What is in the Lean Stack?

The Lean Stack is a single compounded vial containing four peptides: AOD-9604, MOTS-C, tesamorelin and ipamorelin . The 5mL vial holds 6mg of AOD-9604, 10mg of MOTS-C, 10mg of tesamorelin and 10mg of ipamorelin, which is 36mg of peptide in total at $125 . It is one injection rather than four, which is the practical reason it exists.

How is the Lean Stack dosed?

20 units (0.2mL) subcutaneously, once daily for five consecutive days, then two days off. Each 20-unit dose delivers AOD-9604 0.24mg, MOTS-C 0.4mg, tesamorelin 0.4mg and ipamorelin 0.4mg. The two-day break exists for the growth hormone components: continuous ghrelin-receptor stimulation blunts the pulse over time, and the gap preserves responsiveness.

Does the Lean Stack contain tesofensine?

No. The Lean Stack contains tesamorelin , which is frequently confused with tesofensine because the names look similar, and the two are entirely different drugs. Tesamorelin is a GHRH analog that stimulates growth hormone release and has clinical evidence in visceral fat reduction. Tesofensine is a triple monoamine reuptake inhibitor that suppresses appetite and carries a stimulant side-effect profile. Tesofensine is a separate product with its own guide and is not in this vial.

How is the Lean Stack different from a GLP-1?

The mechanism is completely different, and so is the side-effect profile. A GLP-1 works primarily by suppressing appetite and slowing gastric emptying, which is why nausea is its characteristic side effect. The Lean Stack does not act on appetite at all: it works on fat mobilization, mitochondrial output and growth hormone signaling . That makes it an option for patients who cannot tolerate GLP-1 GI effects, and it also means it will not produce the appetite suppression that drives most of a GLP-1's results.

Can I take the Lean Stack with a GLP-1?

That is a provider decision, and it is a reasonable combination on paper because the mechanisms do not overlap: the GLP-1 handles appetite while the Lean Stack handles fat mobilization and lean mass. The considerations are the combined side-effect load and the growth hormone monitoring, since the stack contains two secretagogues. Bring it up at intake rather than adding it to an existing prescription on your own.

How much does the Lean Stack cost?

$125 for the 36mg vial , billed by Optimal Balance Pharmacy at wholesale with no clinic markup. At 20 units per dose the 5mL vial holds 25 doses, which is five weeks on a five-days-on schedule, so it works out to $5 per dose or about $25 per week . Add a one-time $39 medical visit and the pharmacy's $15 flat overnight shipping for a first order total of $179. Buying the four peptides separately costs considerably more.

What are the side effects of the Lean Stack?

The profile is driven by the growth hormone components. Expect the possibility of fluid retention, joint discomfort, and tingling in the hands , all of which are dose-related and typically settle or resolve on a step down. Injection site reactions are common to all four. Because tesamorelin and ipamorelin both raise growth hormone, IGF-1 is the lab worth monitoring on an extended course. The stack is not appropriate with active malignancy, a pituitary tumor, or during pregnancy.

How long until the Lean Stack works?

Expect a slower and less dramatic curve than a GLP-1 produces. The mitochondrial and growth hormone effects build over weeks rather than days, and the visceral fat effect from tesamorelin is measured in months in the published literature. Judge it at 12 weeks on waist circumference and body composition rather than at four weeks on the scale, because two of the four components act on lean mass and visceral fat, neither of which shows up cleanly in scale weight.

The Lean Stack: AOD-9604, MOTS-C, Tesamorelin and Ipamorelin in One Vial

The Lean Stack is four peptides in one vial, aimed at body composition without touching appetite. It exists because the four mechanisms it combines are complementary rather than redundant, and because injecting one vial is a protocol people actually complete where injecting four is not.

10 min read · Updated August 26, 2026

Medically reviewed by Dr. Jonathan Snipes, MD and Kim Callender, NP, FNP-BC. Last reviewed August 26, 2026.

Quick Answer

The Lean Stack is a single compounded vial containing AOD-9604, MOTS-C, tesamorelin and ipamorelin, 36mg of peptide in total for $125. It is dosed at 20 units subcutaneously, five days on and two days off, delivering AOD-9604 0.24mg, MOTS-C 0.4mg, tesamorelin 0.4mg and ipamorelin 0.4mg per injection. Unlike a GLP-1 it does not suppress appetite. It works on fat mobilization, mitochondrial output and growth hormone signaling, which makes it an option for patients who cannot tolerate GLP-1 gastrointestinal effects.

What is actually in the vial

One point of clarification first, because it is the single most common error made about this product. The Lean Stack contains tesamorelin, not tesofensine. The names look alike and the molecules have nothing in common: tesamorelin is a growth-hormone-releasing hormone analog delivered by injection, and tesofensine is an oral triple monoamine reuptake inhibitor that works on appetite and carries a stimulant profile. Tesofensine is a separate product on this formulary with its own guide.

Component	In the vial	Per 20-unit dose	What it contributes
AOD-9604	6mg	0.24mg	Lipolysis, the fat-releasing fragment of growth hormone, without the growth effects
MOTS-C	10mg	0.4mg	Mitochondrial function and AMPK signaling, the cellular energy side
Tesamorelin	10mg	0.4mg	Visceral adipose tissue, through GHRH-mediated growth hormone release
Ipamorelin	10mg	0.4mg	A clean growth hormone pulse without raising cortisol or prolactin

The takeaway from that table is that no two components are doing the same job. AOD-9604 releases fat from the cell, MOTS-C improves the cell’s ability to burn it, and the two growth hormone peptides address visceral fat and lean mass preservation from different points on the same axis. That is what distinguishes a designed stack from a pile of popular peptides in one bottle.

Why the stack contains two growth hormone peptides

Putting tesamorelin and ipamorelin in the same vial looks redundant until you look at where each acts. Tesamorelin is a GHRH analog: it signals the pituitary through the growth-hormone-releasing hormone receptor. Ipamorelin is a ghrelin receptor agonist: it signals the same gland through a different receptor.

Stimulating both pathways produces a larger pulse than either alone at the same dose, which is the pharmacological argument for the pair. Ipamorelin specifically is chosen over older secretagogues because it is selective, meaning it raises growth hormone without the cortisol and prolactin elevation that made earlier compounds in the class unattractive.

Tesamorelin carries the strongest clinical evidence of anything in the vial, with FDA-approved use in HIV-associated lipodystrophy where the endpoint was visceral adipose tissue reduction specifically. That evidence is in a defined patient population rather than in general body composition, which is the honest caveat, and it is more than the other three components can claim.

The protocol

20 units (0.2mL) subcutaneously, once daily, five consecutive days followed by two days off. Most patients run Monday through Friday and take the weekend off, which is a scheduling convenience rather than a pharmacological requirement.

The two-day break is not arbitrary and it is not a detox. Continuous ghrelin receptor stimulation blunts the response over time, which is the one place in peptide therapy where receptor desensitization is a genuine clinical concern rather than community folklore. The gap keeps the pulse responsive. See peptide cycling and tolerance for where cycling matters and where it does not.

Growth hormone peptides are conventionally dosed at night on an empty stomach, since the natural pulse is nocturnal and food, particularly carbohydrate, blunts it. The vial carries a beyond-use date of 90 days from compounding under USP <797>, and at 25 doses per vial a five-days-on schedule consumes it in about five weeks, comfortably inside that window.

What it costs

The vial is $125, billed by Optimal Balance Pharmacy at wholesale with no markup added by the clinic. At 20 units per dose a 5mL vial holds 25 doses.

$5.00 per dose, which is about $25 per week on a five-days-on schedule.
$179 for a complete first order: the $125 vial, a one-time $39 medical visit, and the pharmacy’s $15 flat overnight shipping.
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The combination vial is the reason the arithmetic works. Buying AOD-9604, MOTS-C, tesamorelin and ipamorelin as four separate vials costs substantially more than $125 and means four injections instead of one, which is the adherence problem that sinks most multi-peptide protocols by week six.

Who it suits, and who it does not

It suits patients seeking body recomposition rather than scale weight, patients carrying both visceral and subcutaneous fat, and in particular patients who cannot tolerate the gastrointestinal effects of a GLP-1 or who have a contraindication to that class.

It does not suit someone whose central problem is appetite. Nothing in this vial suppresses appetite, and pretending otherwise sets up a disappointing twelve weeks. If portion control and cravings are the obstacle, a GLP-1 addresses that directly and the honest recommendation is to read peptides for weight loss first.

The stack is not appropriate with active malignancy, a pituitary tumor, or during pregnancy. Because two components raise growth hormone, IGF-1 is the lab worth a baseline and a recheck on an extended course, and that is a provider decision made at intake.

What to expect, honestly

The curve is slower and flatter than a GLP-1 produces, and anyone promising otherwise is selling something. The mitochondrial and growth hormone effects build over weeks. Tesamorelin’s visceral fat effect is measured in months in the published trials rather than in weeks.

Assess it at 12 weeks on waist circumference and body composition rather than at four weeks on the scale. Two of the four components act on lean mass and visceral fat, and neither registers cleanly as scale weight. A patient who loses three inches off the waist while the scale barely moves has had a good outcome on this protocol and a confusing one if they were only weighing themselves.

Expect the growth hormone side effects to be the ones you notice: fluid retention, joint discomfort, and occasionally tingling in the hands. All are dose-related and generally resolve on a step down rather than requiring you to stop.

Bottom line

The Lean Stack is AOD-9604, MOTS-C, tesamorelin and ipamorelin in one 36mg vial at $125, dosed at 20 units daily on a five-on, two-off schedule. It is the non-appetite route to body composition, which makes it the option worth discussing when a GLP-1 is contraindicated or badly tolerated, and the wrong option when appetite is the actual problem.

See the Lean Stack product page for the current vial specification, or compare it with the AOD-9604 and tesamorelin pairing. When you are ready, start a $39 visit.

Common questions about the Lean Stack

What is in the Lean Stack?: The Lean Stack is a single compounded vial containing four peptides: AOD-9604, MOTS-C, tesamorelin and ipamorelin. The 5mL vial holds 6mg of AOD-9604, 10mg of MOTS-C, 10mg of tesamorelin and 10mg of ipamorelin, which is 36mg of peptide in total at $125. It is one injection rather than four, which is the practical reason it exists.
How is the Lean Stack dosed?: 20 units (0.2mL) subcutaneously, once daily for five consecutive days, then two days off. Each 20-unit dose delivers AOD-9604 0.24mg, MOTS-C 0.4mg, tesamorelin 0.4mg and ipamorelin 0.4mg. The two-day break exists for the growth hormone components: continuous ghrelin-receptor stimulation blunts the pulse over time, and the gap preserves responsiveness.
Does the Lean Stack contain tesofensine?: No. The Lean Stack contains tesamorelin, which is frequently confused with tesofensine because the names look similar, and the two are entirely different drugs. Tesamorelin is a GHRH analog that stimulates growth hormone release and has clinical evidence in visceral fat reduction. Tesofensine is a triple monoamine reuptake inhibitor that suppresses appetite and carries a stimulant side-effect profile. Tesofensine is a separate product with its own guide and is not in this vial.
How is the Lean Stack different from a GLP-1?: The mechanism is completely different, and so is the side-effect profile. A GLP-1 works primarily by suppressing appetite and slowing gastric emptying, which is why nausea is its characteristic side effect. The Lean Stack does not act on appetite at all: it works on fat mobilization, mitochondrial output and growth hormone signaling. That makes it an option for patients who cannot tolerate GLP-1 GI effects, and it also means it will not produce the appetite suppression that drives most of a GLP-1's results.
Can I take the Lean Stack with a GLP-1?: That is a provider decision, and it is a reasonable combination on paper because the mechanisms do not overlap: the GLP-1 handles appetite while the Lean Stack handles fat mobilization and lean mass. The considerations are the combined side-effect load and the growth hormone monitoring, since the stack contains two secretagogues. Bring it up at intake rather than adding it to an existing prescription on your own.
How much does the Lean Stack cost?: $125 for the 36mg vial, billed by Optimal Balance Pharmacy at wholesale with no clinic markup. At 20 units per dose the 5mL vial holds 25 doses, which is five weeks on a five-days-on schedule, so it works out to $5 per dose or about $25 per week. Add a one-time $39 medical visit and the pharmacy's $15 flat overnight shipping for a first order total of $179. Buying the four peptides separately costs considerably more.
What are the side effects of the Lean Stack?: The profile is driven by the growth hormone components. Expect the possibility of fluid retention, joint discomfort, and tingling in the hands, all of which are dose-related and typically settle or resolve on a step down. Injection site reactions are common to all four. Because tesamorelin and ipamorelin both raise growth hormone, IGF-1 is the lab worth monitoring on an extended course. The stack is not appropriate with active malignancy, a pituitary tumor, or during pregnancy.
How long until the Lean Stack works?: Expect a slower and less dramatic curve than a GLP-1 produces. The mitochondrial and growth hormone effects build over weeks rather than days, and the visceral fat effect from tesamorelin is measured in months in the published literature. Judge it at 12 weeks on waist circumference and body composition rather than at four weeks on the scale, because two of the four components act on lean mass and visceral fat, neither of which shows up cleanly in scale weight.

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