Overview
Sermorelin is a 29-amino-acid synthetic fragment representing the biologically active N-terminus of human growth hormone-releasing hormone. It was FDA-approved as Geref in 1997 for diagnosis and treatment of growth hormone deficiency in children, and the brand was voluntarily discontinued in 2008 for commercial reasons (not safety). It remains widely available through compounding pharmacies and has become the default 'GHRH on a script' in adult anti-aging clinics, despite the adult-use evidence base being substantially weaker than the pediatric one.
Mechanism
Binds the pituitary GHRH receptor and stimulates pulsatile endogenous GH release. Because GH is released in physiologic pulses, sermorelin preserves negative-feedback regulation that exogenous recombinant GH bypasses — a frequently cited reason for preferring GHRH analogs over rhGH. Tachyphylaxis (diminished response with continuous exposure) is a well-documented limitation.
Evidence by indication
We classify each indication separately. The same peptide can be Tier 1 for one use and Tier 4 for another. Tiers reflect the published literature, not the strength of community framing.
Pediatric growth hormone deficiency
Multi-center pediatric trials supporting the original Geref approval in 1997 demonstrated improved height velocity in children with confirmed GH deficiency. FDA-approved indication; brand later discontinued for commercial reasons.
Adult GH deficiency / age-related GH decline
Small open-label and short-duration human studies demonstrate that sermorelin raises GH and IGF-1 in adults. Studies designed to demonstrate clinical benefit on body composition, strength, sleep, or quality-of-life endpoints in healthy adults are scarce, small, and largely unreplicated. Adult use remains off-label.
Sleep quality / slow-wave sleep
GHRH analogs increase slow-wave sleep in small mechanistic sleep-lab studies. No large RCTs in healthy adults using sermorelin specifically with sleep as a primary endpoint. The mechanism is plausible; the indication-specific human evidence is thin.
Body composition / lean mass in healthy adults
No replicated RCTs in healthy adults with body-composition endpoints. Inferences are extrapolated from broader GHRH-class literature (mostly tesamorelin in HIV lipodystrophy) and from rhGH studies. Anti-aging clinic claims of 'sermorelin builds muscle' are not supported by sermorelin-specific human RCTs.
No primary citations are anchored to this indication — the tier reflects the absence of usable literature, not a missing reference.
Studied dose ranges
The ranges below come from published trial protocols where available, and from documented self-experimenter consensus where the literature does not include human dose-finding work. The notes flag which is which.
Adult off-label dosing in compounded products typically 200–500 mcg nightly, dosed at bedtime to align with natural GH pulsatility. Pediatric historical Geref dosing was 30 mcg/kg/day. The diagnostic GHRH stimulation test used 1 mcg/kg IV.
Contraindications
- Active malignancy (theoretical concern from raised IGF-1)
- Severe obesity with GH-suppression (response is blunted)
- Pituitary surgery, irradiation, or trauma — confirm axis with endocrinology first
- Pregnancy and breastfeeding
- Hypothyroidism (correct first; hypothyroidism blunts GH response)
- Hypersensitivity to sermorelin or compounding excipients
- Concomitant glucocorticoid therapy (suppresses GH response)
Reported side effects
- Injection site reactions (most common; flushing, erythema, mild pain)
- Headache
- Flushing or warmth shortly after injection
- Dysgeusia (transient altered taste)
- Nausea, dizziness (uncommon)
- Hyperglycemia / worsened insulin resistance with chronic use
- Theoretical risk of carpal tunnel-like symptoms with sustained high IGF-1
Reconstitution & storage
Compounded sermorelin is supplied as lyophilized powder, typically 3 mg, 5 mg, or 15 mg vials. Example: a 5 mg vial reconstituted with 2.5 mL bacteriostatic water = 2 mg/mL. A 300 mcg dose at that concentration is 0.15 mL = 15 units on a U-100 syringe. Use the calculator to verify for your vial.
Storage. Lyophilized: refrigerate 2–8 °C; protected from light. Reconstituted: refrigerate 2–8 °C, use within 30 days; do not freeze.
Open the peptide calculator → to compute exact draw volumes for your specific vial and BAC water choice.
Editorial note
DRAFT — pending Wayne's review. Sermorelin's reputation in adult anti-aging clinics dramatically outpaces the adult-use literature. Pediatric GH-deficiency support is solid (Tier 1) and was the basis for FDA approval; everything adults take it for is Tier 3. Don't soften this — the 'FDA-approved' line on clinic websites refers to a discontinued pediatric product, which is materially different from the off-label adult use most readers will be there for.
Citations
- [1]Once daily subcutaneous growth hormone-releasing hormone therapy accelerates growth in growth hormone-deficient children during the first year of therapyThorner M, Rochiccioli P, Colle M, et al. · Journal of Clinical Endocrinology & Metabolism · 1996 · PMID 8675578Tier 1 evidence for pediatric GH deficiency; basis for the original Geref approval.View source
- [2]Sermorelin: a better approach to management of adult-onset growth hormone insufficiency?Walker RF · Clinical Interventions in Aging · 2006 · PMID 16972038Adult-use review used to anchor Tier 3 for adult GH-decline and sleep indications.View source
- [3]Geref (sermorelin acetate) Prescribing Information (historical)Serono Laboratories · FDA-approved label (discontinued) · 1997Historical FDA approval status, dose, and contraindications for the pediatric indication.View source