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Hexarelin

Examorelin · EP-23905 · MF-6003 · His-D-2MeTrp-Ala-Trp-DPhe-Lys-NH2

"The most potent growth hormone-releasing peptide ever synthesised — 10× more potent than GHRP-6. But hexarelin's most distinctive feature isn't its GH-releasing power: it's a second receptor in the heart (CD36) that produces direct cardioprotective effects completely independent of growth hormone. No other GHRP does this."

Structure
6 AA hexapeptide · synthetic GHRP
GH potency
10× GHRP-6 · 2-3× GHRP-2
Unique receptor
CD36 on cardiomyocytes — GH-independent
Desensitisation
85% response at 28 days (vs 40-50% for other GHRPs)
WADA
Prohibited at all times
Protocol summary
Dose
100–200 mcg, 2× daily
Route
SubQ on empty stomach
Cycle
2–4 weeks max, 4–8 wks off
Tachyphylaxis
~45% drop at 16 weeks
How we read the evidence
Strongest acute GH pulse in the GHRP class · severe tachyphylaxis · cardioprotective signal in animal models · cycling is non-negotiable
Animal evidence

Substantial. Hexarelin is a six-amino-acid synthetic GH-releasing peptide first characterised in the 1990s by Ghigo and colleagues. Animal data shows the highest GH-releasing potency in the GHRP class on a per-dose basis. Distinctive cardioprotective findings: Bodart et al. demonstrated CD36 receptor binding (a cardiac scavenger receptor distinct from GHS-R1a) mediates direct cardioprotective effects. Multiple rat MI models (Tóth, Nagaya) show preserved cardiac function, reduced fibrosis, and anti-apoptotic effects after experimental myocardial infarction with twice-daily SubQ hexarelin (10–100 mcg/kg/day for 2–3 weeks).

Community & clinical practice

Community protocols converge on 100–200 mcg SubQ 2–3× daily on an empty stomach, with the bedtime dose being most important. Cycle length is the critical limit: 2–4 weeks on, 4–8 weeks off. Hexarelin shows the fastest receptor downregulation in the GHRP class — Rahim 1998 demonstrated AUC-GH dropped ~45% over 16 weeks of twice-daily dosing in healthy elderly subjects (effect reversible after 4-week washout). Continuous use beyond a few weeks reliably loses effect. Pair with a GHRH analog (CJC-1295 no-DAC, Mod-GRF) for synergistic GH pulse.

Human trial data

Several published human studies. Bisi 1999 — acute IV hexarelin improved LVEF in hypopituitary adults independent of catecholamine or BP changes, suggesting direct cardiac action via the cardiac GHS-R. Rahim 1998 — 16-week twice-daily SubQ hexarelin in healthy elderly subjects characterised the tachyphylaxis curve and confirmed reversibility. Multiple short PK studies establish dose-response. No human cardioprotection RCT has been published — the cardioprotective signal remains preclinical despite 20+ years of mechanistic work.

Regulatory status

Not approved as a therapeutic in any major market. Unlike GHRP-2 (Pralmorelin, approved as a diagnostic in Japan), hexarelin has no diagnostic approval either. WADA-banned for tested athletes. Sourcing via research-peptide vendors. Significant cortisol and prolactin elevation at higher doses — more than GHRP-2 or Ipamorelin. Contraindicated in active malignancy under anabolic-sensitive evaluation, uncontrolled diabetes, pregnancy.

Convergence

Hexarelin produces the strongest acute GH pulse in the GHRP class but is constrained by rapid tachyphylaxis — receptor desensitisation is the central limitation, not a side-quibble. Standard protocol: 100–200 mcg 2× daily for 2–4 weeks max, then 4–8 weeks off, paired with a GHRH analog. The cardioprotective signal is real preclinically but unvalidated in human RCTs. Pep IQ flags this as a pulse-then-rest tool: useful for short intensive cycles, never as a chronic protocol. Ipamorelin or GHRP-2 are cleaner choices for sustained use.

Community-reported
100 mcg SubQ · 1–2× daily · short cycles
Tachyphylaxis reported with chronic use
Origin & Background

The GHRP engineered for maximum potency

Hexarelin was synthesised by Mediolanum Farmaceutici in Milan in 1972, building on Cyril Bowers' discovery that enkephalin analogues could stimulate GH release. It is a hexapeptide (6 amino acids: His-D-2-methyl-Trp-Ala-Trp-D-Phe-Lys-NH2), where the critical innovation is the D-2-methyl-Tryptophan substitution — this modification gives hexarelin its exceptional potency and resistance to enzymatic degradation relative to its parent compound GHRP-6.

The foundational 1994 Ghigo clinical study established hexarelin as the most potent GH secretagogue in its class by a substantial margin. At 1-2 μg/kg IV in healthy volunteers, hexarelin elicited robust GH peaks via multiple routes including intravenous, subcutaneous, intranasal, and oral. The Phase II clinical programme explored both GH deficiency diagnosis and cardiac indications — ultimately discontinued for commercial reasons rather than safety failures.

The discovery of hexarelin's cardiac receptor (CD36) by Papotti et al. (2000) and Bodart et al. (2002) transformed understanding of the GHRP family. CD36, an 88 kDa glycoprotein on cardiomyocytes and microvascular endothelial cells, is not a GH receptor — it is a scavenger receptor involved in fatty acid transport and cellular signalling. Hexarelin's binding to CD36 in cardiac tissue produces cardioprotective effects that persist even in hypophysectomised animals with no pituitary GH response. The heart has its own hexarelin receptor that operates completely separately from the pituitary axis.

Hexarelin vs Ipamorelin: Hexarelin is the most potent GHRP; ipamorelin is the most selective. Hexarelin elevates cortisol and prolactin alongside GH — ipamorelin does not. For pure GH optimisation with the cleanest side effect profile, ipamorelin is generally preferred. For maximum GH output or cardiac applications, hexarelin's unique profile becomes relevant. Choose based on your goals and tolerance for the cortisol/prolactin effects.

Science & Mechanism

Dual receptor biology — GHS-R1a and CD36

Mechanism of Action

1
GHS-R1a agonism (pituitary): Hexarelin binds ghrelin receptors in the hypothalamus and pituitary with higher affinity than any other synthetic GHRP. Activates PKC signalling and calcium mobilisation → GH pulse release. 10-fold higher potency than GHRP-6, 2-3 fold higher than GHRP-2 in head-to-head GH release assays.
2
Resistance to desensitisation: Where GHRP-2 and GHRP-6 show 40-50% reduction in GH response after 28 days of continuous use, hexarelin maintains ~85% of initial response. The methyltryptophan modification appears to influence receptor binding kinetics and allosteric modulation, reducing tachyphylaxis.
3
CD36 receptor activation (heart): The most distinctive hexarelin mechanism. CD36 is expressed at highest density in human myocardium — higher than any other peripheral tissue. Bodart et al. (2002) used photoaffinity cross-linking to identify Met169 within the CD36-(Asn132-Glu177) sequence as the primary hexarelin contact residue. Crucially: hexarelin's cardioprotection was completely absent in CD36-null mice, confirming receptor dependence.
4
Ischaemia/reperfusion protection: Pre- or post-treatment with hexarelin (1 nM) protected mouse cardiomyocytes from I/R injury by recovering phospholamban phosphorylation and sarcoplasmic reticulum calcium handling. In vivo: hexarelin reduced infarct size by 40-45% when administered 30 minutes before ischaemic insult, activating Akt and ERK1/2 survival kinases.
5
Human cardiac proof-of-concept: 1999 study: 7 patients with GH deficiency and left ventricular failure received IV hexarelin. GH response was negligible (pituitary-deficient patients). Despite no GH release, hexarelin increased LVEF — the first proof in humans of GH-independent cardiac effects mediated by myocardial GHS receptors.
6
Anti-apoptosis in cardiomyocytes: Hexarelin significantly decreased angiotensin II-induced apoptosis in neonatal rat cardiomyocytes and inhibited doxorubicin-induced apoptosis in H9c2 cells and endothelial cells — providing additional mechanisms beyond the ischaemia/reperfusion protection.
Benefits & Evidence

What the data shows

💪
Maximum GH release in class
Ghigo 1994: most potent GH secretagogue tested across IV, SubQ, intranasal, and oral routes. 10× more potent than GHRP-6. 85% maintained response at 28 days vs 40-50% for competitors. Synergistic with GHRH — combination produces 2-3× greater GH than either alone.
● Strong — Phase 2 human trials (Ghigo group)
❤️
Cardioprotection — CD36 mediated
Reduces I/R infarct size 40-45% in animal models. Human proof-of-concept: improved LVEF in GH-deficient patients with LV failure with no GH response — confirming the cardiac mechanism is GH-independent. Protects against angiotensin II and doxorubicin-induced cardiomyocyte apoptosis.
● Moderate — animal models + human proof-of-concept
💤
Sleep quality and recovery
Like all GHRPs, GH elevation translates to improved slow-wave sleep quality. Hexarelin's greater GH potency may produce correspondingly stronger sleep benefits. Consistently reported as one of the most noticeable subjective effects.
● Moderate — consistent with GH class effects
Safety First

Risks & considerations

⚠️
Safe in Phase 2 trials but more hormonal side effects than selective GHRPs. Zero serious adverse events across 500+ subjects in published studies. Main practical concern vs ipamorelin: dose-dependent cortisol and prolactin elevation. Cortisol returns to normal between doses; prolactin elevation is modest (23% above baseline, within normal range). Select ipamorelin for clean GH with no cortisol effects; select hexarelin when maximum GH or cardiac benefits are the priority.
Mild
Cortisol and ACTH elevation — dose-dependent. More pronounced than GHRP-6 at equivalent doses. Cortisol returns to normal between doses; no sustained HPA axis overstimulation at 16 weeks twice-daily in clinical studies.
Mild
Prolactin elevation — modest (23% above baseline). Remains within normal range throughout 16-week twice-daily dosing. Less than might be expected given potency.
Mild
Appetite stimulation — 5-15% incidence. Less than GHRP-6 (~30-50% incidence). More than ipamorelin (negligible). Caused by GHS-R1a activation in hypothalamic feeding centres.
Mild
Water retention — mild fluid retention at higher doses, similar to class effects.

⚠ Key Warnings

WADA prohibited at all times — detection methods established for competitive athletes.
Not FDA-approved. Research compound only. No compounding pharmacy availability.
If cortisol elevation is a concern (e.g., managing stress, sleep, body composition), ipamorelin is the preferred alternative with equivalent GH protocols.
The cardiac benefits are preclinical + proof-of-concept only. Do not use hexarelin as a cardiac medication — this is not a validated therapeutic application.