Lean Stack (SS-31/MOTs-C/Tesamorelin)
Three distinct pathways: Tesamorelin is a GHRH analog that drives growth hormone release, MOTs-C is a mitochondrial-derived peptide studied for metabolic signaling and AMPK activation, and SS-31 (elamipretide) binds cardiolipin in the inner mitochondrial membrane.
Medically reviewed by Dr. Jonathan Snipes, MD. Last reviewed September 23, 2026.
What It Is
The current Lean Stack formula, compounded by Optimal Balance Pharmacy as their Fat Burner Blend 2.0. It replaced the original four-peptide formula in September 2026: AOD-9604 and ipamorelin came out and SS-31 went in, so each of the three peptides covers a different pathway instead of overlapping.
How It Works
One injection covers three areas. Tesamorelin acts on the growth hormone pathway and has established activity on visceral fat. MOTs-C is studied for its role in cellular metabolism and energy use. SS-31 is studied for mitochondrial membrane stability, cellular energy production, and oxidative stress.
Who It's For
Patients working on body composition who want growth hormone, metabolic, and mitochondrial support in a single daily injection, including patients who were on the original Lean Stack.
Who Should Avoid It
Combined contraindications of all three components. Not for active cancer, pituitary tumors, or pregnancy. Monitor IGF-1.
Protocol & Pricing
OBP Pharmacy Price
$125/30mg
You pay pharmacy price. No markup.
Starting Dose
20 units (0.4mg SS-31 + 0.4mg MOTs-C + 0.4mg Tesa)
Form
Injectable vial (5mL, 2mg-2mg-2mg/mL, SS-31 10mg + MOTs-C 10mg + Tesamorelin 10mg total)
Dosing Protocol
20 units subcutaneous injection daily for 5 days, 2 days off. 20 units = 0.2mL delivering SS-31 0.4mg + MOTs-C 0.4mg + Tesamorelin 0.4mg per injection.
Beyond Use Date
90 Days from compounding (USP <797>)
Optimal Balance Pharmacy assigns this date and prints it on your vial label. Always follow the label. Once a multi-dose vial is punctured, the in-use date on the label is shorter than the compounding date shown here.
Stacking Guide
Stacks Well With
Do Not Combine With
Related Peptides
Independently tested
Lean Stack (SS-31/MOTs-C/Tesamorelin) lab test reports
Every Lean Stack (SS-31/MOTs-C/Tesamorelin) batch dispensed by Optimal Balance Pharmacy is independently tested by Eagle Analytical Services (FDA-registered, A2LA ISO 17025 accredited) for sterility (ScanRDI or Celsis) and bacterial endotoxin (USP <85>). The most recent report:
| Submission | Lot | Sample | Sterility | Endotoxin | |
|---|---|---|---|---|---|
| ETX-260914-0354 | LG342010615 | ELAMIPRETIDE/ MOTs-C/ TESAMORELIN 2 MG/ 2 MG/ 2 MG/ML (5 ML) Injection | Pass | Pass <2 EU/mL / 1400 EU/mL | Download |
Eagle Analytical Services is an independent FDA-registered laboratory, A2LA accredited to ISO 17025, based in Houston, Texas. They have no commercial relationship with Rx Peps Direct. Rx Peps Direct prescribes; Optimal Balance Pharmacy compounds and dispenses; Eagle tests every batch. Three separate companies. Browse our full quality program on the quality page.
How to get Lean Stack (SS-31/MOTs-C/Tesamorelin) prescribed online
Lean Stack (SS-31/MOTs-C/Tesamorelin) is available by prescription through a licensed telehealth visit and dispensed for human use by a named 503A pharmacy. That is what separates it from research-use-only vials sold without a prescription. There is no subscription and no membership, just a one-time visit fee.
- 1
Complete a $39 medical visit. Answer a short intake about your health history and your goals for Lean Stack (SS-31/MOTs-C/Tesamorelin). The $39 fee is the only charge Rx Peps Direct collects, paid once, not a recurring subscription.
- 2
A licensed provider reviews it. A US-licensed nurse practitioner or physician reviews your intake and, if Lean Stack (SS-31/MOTs-C/Tesamorelin) is appropriate for you, writes a patient-specific prescription. The starting dose is typically 20 units (0.4mg SS-31 + 0.4mg MOTs-C + 0.4mg Tesa).
- 3
The pharmacy compounds and ships it. Optimal Balance Pharmacy, a 503A pharmacy in Texas, compounds Lean Stack (SS-31/MOTs-C/Tesamorelin) and ships it pre-reconstituted by FedEx overnight in a reusable cooled case. Your fill is Injectable vial (5mL, 2mg-2mg-2mg/mL, SS-31 10mg + MOTs-C 10mg + Tesamorelin 10mg total), and you pay the pharmacy $125/30mg at wholesale, with no clinic markup, plus a $15 flat FedEx overnight shipping fee charged by the pharmacy.
Rx Peps Direct prescribes Lean Stack (SS-31/MOTs-C/Tesamorelin) in the 29 jurisdictions its medical team is licensed in. Start a $39 visit or browse the full Weight Loss & Metabolic range. Comparing services first? See how Rx Peps Direct stacks up against seven other providers in our best telehealth for compounded peptides comparison.
Common questions about Lean Stack (SS-31/MOTs-C/Tesamorelin)
- What is in the Lean Stack?
- Three peptides in one 5 mL vial, each at 2 mg/mL: SS-31 (elamipretide), MOTS-C, and tesamorelin, for 10 mg of each and 30 mg total. Optimal Balance Pharmacy compounds it as their Fat Burner Blend 2.0 and charges $125 per vial at wholesale. Rx Peps Direct charges a separate $39 medical visit fee.
- What happened to the AOD-9604 version of the Lean Stack?
- The pharmacy discontinued the original four-peptide Lean Stack (AOD-9604, MOTS-C, tesamorelin and ipamorelin) in September 2026 and replaced it with the current formula, which drops AOD-9604 and ipamorelin and adds SS-31. An open order for the old formula cannot be converted; the new vial needs a new prescription. AOD-9604 is still available on its own as a sublingual troche, and tesamorelin with ipamorelin is available as its own vial.
- Can you take tesamorelin and MOTS-C together?
- Yes. The Lean Stack puts tesamorelin and MOTS-C, plus SS-31, in the same vial so they are taken as one injection. Do not add standalone tesamorelin, MOTS-C, or SS-31 on top of it, because the vial already contains them. Rx Peps Direct's ordering system blocks those duplicate combinations, and your provider reviews every order.
- What is the Lean Stack dosage?
- The pharmacy's direction is 20 units (0.2 mL) injected subcutaneously once daily for 5 days, then 2 days off. Each 20-unit dose delivers 0.4 mg each of SS-31, MOTS-C, and tesamorelin. A 5 mL vial holds 25 doses, which lasts about five weeks on that schedule. Your provider confirms the protocol at review.