Retatrutide + MOTS-c + Tesamorelin (Recomposition Stack)

This community-originated stack combines retatrutide (a triple GIP/GLP-1/glucagon agonist, not commercially approved), MOTS-c (a mitochondrial-derived peptide), and tesamorelin (an FDA-approved GHRH analog for HIV-associated lipodystrophy). Three separate injections on independent schedules.

The marketing pitch is body recomposition: aggressive fat loss from the triple agonist, mitochondrial and metabolic support from MOTS-c, and lean-mass preservation plus visceral fat reduction from tesamorelin. Two components have real phase 3 evidence individually: retatrutide showed up to 28-30% weight loss in TRIUMPH-1 (May 2026, n=2,339), and tesamorelin has meta-analysis support for visceral and hepatic fat reduction. MOTS-c received a positive PCAC recommendation in July 2026.

However, no study has tested GH secretagogues or MOTS-c as adjuncts to GLP-1-class therapy. The three components act through three mechanistically non-overlapping arms: incretin, mitochondrial-derived peptide, and GHRH axis. This is the marketing basis but also means three simultaneous variables make any adverse event untraceable.

The critical problem is supply: retatrutide is not approved and not legally available. Any supply is gray-market and unverified, carrying counterfeit and contamination risk. Gray-market retatrutide has been found with incorrect sequences, unidentified impurities, and bacterial endotoxin contamination.

Layering a GH-axis agent on top of an incretin can push in opposite directions on insulin sensitivity. Aggressive multi-agent weight loss increases risks of dehydration, gallbladder disease, and sarcopenia. This stack has no medical supervision protocol behind it.

Tesamorelin is increasingly discussed as an adjunct to preserve lean mass during GLP-1 therapy, a use with no controlled data. The TRIUMPH trial for tesamorelin plus home exercise for muscle strength in adults with HIV is ongoing.