Follow-up: Tesamorelin has an approved indication — what that changes about the evidence

Sensible. I would want the same detail before I acted on it either.

My position on Tesamorelin is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly.

Post #13 is right about the mechanism and I think understates the practical bit.

Reading a rodent study on a secretagogue without over-extrapolating: rodent studies can show a mechanism is plausible. They cannot show magnitude of effect in humans or safety profile in humans. That gap is larger for secretagogues than for incretin agonists because the human evidence is thinner.

Marking my uncertainty on Tesamorelin explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post.

Post #35 answers the question as asked. The question underneath it is different.

A note on scope: what I am saying about Tesamorelin applies to the case in the first post and I would not extend it further without checking.

Evidence quality in the secretagogue literature is honestly weaker than in the incretin literature. Large randomised controlled trials are rare. Most evidence is mechanistic or from small studies. This is why this subcategory has higher sourcing standards than most.

Someone should write this up properly, and it should probably not be me.

Research-use-only secretagogues are not approved for human use. That statement is doing real work in this subcategory, where the published evidence base is thinner than the volume of confident discussion.

A single observation, in a thread that deserves better than single observations.

Distinguishing three things in the Tesamorelin discussion that keep getting used interchangeably: the observation, the proposed mechanism, and the recommendation that gets attached to both.

Tesamorelin would be much easier to settle if anyone reported the denominator. Almost nobody reports the denominator.