Key Takeaways
- Sermorelin acts on your pituitary gland to support your body's own growth hormone release.
- Your provider tracks your response with an IGF-1 blood test at 2 to 6 weeks, reviewed alongside your sleep data and how you feel.
- Your provider sets your dose, may raise it within a maximum, and plans a two-week break every six months.
- Four questions help you get more out of the before-and-after photos you see online.
When you start sermorelin, it's natural to wonder what will change, and when. Here's what your provider measures along the way, starting with an IGF-1 blood test at 2 to 6 weeks.
Deep sleep and growth hormone fall together in midlife. In sleep-lab data from healthy men, growth hormone secretion dropped roughly 75% between young adulthood (ages 16 to 25) and midlife (ages 36 to 50). Deep, slow-wave sleep fell from nearly 20% of the night before age 25 to under 5% after 35. Sermorelin acts on the growth hormone side of that picture: it signals your body to release its own.
Your Own Growth Hormone, Not a Substitute
Sermorelin is a synthetic analog of growth hormone-releasing hormone, the signal your body already responds to. It acts on your pituitary gland to support your body's own growth hormone release, rather than supplying growth hormone itself. A licensed pharmacy compounds your prescription for you.
A measurable response in two weeks. In a small study, older men's growth hormone and IGF-1 levels rose after 14 days of GHRH injections at the higher dose tested. IGF-1 is the marker that moves when growth hormone release changes, which is why it's the number your provider checks.
A six-month study. In a separate study, older adults did better on tests of thinking and attention after six months of sermorelin injections.
A Plan Built Around You, and Adjusted as You Go
A licensed provider reviews your history, sets your dose and schedule, and refines them over time.
Start: your evaluation. You share your health history and what you'd like help with. A licensed provider then decides whether sermorelin is right for you and, if it is, sets your dose and schedule.
Weeks 2 to 6: your first IGF-1 check. Under LIV's protocol, this is when you have your first IGF-1 blood test. Your provider reviews the result alongside your wearable sleep data and a structured check-in on how you feel. From there, your provider decides whether to raise your dose, keep it where it is or stop.
Once you're comfortable: a step up, within a limit. Your plan starts at a moderate dose, and your provider may move you to the maximum once you tolerate it. Past the maximum, more does nothing, because your body can't use it.
Every six months: a two-week break. It's built into your plan, and your provider lets you know when it starts and what to do during the break.
Along the way: refills and check-ins. Before each refill, you let us know how things are going, and your provider reviews your progress and adjusts your plan if needed. You'll also check in every three months.
When Your Numbers and How You Feel Don't Match
Sometimes IGF-1 rises and you don't notice much. If your pituitary is already producing well, the increase may be small.
If neither your numbers nor how you feel moves, you and your provider talk through both and whether to continue.
- Layout: a horizontal timeline, left to right, with four marked points at uneven spacing that reflects real intervals. Above the line: what happens. Below the line: what gets decided
- Point 1, "Start": above, "evaluation, then prescription"; below, "is this appropriate at all? The answer can be no"
- Point 2, "Weeks 2 to 6": above, "IGF-1 blood test, sleep data, structured subjective report"; below, "titrate up, hold, or stop"
- Point 3, "Once tolerated": above, "moderate dose to maximum dose"; below, "past the maximum, more does nothing"
- Point 4, "Every 6 months": above, "two-week break"; below, "the protocol's stated reason: tolerance and loss of efficacy"
- A continuous weekly rhythm band running underneath the whole line, labeled "five consecutive days on, two off, each week"
- Caption underneath: "Four decision points. None of them is a result."
- Critical: this is a schedule of MEASUREMENTS and DECISIONS. Nothing on it may depict, imply or gesture at an outcome, a body, a physique, a scale, a tape measure, a progress bar or an upward curve. A rising line anywhere in this graphic would restore by picture the exact claim the page declines to make in words. The four points are equally weighted; none is drawn as a destination
- Do not include: packaging, branding, human figures, before-and-after devices, arrows implying improvement, or any number other than the intervals named above
What LIV's Prescribed Schedule Looks Like
LIV's prescribing protocol calls for 0.3 mg once daily, on five consecutive days a week, injected under the skin of your stomach or thigh at bedtime. You take two days off each week as part of the plan.
You'll also avoid carbohydrates and fats for an hour before and after each dose. Your provider sets your own dose and schedule, and instructions come with your shipment.
Staying Safe With Your Provider
Your provider stays involved the whole way:
- Before you start: a licensed provider reviews your health history.
- Your dose: your provider makes any change, so don't increase it on your own.
- Between refills: your care team is available whenever you need them.
At each check-in, tell your provider how you're feeling, including anything new since you started.
Getting More From Before-and-After Photos
Four questions help you judge what a photo can and can't show.
What else changed? Sleep, training, diet and other prescriptions often change in the same month, and a photo can't separate them.
What was measured, and how? A tape measure and a scale are measurements, and a caption isn't. "Before" is often a phone photo in dim light and "after" a better one.
Is the poster connected to the seller? Some posts are sponsored, affiliated or incentivized. The FTC's Guides Concerning the Use of Endorsements and Testimonials in Advertising call for that connection to be disclosed.
Is the result typical? People tend to post when something has changed, so a striking photo may show an unusual result rather than a common one.
Your own timeline starts with an evaluation, where a licensed provider reviews your history and helps you decide on next steps.
Frequently Asked Questions
How long does sermorelin take to work?
Your provider checks your response with an IGF-1 blood test at 2 to 6 weeks, reviewed with your sleep data and how you feel. In a small study of older men, growth hormone and IGF-1 levels rose after 14 days at the higher dose tested. Those are hormone measurements rather than a timeline for noticing a change, and your provider will talk with you about what your own results show.
What results should I expect?
Your provider tracks your IGF-1 level at 2 to 6 weeks, your sleep data and how you feel. Studies have measured rises in growth hormone and IGF-1, and better scores on tests of thinking and attention after six months. How much your own level moves depends partly on your pituitary, and your provider reviews that with you.
What did the two-week study measure?
Corpas and colleagues gave ten healthy, nonobese older men (average age 68) GHRH-(1-29) injections under the skin twice daily for 14 days at each of two doses, 0.5 mg and 1 mg, in a randomized crossover with a 14-day break between. Growth hormone and IGF-1 rose significantly only at the higher dose, 1 mg twice daily. These hormone measurements aren't a promise of symptom improvement in two weeks, and the study regimen isn't dosing advice. The study didn't test women or LIV's compounded preparation, and equivalent results aren't established for that preparation.
What did the six-month study find?
Vitiello and colleagues enrolled 100 adults ages 60 to 85 in a randomized, placebo-controlled study, and 89 completed it. Participants injected sermorelin acetate (GEREF) for six months, starting at 1 mg nightly, with the dose adjusted for some. Improvements appeared on several cognitive tests and didn't depend on gender or estrogen status. It isn't evidence of dementia prevention, longer life or a percentage improvement in everyday memory, it didn't test adults ages 35 to 55, and it doesn't establish the same results for LIV's compounded preparation.
Where does the 75% figure come from?
Van Cauter and colleagues combined sleep-laboratory data on 149 healthy, normal-weight men ages 16 to 83, collected at four centers between 1985 and 1999. The study was observational, included men only, and compared ages 16 to 25 with ages 36 to 50. It describes how sleep and growth hormone change with age. It didn't test sermorelin and doesn't show that sermorelin restores deep sleep, growth hormone levels or any health outcome.
What if my numbers move and I feel the same?
Tell your provider how you're feeling, not only what your labs show. A change in IGF-1 doesn't necessarily mean you'll notice a benefit, particularly if your level was already adequate. If neither changes, your provider talks with you about whether to continue. Your provider considers both your results and your experience when discussing it with you.
Why does LIV build in a break every six months?
LIV's protocol includes a planned two-week pause every six months, also called a washout, intended to limit tolerance. Your provider explains when to pause and what to do during the break.
Is there a maximum sermorelin dose?
Yes. LIV's prescribing protocol sets a starting dose and a maximum, and your provider may increase the dose if you tolerate it, while staying within that limit. Past the maximum, more does nothing because your body can't use it, so don't increase your dose on your own.
Is sermorelin FDA approved?
Sermorelin was the active ingredient in GEREF, an approved injection (NDA 020443) for short stature in children with low growth hormone. Its sponsor discontinued it in December 2008, and the FDA later determined it wasn't withdrawn from sale for reasons of safety or effectiveness. The sermorelin you'd be prescribed today is compounded, which means a licensed pharmacy mixes it for you, and the FDA doesn't approve compounded medicines for safety, quality or how they're made.
Can I trust the before-and-after photos I find online?
They're more useful with the four questions above. Some come from posters with an undisclosed connection to the seller, or show unusual results without context, which the FTC's endorsement guides address. Your own progress is tracked with measurements your provider reviews with you.
References
Corpas, E., Harman, S. M., Piñeyro, M. A., Roberson, R., & Blackman, M. R. (1992). Growth hormone (GH)-releasing hormone-(1-29) twice daily reverses the decreased GH and insulin-like growth factor-I levels in old men. Journal of Clinical Endocrinology and Metabolism, 75(2), 530-535. https://pubmed.ncbi.nlm.nih.gov/1379256/
Federal Register. (2013). Determination that GEREF (sermorelin acetate) injection and GEREF Diagnostic were not withdrawn from sale for reasons of safety or effectiveness, 78 FR 14104, March 4, 2013.
Federal Trade Commission. (n.d.). Guides Concerning the Use of Endorsements and Testimonials in Advertising, 16 CFR Part 255. Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-16/part-255
LIV Health. (2026). Sermorelin prescribing protocol, supplied July 29, 2026, and Paul Stanfield, LIV concierge, August 7, 2026, for the monitoring schedule and dose ceiling. Internal source, not a public citation.
U.S. Food and Drug Administration. (2024). FDA briefing document: Ipamorelin-related bulk drug substances. Pharmacy Compounding Advisory Committee meeting, October 29, 2024. Cited for GEREF's approval under NDA 020443. https://www.fda.gov/media/182088/download
Van Cauter, E., Leproult, R., & Plat, L. (2000). Age-related changes in slow wave sleep and REM sleep and relationship with growth hormone and cortisol levels in healthy men. JAMA, 284(7), 861-868. https://jamanetwork.com/journals/jama/fullarticle/192981
Vitiello, M. V., Moe, K. E., Merriam, G. R., Mazzoni, G., Buchner, D. H., & Schwartz, R. S. (2006). Growth hormone releasing hormone improves the cognition of healthy older adults. Neurobiology of Aging, 27(2), 318-323. https://faculty.washington.edu/vitiello/Recent%20Publications/GHRH%20and%20Cognition%20in%20Aging.pdf
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