NAD+: 1 to 3 times a week. None of the add-ons has been tested together with a GLP-1 drug in people. Adding one daily add-on turns one weekly injection into about eight. What has reduced lean-mass loss on a GLP-1 drug in trials is a different group of experimental drugs, not these add-ons. These are separate protocols, not a combined schedule.

Each part's frequency comes from its own guide's most common protocol; they are not a combined schedule. No trial has given any add-on together with a GLP-1 drug. [1], [2], [3], [4], [5], [6]
Published by DoserlyUpdated Next scheduled review: December 202615 min readHow this guide was made
In this guide

What is the GLP-1 support stack?

The GLP-1 support stack is a weekly GLP-1 weight-loss drug with add-ons: usually tesamorelin or CJC-1295 with ipamorelin (Tesa/Ipa, CJC/Ipa; some sellers call these Hulk), or MOTS-c, SS-31 and NAD+. People add them hoping to keep muscle, lose more belly fat or feel less tired. No human trial has tested any add-on with a GLP-1 drug. [7], [25]

The anchor is one drug: approved semaglutide or tirzepatide, or experimental retatrutide. Add-ons range from an approved medicine used off label (tesamorelin) to compounds never tested in people (MOTS-c). Premixed options include compounded GLP-1 vials with NAD+ or a vitamin, and "GLP support" vials such as Kali and FUSION. [1], [12], [22], [24]

This guide covers timing around the weekly shot, overlapping risks and what has been tested for muscle. Each part and the growth-hormone pairs have their own guides.

What's in it, and what else is it called?

Anchor, one only: semaglutide, tirzepatide or retatrutide. Growth-hormone add-ons: tesamorelin and ipamorelin; CJC-1295 appears here only inside CJC/Ipa blends, covered in the CJC-1295 and ipamorelin stack. Energy add-ons: MOTS-c, SS-31 and NAD+. Most people use one or two add-ons, not all.

Names people use for this stack and its blends
NameTypeWhat it usually containsWhere sources disagree
Tesa/IpaPremixed blendTesamorelin + ipamorelin in one vial, for example 10 mg + 10 mg (20 mg in total) or 10 mg + 3 mg (13 mg) [13], [14]Ratios run from 1:1 to more than 4:1. See the tesamorelin and ipamorelin stack.
HulkPremixed blendA seller nickname with no fixed contents. Most often CJC-1295 + ipamorelin: 5 mg + 5 mg without DAC, 10 mg + 10 mg with DAC, or 20 mg with DAC (split not stated). At one seller, tesamorelin 6 mg + ipamorelin 3 mg ("The Hulk", also sold as a nasal spray) or 13 mg + 3 mg ("Hulk XL") [15], [16], [17], [14]No Hulk product we found contains a GLP-1 drug. One seller uses the name for BPC-157 15 mg + TB-500 15 mg, a recovery blend. [18] All Hulk products
CJC/IpaPremixed blendCJC-1295 5 mg + ipamorelin 5 mg per vial (10 mg in total) [15], [14]Sold with CJC-1295 with or without DAC; check the label. See the CJC-1295 and ipamorelin stack. [17]
Compounded semaglutide or tirzepatide with NAD+, B12, B6 or niacinamidePremixed blendPer mL: semaglutide 5 mg + NAD+ 5 mg; tirzepatide 15 mg + NAD+ 5 mg; semaglutide 5 mg + B12 0.5 mg; tirzepatide 17 mg + niacinamide 2 mg; semaglutide 1 mg + B6 15 mg [12], [19], [20]The only mixes that contain the GLP-1 drug itself. FDA says the safety and effectiveness of adding other ingredients to semaglutide "has not been established". [21]
KaliPremixed blendBPC-157 10 mg + MOTS-c 10 mg + KPV 10 mg per 5 mL vial (30 mg in total) [22]Sold as "GLP support"; one seller family. [22], [23]
FUSIONPremixed blendBPC-157 10 mg + MOTS-c 10 mg + 5-Amino-1MQ 10 mg + tesamorelin 15 mg per 5 mL vial (45 mg in total) [24]One telehealth seller, marketed for use "without a GLP-1, or alongside one". [24]
Reta and tesaCommunity nameRetatrutide with tesamorelin, from separate vials [25], [26]The same pairing is published with semaglutide or tirzepatide in place of retatrutide. [27], [28]
Reta and MOTS-cCommunity nameRetatrutide or tirzepatide with MOTS-c, often plus SS-31 or NAD+, from separate vials [29], [30]—

A name does not fix what is in the vial. "Hulk" is CJC-1295 with ipamorelin at most sellers we found, tesamorelin with ipamorelin at one and a recovery blend at another (see Hulk). Only the label's amount of each ingredient tells you what a dose contains. [15], [16], [14], [18]

What is in each blend in this stack?

The GLP-1 drug is usually a separate weekly shot. The blends are mostly the add-ons: Tesa/Ipa and CJC/Ipa (some sold as Hulk), then compounded GLP-1 vials with NAD+ or a vitamin added, and two "GLP support" vials, Kali and FUSION. No blend has been tested with a GLP-1 drug in people.

Amounts are label claims, not doses or proof of contents.

Tesa/Ipa, CJC/Ipa and Hulk

Two-peptide growth-hormone blends: tesamorelin or CJC-1295 with ipamorelin. Both pairs have their own stack guides (Tesa/Ipa, CJC/Ipa).

Name on the labelContents per vialTotalSources
CJC/Ipa, HULK blendCJC-1295 (no DAC) 5 mg + ipamorelin 5 mg10 mg[15], [14]
Hulk blendCJC-1295 with DAC 10 mg + ipamorelin 10 mg20 mg[16]
Hulk StackCJC-1295 with DAC + ipamorelin, split not stated20 mg[17]
Tesa/IpaTesamorelin 10 mg + ipamorelin 10 mg20 mg[13]
The Hulk (vial or nasal spray)Tesamorelin 6 mg + ipamorelin 3 mg9 mg[14]
Hulk XLTesamorelin 13 mg + ipamorelin 3 mg16 mg[14]
  • Where sellers disagree: "Hulk" has no fixed meaning: three products are CJC/Ipa, with or without DAC (which makes CJC-1295 last far longer), one is Tesa/Ipa, and one is BPC-157 15 mg + TB-500 15 mg, a recovery blend. Tesa/Ipa ratios run from 1:1 to more than 4:1. [15], [16], [17], [14], [18], [13] All Hulk products
  • What they are claimed to add: keeping muscle and losing belly fat on a GLP-1 drug. Tesamorelin's guide finds two trials in people with HIV (belly fat, not muscle); ipamorelin's finds no human study of the under-the-skin injections people use. [1], [31]
  • Stated amounts: the Hulk pages we checked give no dose. A telehealth seller of a Tesa/Ipa blend publishes an ipamorelin-with-tirzepatide schedule. [32]
  • Regulators: no notice we found names Hulk. In August 2026 FDA sent warning letters to two companies selling tesamorelin and ipamorelin blends as unapproved drugs. [33], [34]
  • GLP-1 drugs: no Hulk product we found contains one.

Compounded GLP-1 with an added ingredient

The only blends that contain the GLP-1 drug itself: pharmacies add NAD+ or a vitamin to compounded semaglutide or tirzepatide.

ProductGLP-1 drug per mLAdded per mLSources
Semaglutide/NAD+ (2 mL)Semaglutide 5 mgNAD+ 5 mg[12]
Tirzepatide/NAD+ (2 mL)Tirzepatide 15 mgNAD+ 5 mg[12]
Semaglutide/B12Semaglutide 5 mgVitamin B12 0.5 mg[12], [19]
Tirzepatide/niacinamideTirzepatide 17 mg or 8 mgNiacinamide 2 mg[19]
Semaglutide/B6 (recalled in Canada)Semaglutide 1 mg or 2 mgVitamin B6 15 mg or 30 mg[20]
  • What NAD+ is claimed to add: energy. Its guide finds no studies for energy or weight; forum posts on tirzepatide with NAD+ are mixed. [35], [36]
  • Regulators: FDA says the safety and effectiveness of adding B12, B6, L-carnitine or NAD to semaglutide "has not been established", and on 18 September 2026 it named semaglutide/B12 and tirzepatide/niacinamide products in a warning letter. [21], [19] Health Canada recalled a semaglutide/B6 product. [20]
  • Testing: in a 2026 review, 48% of 33 compounded GLP-1 products had added ingredients; a lab study found a new tirzepatide-B12 impurity. [37], [38]

Kali

BPC-157 10 mg + MOTS-c 10 mg + KPV 10 mg per 5 mL vial (30 mg), sold as "GLP support" for people on a GLP-1 drug by one seller family. [22], [23]

  • What each part is claimed to add: BPC-157 for nausea, MOTS-c for "GLP-induced fatigue" and KPV for the gut. [22] Their guides find three small uncontrolled human reports for BPC-157 and no human data for the other two.
  • Stated amounts, regulators, related stacks: no Kali dose is published and no regulator notice names it. [22] BPC-157 and KPV belong mainly to the healing and recovery stack.

FUSION

BPC-157 10 mg + MOTS-c 10 mg + 5-Amino-1MQ 10 mg + tesamorelin 15 mg per 5 mL vial (45 mg), from one telehealth seller, for use "without a GLP-1, or alongside one". [24]

  • What the extra parts are claimed to add: metabolism (MOTS-c, 5-Amino-1MQ) and belly fat (tesamorelin). Only tesamorelin has controlled human trials, in people with HIV. [24], [1]
  • Stated amounts, regulators, related stacks: concentrations (tesamorelin 3 mg per mL, the others 2 mg per mL) but no dose; no regulator notice names it. [24] 5-Amino-1MQ belongs to the non-incretin fat-loss stack.

Other names you may see

Superhuman Blend is an injectable mix of amino acids and L-carnitine, not a peptide. PHYSIQ and SHRED, from FUSION's seller, target fat loss without a GLP-1 (non-incretin fat-loss stack). [24] MitoBoost, Blazer and Mito-Genesis belong to the mitochondrial stack. Premixed retatrutide with tirzepatide or cagrilintide puts two weight-loss drugs in one vial, a risk rather than a support blend (see risks); cagrilintide with semaglutide is a separate stack.

Why do people combine a GLP-1 drug with these add-ons?

To fix what they dislike about GLP-1 weight loss: lost muscle, stubborn belly fat and tiredness. That is reasoning from each part's separate research, not proof. [25], [30]

  • Muscle. In body-scan substudies, lean mass fell 10.9% on tirzepatide and 9.7% on semaglutide, though fat fell far more. [39], [40]
  • Belly fat. Tesamorelin is approved to reduce deep belly fat in people with HIV. [1]
  • Energy. MOTS-c, SS-31 and NAD+ are added for tiredness on a calorie deficit. [30], [41]

In community education groups, skeptics argue that the GLP-1 does the work and that growth-hormone peptides add water and raise blood sugar. Several educators advise adding one compound at a time.

What does the evidence show?

No human trial has tested any add-on with a GLP-1 drug. The anchors have strong evidence alone; the add-ons have little or none.

The GLP-1 anchors

  • Semaglutide: 14.9% average weight loss at 68 weeks versus 2.4% on placebo (STEP 1). [42]
  • Tirzepatide: 20.9% at 72 weeks versus 3.1%; about three-quarters of the loss was fat, as on placebo. [43], [39]
  • Retatrutide: 28.3% at 80 weeks on 12 mg (a company announcement); the lean share of the loss was "similar to other obesity treatments". [10], [44]

The add-ons, alone

  • Tesamorelin: in two HIV trials, deep belly fat fell about 15% more than on placebo over 26 weeks, without weight change. [1]
  • Ipamorelin: three small human studies, by vein or nose; none tested the under-the-skin injections people use, or fat or muscle. [31]
  • CJC-1295 appears here only inside CJC/Ipa blends; its evidence is in the CJC-1295 and ipamorelin stack.
  • MOTS-c: no human data; only a modified version, CB4211, was given to people. [45], [46]
  • SS-31: every randomized trial of daily use missed its main goal. [47], [48], [49], [50]
  • NAD+: about a dozen small studies, none for energy or weight loss (NAD+ guide).

The combination

  • No human trial of any anchor with any add-on on PubMed or ClinicalTrials.gov.
  • One rat study: growth hormone added nothing to liraglutide, an older GLP-1 drug, for diabetes outcomes. [7]
  • Two registered trials, no results: both pair recombinant growth hormone, not a stack part, with a GLP-1. [51], [52]

What has been tested for muscle on a GLP-1 drug

Only experimental drugs, not stack parts: lean mass fell 0.8–2.3% with bimagrumab plus semaglutide versus 4.7–6.9% on semaglutide alone over 48 weeks (BELIEVE) [53]; 1.6 kg with apitegromab plus tirzepatide versus 3.5 kg over 24 weeks (EMBRAZE) [54]; and 71% less with enobosarm plus Wegovy, per a company announcement (QUALITY). [55]

How do the GLP-1 support stack protocols line up?

Subcutaneous injection · each part alone, from its own guide · approved drugs at labeled or trial doses · 1 mg = 1,000 mcg · none tested together
PartAmount each timeFrequencyTotal per day or weekDurationSource
Semaglutide (Wegovy)0.25 mg, rising every 4 weeksOnce a week2.4 mg a week from week 17Long term[8]
Typical labeled dose
Tirzepatide (Zepbound)2.5 mg for 4 weeks, then 5 mg; steps of 2.5 mg at least 4 weeks apartOnce a week5, 10 or 15 mg a weekLong term[9]
Typical labeled dose
Retatrutide2 mg for 4 weeks, then a step every 4 weeksOnce a week4, 9 or 12 mg a week80 weeks in TRIUMPH-1[10], [56]
Trial schedule; no dose is approved
Tesamorelin (EGRIFTA)1.28 mg (WR) or 1.4 mg (SV)Once daily1.28 or 1.4 mg a dayOngoing[1], [57]
Labeled dose. Off label, 1–2 mg at bedtime, daily or 5 days on and 2 off, for 12–16 weeks [58], [2], [59]
Ipamorelin100–300 mcg1–3 times a day, bedtime most common100–600 mcg a day8–12 weeks, then about 4 weeks off[3]
MOTS-c5–10 mg (5 mg most named)2–3 times a week15 mg a week most namedAbout 4–8 weeks[60], [61], [4]
Website protocols; untested in people
SS-31 (research vials)5–10 mgOnce daily5–10 mg a dayAbout 4–8 weeks[5], [62], [63], [64]
The Forzinity label dose, for Barth syndrome only, is 40 mg a day [11]
NAD+50 mg, often raised toward 100 mg1–3 times a week50–300 mg a week4 weeks to 3 months[6], [65]
Website protocols; untested

These are each part's own protocol, not a stack protocol. CJC-1295 schedules are in the CJC-1295 and ipamorelin stack.

Schedules published for the combination

Six websites publish complete combination schedules, shown whole. Three say no trial has tested the combination; none includes SS-31. [26], [66], [67]

Subcutaneous injection · each row is one website's complete schedule · website practice, not tested doses
CombinationGLP-1 drugAdd-onTimingSource
Retatrutide + tesamorelin1 mg a week (weeks 1–4), 2 mg (5–8), 3–4 mg (9–12)1 mg a day, 5 days on and 2 offTesamorelin evenings, 2+ hours after food; 12 weeks[26]
Semaglutide + tesamorelinLabel steps to 2.4 mg a week1 mg a day (weeks 1–4), 1–2 mg (5–8), 2 mg from week 9Tesamorelin early morning, fasted[27]
Tirzepatide + tesamorelin5 mg a week2 mg nightly26 weeks[28]
Tirzepatide + ipamorelinLabel steps from 2.5 mg100–200 mcg from about week 430 minutes before bed, 90+ minutes after food[32]
Retatrutide + CJC-1295 + ipamorelin2, 4, 6, 9, then 12 mg a week, 4 weeks each100 mcg of each at bedtime, then 100–200 mcg of each once or twice a dayBedtime; the page later contradicts its own week 9–12 dose[66]
Retatrutide + NAD+ + MOTS-c + tesamorelin1 mg on MondaysNAD+ 100 mg and MOTS-c 5 mg Mon, Wed, Fri; tesamorelin 1–2 mg dailyOne syringe per compound[67]

How people line them up

  • The GLP-1 shot keeps its weekly steps. Some schedules start the add-on in week 1; one waits until about week 4. [26], [32]
  • Bedtime or morning. Growth-hormone peptides are usually taken at bedtime on an empty stomach. GLP-1 drugs slow digestion, so many people shift the growth-hormone peptide to mornings or leave 3–4 hours after a meal before it. [27], [68], [69]
  • Energy add-ons. In community education groups, MOTS-c and NAD+ often go on alternating days, and SS-31 is often started first.
  • Separate syringes. The SS-31 label says not to mix Forzinity with other medicines in one syringe. [11]

These schedules come from protocol sources for each part; no trial has tested this combination.

Where these numbers come from

The first table copies each part's most common protocol from its Doserly guide, citing the sources those guides verified. Each combination schedule comes from one website, shown as published. Blend tables list vial contents only. We did not merge doses from different pages or scale animal doses to people. [8], [9], [10], [1], [3], [4], [5], [6]

Open the searchable source directory

What are the overlapping risks and interactions?

The combination has never been safety-tested. The risks that add up: blood sugar pushed both ways, heart rate, fluid retention, untraceable reactions and doubling up on GLP-1-class drugs.

  • Blood sugar both ways. GLP-1 drugs lower it, and lows become more likely with insulin or a sulfonylurea. [9], [8] Tesamorelin pushes up: diabetes-range blood sugar was more common than on placebo (5% versus 1%). [1] MOTS-c lowered blood sugar in mice, and forum users describe low glucose-monitor readings. [70], [71], [72] In community education groups, some describe blood sugar rising on Tesa/Ipa with retatrutide.
  • Heart rate. Retatrutide raised heart rate by about 6 beats a minute on 12 mg; palpitations affected 1–4% on tesamorelin, and MOTS-c forum reports include a racing heart. Started together, the cause cannot be told apart. [73], [74], [1], [75], [76]
  • Water that looks like a stall. Swelling, joint pain and hand numbness are tesamorelin side effects. [1] In community education groups, people describe scale stalls after adding a growth-hormone peptide.
  • Never two GLP-1-class drugs. The tirzepatide label says not to combine it with another GLP-1 receptor agonist; retatrutide with tirzepatide has never been tested. [9], [77]
  • Untraceable reactions. When several products start together, a reaction cannot be pinned on one. Community education groups describe a large hive after every dose of a compounded tirzepatide and NAD+ product.

Interactions. No add-on has been studied with a GLP-1 drug; missing data is not evidence of safety. [31], [78], [79] Slower stomach emptying can change how pills are absorbed, and the tirzepatide label advises people on birth-control pills to switch or add a barrier method for 4 weeks after starting and after each dose step. [9] Tesamorelin can change how liver-cleared drugs and steroid replacement work, and SS-31 blocks a kidney transporter that clears metformin, an interaction FDA has asked to be studied. [80], [11], [81]

Be especially cautious or avoid them in pregnancy, breastfeeding or when trying to conceive; under 18; with diabetes medicines that can cause lows; with heart-rhythm problems; with a current or past cancer (growth-hormone add-ons raise IGF-1); with past allergic reactions; and in tested sport.

Legal and sport status (checked September 2026):

  • United States: semaglutide and tirzepatide are prescription medicines; the shortage exception for compounded copies has ended. FDA says retatrutide "cannot be used in compounding under federal law". [82], [83] FDA called "research" tesamorelin products unapproved drugs in August 2026. [1], [84] Ipamorelin is on FDA's compounding safety-risk list; MOTS-c won an advisory vote for compounding in July 2026, with no rule since; NAD+ is not approved. [85], [86], [87], [88]
  • Canada: ipamorelin and MOTS-c are unauthorized, tesamorelin is no longer marketed, and a compounded semaglutide/B6 product was recalled. [20], [89], [90], [91]
  • Australia: vials sold as retatrutide held 51% to 190% of their labeled amount. Ipamorelin is prescription-only, as is the growth-hormone-releasing hormone class that tesamorelin belongs to (our reading, since it is not named). [92], [93]
  • Sport: WADA monitors semaglutide and tirzepatide but does not ban them. Retatrutide falls under the ban on unapproved substances. Tesamorelin, CJC-1295, ipamorelin and MOTS-c are banned at all times. SS-31 and NAD+ are not named, though NAD+ drips over 100 mL in 12 hours are prohibited. [94], [95], [96], [97]

What should be monitored?

No guidance exists for the combination. The parts' trials and labels measured:

  • Weight, waist and body composition (Weight Management, Fat Loss, Muscle Growth): body scans showed how much of the loss was lean tissue. [42], [39]
  • Blood sugar and IGF-1 (Other): fasting glucose or HbA1c, plus IGF-1, which rose above normal in almost half of people on tesamorelin. [9], [1]
  • Heart rate and blood pressure (Heart Rate & Palpitations, Blood Pressure), especially on retatrutide. [74]
  • Side effects (Side Effect Burden, Fluid Retention, Nausea & GI Tolerance, Appetite & Satiety): site reactions, swelling and stalls, nausea, hand numbness, hives and hunger. [8], [1], [11]
  • Energy and sleep (Energy Levels, Sleep Quality), the reasons for the energy add-ons.

Starting compounds separately, with several days between them, keeps a change traceable.

What happens when you stop?

Stopping the GLP-1 drug brings weight back, and stopping tesamorelin brings belly fat back. Nobody has studied stopping one part while continuing another.

  • GLP-1 drugs. A year after switching to placebo, people who had taken tirzepatide were 9.9% below their starting weight, versus 25.3% if they stayed on it; after semaglutide, about two-thirds of lost weight returned within a year. Nothing is reported for retatrutide. [98], [99], [74]
  • Tesamorelin. Deep belly fat returned within about 3 months. [1]
  • Other add-ons. Stopping has not been studied.

Premixed blend or separate vials?

Separate vials let the GLP-1 dose step up on its own and keep reactions traceable. A premixed vial saves an injection but fixes the ratio, has no stability data and hides which part caused a problem.

  • Mixing and stability. No published study shows whether a GLP-1 drug stays stable with NAD+, a vitamin or another peptide, or whether vials such as Kali do. Tirzepatide and B12 formed a new impurity in one lab study, and only 18% of compounded GLP-1 products in a 2026 review stated storage or a use-by date. [38], [37]
  • The ratio is locked. A tirzepatide/NAD+ vial holds 15 mg tirzepatide and 5 mg NAD+ per mL, so a 5 mg dose carries about 1.7 mg of NAD+, and stepping up to 10 mg doubles it. [12] In FUSION, halving a dose to ease a tesamorelin side effect halves the other three parts too. [24]
  • Tracking. With separate vials, a hive or blood-sugar change can be traced to one product; with a blend it cannot.
  • Units. Blend doses are volumes of a mixture: 0.5 mL of FUSION is 1.5 mg of tesamorelin plus 1 mg each of the other three. Work out units for your own vial with the reconstitution calculator. [24]

Common questions about the GLP-1 support stack

Does tesamorelin protect muscle on a GLP-1 drug?

Nobody knows. No trial has given tesamorelin with a GLP-1 drug. In people with HIV it cut belly fat without changing weight. The add-ons that reduced lean-mass loss with a GLP-1 in trials are experimental antibodies, not tesamorelin. [1], [53], [54]

Is Hulk a GLP-1 blend?

No. Hulk is a seller nickname with no fixed contents: CJC-1295 with ipamorelin at most sellers we found, tesamorelin with ipamorelin at one, and BPC-157 with TB-500 (a recovery blend) at another. None contains a GLP-1 drug. It is listed here because its growth-hormone versions are the add-ons people pair with a GLP-1. [15], [16], [14], [18]

Can you take two GLP-1 drugs together, such as tirzepatide and retatrutide?

No approved label allows it. The tirzepatide label says not to combine it with any other GLP-1 receptor agonist, and retatrutide has never been tested with tirzepatide or semaglutide. [9], [77]

Do MOTS-c, SS-31 or NAD+ fix GLP-1 tiredness?

It has not been tested. MOTS-c has no human data, daily SS-31 trials missed their goals, and NAD+ has no trials for energy. Forum posts are mixed; some describe more tiredness or hunger. [45], [47], [36]

How this guide was researched

How this guide was made

This stack guide was built from the verified sources of the semaglutide, tirzepatide, retatrutide, tesamorelin, ipamorelin, MOTS-c, SS-31 and NAD+ guides, re-citing the original documents. New research covered only what the combination raises: trials of a GLP-1 drug with an add-on, lean-mass trials, published combination schedules, blend names and contents, and regulator action on mixed products. Community education groups informed the descriptions of how people line up doses; no private post is quoted or linked.

The research file holds 147 records, 143 verified against the original page; this guide cites 99. Seller pages are cited only for listed contents, never as evidence of purity or effect.

Drafting used AI assistance under Doserly's editorial rules, followed by source checks and editorial review. It is general education, not medical advice.

Explore the sources

These are the documents cited in this guide. Labels, trials, regulator pages, dosing websites and seller pages answer different questions. Seller and pharmacy pages are cited only for listed contents or published schedules, never as proof of purity or effect. No study has tested this combination in people.

Showing 99 sources

  1. 01

    EGRIFTA WR (tesamorelin) for injection, prescribing information ↗

    Label

    Full current US prescribing information reviewed, including patient information.

  2. 02

    Tesamorelin Dosage: Units, Timing & Cycle Guide ↗

    Dosing website

    Selected original page sections reviewed; describes practice, not a tested dose.

  3. 03

    Ipamorelin Dosage Guide: Protocols, Timing & How Much to Take (2026) ↗

    Protocol source

    Page checked; protocol wording confirmed.

  4. 04

    MOTS-c Dosage Calculator ↗

    Dosing website

    Selected original page sections reviewed; a protocol-source claim, not a tested dose.

    Result detail: Also says its 5 mg starting level is based on “early published data”; no human study of MOTS-c exists.

  5. 05

    SS-31-Doctor-Sheet ↗

    Dosing website

    Selected page sections reviewed; protocol-source claim, not a tested dose.

  6. 06

    NAD+: Research Profile & Guide ↗

    Protocol source

    Page text reviewed (retrieved September 2026). Describes practice; not clinical validation.

  7. 07

    Growth hormone treatment does not augment the anti-diabetic effects of liraglutide in UCD-T2DM rats ↗

    Animal study

    Original abstract reviewed.

  8. 08

    WEGOVY (semaglutide) injection, for subcutaneous use; WEGOVY (semaglutide) tablets, for oral use ↗

    Product label (US)

    Full label reviewed.

    Detail: Wegovy injection 0.25 → 2.4 mg weekly with a conditional 7.2 mg step; Wegovy tablets 1.5 → 25 mg daily; side-effect tables, warnings and pharmacokinetics.

  9. 09

    ZEPBOUND (tirzepatide) injection, for subcutaneous use: prescribing information ↗

    Product label (US)

    Full label reviewed.

    Detail: Weight reduction and maintenance (5, 10 or 15 mg) and sleep apnea (10 or 15 mg); side-effect tables from the SURMOUNT trials, warnings, storage and pharmacokinetics.

  10. 10

    Lilly's triple agonist, retatrutide, delivered powerful weight loss in pivotal Phase 3 obesity trial ↗

    Company trial report (not peer reviewed)

    Full text reviewed (saved copy). Not peer reviewed.

    Result detail: TRIUMPH-1, 2,339 adults without diabetes, 80 weeks: −19.0%, −25.9% and −28.3% versus −2.2% (efficacy estimand); dysesthesia 5.1% to 12.5% versus 0.9%. Includes the Zepbound safety summary quoted in this guide.

  11. 11

    FORZINITY (elamipretide) injection, for subcutaneous use: prescribing information and instructions for use ↗

    Official label

    Official label reviewed in full.

  12. 12

    PCI office-use order form (compounded semaglutide and tirzepatide options) ↗

    Compounding pharmacy order form

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  13. 13

    Tesamorelin-10mg + Ipamorelin-10mg | 20mg Blend ↗

    Seller product page

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  14. 14

    Shop: The Hulk Tesa / Ipa Blend 6/3 mg, Hulk XL Tesa / Ipa Blend 13/3 mg, SomatoPulse (Tesa 10 mg / Ipamorelin 3 mg), CJC-1295 Ipa 5 mg/5 mg ↗

    Seller product listing

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  15. 15

    HULK Blend 10mg Pen Kit (CJC-1295 No DAC 5mg · Ipamorelin 5mg) ↗

    Seller product page

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  16. 16

    Hulk Blend 10 mg/10 mg (CJC-1295 with DAC + ipamorelin) ↗

    Seller product page

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  17. 17

    Hulk Stack (CJC-1295 with DAC & Ipamorelin) | 20mg ↗

    Seller product page

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  18. 18

    (HULK STACK) BPC-157 15mg + TB-500 15mg Research Peptide Blend ↗

    Seller product page

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  19. 19

    Warning letter: Empower Clinic Services LLC dba Empower Pharmacy (MARCS-CMS 738238) ↗

    Regulator warning letter

    Original page reviewed.

  20. 20
  21. 21
  22. 22

    Exclusive Peptide Blends catalogue (Kali: GLP Support & Metabolic Shield), dated 12.8.2025 ↗

    Compounding blend catalogue

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  23. 23

    CFAU Peptide Blend Program (lists KALI under GLP-1 support) ↗

    Clinic programme document

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  24. 24

    Specialty peptide blends: TITAN, SHRED, SERENITY and more (PHYSIQ, FUSION) ↗

    Telehealth blend catalogue

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  25. 25

    1 month Retatrutide/Tesamorelin results ↗

    Community account

    Public thread and replies reviewed from an archived copy; usernames not recorded. Personal accounts, not verified.

  26. 26

    Ultimate Shred Stack: retatrutide + tesamorelin protocol ↗

    Dosing website

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  27. 27

    Weight loss stack: semaglutide + tesamorelin ↗

    Dosing website

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  28. 28

    Tirzepatide + Tesamorelin protocol ↗

    Dosing website

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  29. 29

    “Reta and MOTS-c stack” (r/Retatrutide thread) ↗

    Community account

    Public thread and comments reviewed; usernames not reproduced.

  30. 30

    “MOTS-c and reta” (r/Peptidesource thread) ↗

    Community account

    Public thread and comments reviewed; usernames not reproduced.

  31. 31

    FDA Briefing Document Pharmacy Compounding Advisory Committee (PCAC) Meeting October 29, 2024 ↗

    Regulator review

    Full document reviewed.

    Result detail: FDA's full review: no data for subcutaneous use; two deaths in the ipamorelin group of the post-surgery trial, relationship unclear; more low potassium, insomnia and high blood sugar than placebo.

  32. 32

    Ipamorelin with tirzepatide: best protocol ↗

    Telehealth article

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  33. 33

    Warning letter to NuScience Peptides LLC ↗

    Regulatory source

    Original letter reviewed.

  34. 34

    Warning letter to Royal Peptides LLC ↗

    Regulatory source

    Original letter reviewed.

  35. 35

    Did adding NAD+ boost my results? ↗

    Community account

    Public thread; first-hand accounts reviewed; usernames omitted.

  36. 36

    Tirz + NAD+ I’m feeling hungrier and more tired ↗

    Community account

    Public thread; first-hand accounts reviewed; usernames omitted.

  37. 37

    Compounded Semaglutide and Tirzepatide Products Use Unique Formulations but Efficacy and Safety Largely Unknown. ↗

    Product review

    Original abstract reviewed.

  38. 38

    A novel, widespread impurity in mass-compounded tirzepatide/B12 products: potential patient safety implications. ↗

    Laboratory product test

    Original abstract reviewed.

  39. 39

    Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight. ↗

    Human trial analysis

    Original abstract and selected full-text sections reviewed.

    Result detail: 160-person body-scan substudy: fat mass −33.9%, lean mass −10.9%; about 75% of weight lost was fat in both groups.

  40. 40

    Impact of Semaglutide on Body Composition in Adults With Overweight or Obesity: Exploratory Analysis of the STEP 1 Study ↗

    Conference abstract (STEP 1 substudy)

    Original abstract reviewed.

    Result detail: STEP 1 DXA substudy: fat mass −19.3%, lean mass −9.7%.

  41. 41

    SS-31 + MOTS-c Protocol: Mito Peptide Stack with NAD+ ↗

    Dosing website

    Selected page sections reviewed; protocol-source claim, not a tested dose.

  42. 42

    Once-Weekly Semaglutide in Adults with Overweight or Obesity ↗

    Human trial

    Original abstract and posted registry results reviewed.

    Result detail: STEP 1, 1,961 adults: −14.9% vs −2.4% at 68 weeks; 86.4% vs 31.5% lost at least 5%.

  43. 43

    Tirzepatide Once Weekly for the Treatment of Obesity. ↗

    Human trial

    Original abstract reviewed.

    Result detail: SURMOUNT-1, 2,539 adults without diabetes, 72 weeks: −15.0%, −19.5% and −20.9% on 5, 10 and 15 mg versus −3.1% on placebo.

  44. 44

    Effects of retatrutide on body composition in people with type 2 diabetes: a substudy of a phase 2, double-blind, parallel-group, placebo-controlled, randomised trial ↗

    Human trial (substudy)

    Original abstract reviewed.

    Result detail: DXA in 103 people with type 2 diabetes: fat mass −26.1% (8 mg) and −23.2% (12 mg) versus −4.5% at 36 weeks.

  45. 45

    CohBar investor presentation (SEC 8-K Ex 99.1, 2021) ↗

    Company report of the CB4211 trial

    Original filing reviewed.

    Result detail: Reports injection-site reactions in 79% on CB4211 versus 33% on placebo across the Phase 1a and 1b stages combined, and the interruption of the first stage to change the formulation.

  46. 46

    CohBar Announces Positive Topline Results from the Phase 1a/1b Study of CB4211 (press release, SEC 8-K Ex 99.2) ↗

    Company report of the CB4211 trial

    Original filing reviewed.

    Result detail: Company-reported results for CB4211, a MOTS-c analogue; not peer reviewed and not posted to the trial registry.

  47. 47
  48. 48

    Efficacy and Safety of Elamipretide in Individuals With Primary Mitochondrial Myopathy: The MMPOWER-3 Randomized Clinical Trial. ↗

    Human study

    Selected original full-text sections reviewed.

  49. 49
  50. 50
  51. 51

    Effects of GH and Liraglutide on AgRP (NCT05681299) ↗

    Registered trial (recruiting, no results)

    Original page reviewed.

  52. 52

    PEG-rhGH Injection Combined with Semaglutide vs Semaglutide Monotherapy in Body Composition of Non-Diabetic Obese Adults (NCT06863363) ↗

    Registered trial (not yet recruiting)

    Original page reviewed.

  53. 53

    Bimagrumab plus semaglutide alone or in combination for the treatment of obesity: a randomized phase 2 trial (BELIEVE) ↗

    Human trial (RCT phase 2)

    Original full text reviewed.

  54. 54
  55. 55

    Veru announces positive topline data from phase 2b QUALITY clinical study: enobosarm preserved lean mass in patients receiving Wegovy ↗

    Company announcement (not peer reviewed)

    Original announcement reviewed; company claim, not peer reviewed.

  56. 56

    Lilly's triple agonist, retatrutide, successful in two additional Phase 3 obesity trials, delivering significant improvements in weight and A1C ↗

    Company trial report (not peer reviewed)

    Full text reviewed (saved copy). Not peer reviewed.

    Result detail: TRIUMPH-2 (−20.8% on 12 mg versus −4.0%) and TRIUMPH-3 (−22.6% versus −3.2%; MACE hazard ratios 0.82 and 1.12, both uncertain); US application planned for the first quarter of 2027.

  57. 57

    EGRIFTA SV (tesamorelin) for injection, prescribing information ↗

    Label

    Full current US prescribing information reviewed.

  58. 58

    Tesamorelin For Beginners: Benefits, Dosage, and Peptide Stacking Tips ↗

    Dosing website

    Selected original page sections reviewed; describes practice, not a tested dose.

  59. 59

    Tesamorelin Dosage: 10 mg Vial ↗

    Dosing website

    Selected original page sections reviewed; describes practice, not a tested dose.

  60. 60

    MOTS-C (40mg Vial) Dosage Protocol ↗

    Dosing website

    Selected original page sections reviewed; a protocol-source claim, not a tested dose.

    Result detail: Describes its daily ramp as based on animal-to-human extrapolation.

  61. 61

    MOTS-c: reference protocol and units (RUO) ↗

    Dosing website

    Selected original page sections reviewed; a protocol-source claim, not a tested dose.

  62. 62

    Peptide Therapy in Chicago ↗

    Dosing website

    Selected page sections reviewed; protocol-source claim, not a tested dose.

  63. 63

    Peptide Clinic Bangkok ↗

    Dosing website

    Selected page sections reviewed; protocol-source claim, not a tested dose.

  64. 64

    SS-31 (Elamipretide) - Peptide Research Guide ↗

    Dosing website

    Selected page sections reviewed; protocol-source claim, not a tested dose.

  65. 65

    NAD+ (500mg) Injectable Peptide Patient Information ↗

    Protocol source

    Page text reviewed (retrieved September 2026). Describes practice; not clinical validation.

  66. 66

    Advanced Recomp Stack: retatrutide + CJC-1295 (no DAC) + ipamorelin ↗

    Dosing website

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  67. 67

    Retatrutide dual-axis stack ↗

    Dosing website

    Original page reviewed for listed contents or the published schedule only; not evidence of purity or effect.

  68. 68

    Tesamorelin timing ↗

    Community account

    Public thread and replies reviewed from an archived copy; usernames not recorded. Personal accounts, not verified.

  69. 69

    Tesamorelin side effects how long to trial ↗

    Community account

    Public thread and replies reviewed from an archived copy; usernames not recorded. Personal accounts, not verified.

  70. 70

    The mitochondrial-derived peptide MOTS-c is a regulator of plasma metabolites and enhances insulin sensitivity. ↗

    Animal study

    Original full text reviewed.

  71. 71

    “MOTS-c negative side effects” (r/PeptideForum thread) ↗

    Community account

    Public thread and comments reviewed; usernames not reproduced.

  72. 72

    “MOTS-c experience” (r/PeptideGuide thread) ↗

    Community account

    Public thread and comments reviewed; usernames not reproduced.

  73. 73

    Lilly's triple agonist, retatrutide, delivered weight loss of up to an average of 71.2 lbs along with substantial relief from osteoarthritis pain in first successful Phase 3 trial ↗

    Company trial report (not peer reviewed)

    Full text reviewed (saved copy). Not peer reviewed.

    Result detail: TRIUMPH-4, 445 adults with knee osteoarthritis, 68 weeks: −26.4% and −28.7% versus −2.1%; dysesthesia 8.8% and 20.9% versus 0.7%; stopped for side effects 12.2% and 18.2% versus 4.0%. The release prints the wrong registry number (NCT05869903); TRIUMPH-4 is NCT05931367.

  74. 74

    Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial ↗

    Human trial

    Full text and supplementary appendix reviewed (public copies saved).

    Result detail: 338 adults without diabetes, 48 weeks: −8.7% (1 mg) to −24.2% (12 mg) versus −2.1%; pulse +6.0 beats per minute on 12 mg at week 48; 16% stopped for side effects on 12 mg.

  75. 75

    “MOTS-c” (r/RetatrutideWomen thread) ↗

    Community account

    Public thread and comments reviewed; usernames not reproduced.

  76. 76

    “Impressed with MOTS-c again” (r/Peptides thread) ↗

    Community account

    Public thread and comments reviewed; usernames not reproduced.

  77. 77

    A Study of Retatrutide (LY3437943) Compared to Tirzepatide (LY3298176) in Adults Who Have Obesity ↗

    Registered study plan

    Full registry record reviewed on 24 Sep 2026; no results posted.

  78. 78

    FDA Evaluation of MOTS-c-Related Bulk Drug Substances (MOTS-c (free base) and MOTS-c acetate) for Inclusion on the 503A Bulk Drug Substances List (PCAC briefing, July 23-24, 2026) ↗

    Regulatory source

    Full text reviewed.

    Result detail: FDA found no clinical studies or human exposure data for MOTS-c by any route and no pharmacokinetic, toxicology, reproductive or cancer studies, and proposed not listing it for compounding. Its summary of the 2021 mouse lifespan study omits that the result was not statistically significant.

  79. 79

    The Mitochondrial Triple Stack: MOTS-c + SS-31 + NAD+ — What's Actually Tested vs. What's Taught ↗

    Dosing website

    Selected page sections reviewed; protocol-source claim, not a tested dose.

  80. 80
  81. 81

    Approval letter: NDA 215244, FORZINITY (elamipretide), accelerated approval and postmarketing requirements ↗

    Regulatory source

    Original letter reviewed.

  82. 82

    FDA clarifies policies for compounders as national GLP-1 supply begins to stabilize ↗

    Regulator document (US)

    Full page or document reviewed.

  83. 83

    FDA's concerns with unapproved GLP-1 drugs used for weight loss ↗

    Regulator statement (FDA)

    Original page reviewed.

  84. 84

    FDA warning letters: full-text search for "tesamorelin" ↗

    Regulatory source

    Search export reviewed: five letters name tesamorelin, all dated 24 Aug 2026.

  85. 85

    Certain Bulk Drug Substances for Use in Compounding that May Present Significant Safety Risks ↗

    Regulator

    Full document reviewed.

    Result detail: ipamorelin acetate in 503B Category 2 since September 29, 2023; the page also carries FDA's CJC-1295 risk text.

  86. 86

    FDA Pharmacy Compounding Advisory Committee, July 23, 2026: MOTS-c session and votes (official FDA livestream captions) ↗

    Regulatory source

    Official FDA livestream reviewed (automatic captions).

    Result detail: Votes: 7 yes, 5 no, 2 abstentions for the free base and the same for the acetate. Transcribed from the official livestream's automatic captions; FDA had posted no minutes when checked.

  87. 87

    Drugs@FDA: FORZINITY, NDA 215244 ↗

    Regulatory source

    Official record reviewed.

  88. 88

    GenoGenix LLC - 718739 - 01/20/2026 ↗

    Regulator warning letter (FDA)

    Original full text reviewed.

  89. 89
  90. 90

    Unauthorized injectable peptide drugs seized from Optimum Wellness Centre in Calgary, Alberta may pose serious health risks ↗

    Regulatory source

    Full text reviewed.

    Result detail: Lists “Mots-C” among the seized unauthorized products. The notice does not verify the contents of any vial.

  91. 91

    Drug Product Database: EGRIFTA (two product listings) ↗

    Regulatory source

    Records reviewed: both product registrations cancelled (2022 and 2023).

  92. 92

    Composition and Labelling Accuracy of Products Sold as Retatrutide in Australia ↗

    Product analysis (published)

    Full text reviewed.

    Result detail: Three vials labeled 10 mg contained 5.13, 16.5 and 19.0 mg of retatrutide; sterility and bacterial toxins not tested.

  93. 93

    Poisons Standard June 2026 ↗

    Regulator

    Full document reviewed.

  94. 94

    The 2026 Monitoring Program (World Anti-Doping Agency) ↗

    Anti-doping document

    Full page or document reviewed.

  95. 95

    2027 Prohibited List ↗

    Anti-doping list

    Original document reviewed; retatrutide is not named.

  96. 96

    World Anti-Doping Code International Standard: Prohibited List 2026 ↗

    Regulatory source

    Official list reviewed; elamipretide is not named.

  97. 97

    The 2026 Prohibited List ↗

    Anti-doping rule (WADA)

    Original full text reviewed.

  98. 98

    Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. ↗

    Human trial

    Original abstract reviewed.

    Result detail: SURMOUNT-4, 670 adults randomized after a 36-week lead-in (−20.9%): weeks 36 to 88, −5.5% on tirzepatide versus +14.0% on placebo.

  99. 99

    Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension ↗

    Human trial (extension)

    Original abstract reviewed.

    Result detail: 327 people followed a year after stopping: regained 11.6 percentage points, ending 5.6% below baseline.