by Dr. G. Pepper | Aug 25, 2010 | diet, diet and weight loss, fitness, general health & nutrition, health, hormones, metabolism
Due to the potential for abuse and high cost, growth hormone treatment in adults is the subject of much controversy. I believe that treating adults with growth hormone deficiency is many times an appropriate and beneficial choice. Firming up my conviction for treating adult growth hormone deficiency is a recent study conducted in the Netherlands and UK published in the Journal of Endocrinology and Metabolism (JCEM 95:3664-3674, 2010). The researchers compared Body Mass Index (BMI), waist circumference, triglycerides, and HDL (good cholesterol), between normal adults and those with low growth hormone levels due to deficient pituitary function (hypopituitarism). All measurements of obesity and lipid metabolism were significantly worse in the young adults (younger than 57 years) with growth hormone deficiency compared to normal adults of a similar age.
As I pointed out in previous articles at metabolism.com, growth hormone levels naturally decline as we get older. The authors of the present study note that growth hormone levels decline 14% per decade in adults. I conceive of this as one of the ways nature gets rid of us after we complete our biological/reproductive functions, since without growth hormone our muscles, immune and nervous systems, decline, leading to death. It’s planned obsolescence… what is typically referred to as aging. In the recent study senior citizens have equivalent levels of obesity and abnormal lipid metabolism as young adults with growth hormone deficiency. The authors note the effect on the body of growth hormone deficiency in young adults is equivalent to 40 years of aging. The theory that growth hormone functions to preserve our tissues during youth and aging results from its absence, appears confirmed by these results.
Most normal young adults aren’t growth hormone deficient and the population that would qualify for growth hormone treatment from this group is small. What about older adults with low growth hormone who are troubled by the “natural†decline in their body function? Should or could we treat this much larger population with growth hormone? It is my experience that private and federal insurers will not pay for this treatment regarded as “cosmeticâ€. On the other hand, there will be physicians who will comply with a request for growth hormone treatment from individuals who possess enough cash and motivation. Less affluent or determined individuals will have to contend with natural aging just as our ancestors have done for thousands of years.
This information is for educational purposes only and is not intended as medical advice or treatment.
Gary Pepper, M.D.
Editor-in-Chief, metabolism.com.
by Dr. G. Pepper | Oct 11, 2009 | general health & nutrition, health, hormones, Uncategorized
At metabolism.com we receive a lot of questions from members wondering whether growth hormone therapy will help them grow taller. Lorraine’s question, posted below, is typical. The single most important factor determining the effect of growth hormone on improving height, is whether the bone still has growth plates that are “open” because when the growth plates close (or fuse), the bone cannot get any longer. If the bone’s in the legs cannot grow full adult height has been achieved and taking growth hormone won’t change that.
Here is Lorraine’s question and below that is my response.
Lorraine writes to metabolism.com:
I’m 21 years old and am only 4 “10. Is there any way that HGH injections could help me grow a couple of inches? Please respond back to my question because I need to know if its too late since I already hit puberty.
My response to Lorraine is the following (I’m assuming Lorraine is really 21…not 12)
Lorraine:
From the time of birth we grow rapidly in good part due to the action of growth hormone which is released from the pituitary gland.
At puberty the release of testosterone in boys and estrogen in girls begins the process of final bone maturation. Children often experience a period of rapid growth known as a growth spurt at this time. Girls usually complete their growth spurt within a year or two of their first menstrual period. Boys tend to finish their growth phase when they are older compared to girls.
Growth ends because the areas of the bones known as the growth plates become sealed or fused. After that growth hormone has little effect to cause increased height. Bones in the face, feet and hands may still be susceptible to growth effects of growth hormone, with not particularly desirable results.
An adult who has not grown in a few years cannot generally get taller in response to growth hormone due to the fusion of their long bones. Taking HGH is unlikely to make you taller.
Aside from controlling height, growth hormone is likely to have other non-growth related benefits like preserving muscle and soft tissue and perhaps other general maintenance functions in the immune and central nervous systems. These benefits of growth hormone can be lost during aging since the pituitary production of growth hormone usually declines in later years.
I hope this information is helpful for you.
Disclaimer: This information does not substitute for the advice of your own physician and is for general learning purposes only.
by Dr. G. Pepper | Nov 25, 2008 | hormones, misc, Uncategorized
 For years, false promises have been made about pills that produce therapeutic increases in growth hormone levels in adults. I countered those claims in a number of articles on this site https://www.metabolism.com/2008/08/23/adults-receive-growth-hormone-treatment/. Recent scientific advances may have finally made this myth into reality. A recent study from the University of Virginia of healthy elderly individuals whose growth hormone levels were low has shown that a synthetic drug mimicking a naturally occurring brain hormone, when taken orally, can restore growth hormone levels to young healthy levels.
Growth hormone levels normally decline as we get older. It is my opinion that age related declines in hormones like growth hormone may be a form of natural programmed death of the aging body. Along with decline in growth hormone comes a decline in muscle mass and an increase in body fat. This combination makes older people weaker more likely to suffer injury and develop diseases such as diabetes, high blood pressure and coronary artery disease. Ghrelin is a hormone normally made in the intestine and brain.  It has the ability to stimulate the release of growth hormone from the pituitary gland. The new drug MK-677, a synthetic molecule which mimics ghrelin action, is absorbed into the blood after oral administration and creates a long acting natural stimulus to the pituitary to release growth hormone. Making this drug even more appealing is that it causes growth hormone release in a natural up and down rhythm (pulsatile) rather than a single big daily elevation as occurs with standard injections of growth hormone.
Does MK-677 help?  According to the researchers, muscle mass increased, and body fat remained the same but overall weight increased a small amount. The bad cholesterol (LDL) level declined when taking the drug. The study was conducted in healthy elderly people so any benefit to quality of life was hard to measure. Additional problems may arise because ghrelin also stimulates appetite and may cause weight gain as shown in the present study.
MK-677 is an investigational medicine and is not available to the public. Only your personal health care professional can recommend whether any medical therapy is appropriate for you.
Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com
by Gary Pepper M.D. | Aug 23, 2008 | general health & nutrition
The controversy surrounding growth hormone use in adults deepens. Recent editorials in the prestigious New England Journal of Medicine have taken a negative view of growth hormone supplementation for adults. Dr. Mary Lee Vance comments, “general use (sic- of growth hormone therapy in adults) now or in the immediate future is not justified.”
My medical practice has recently received a letter from a major health insurer, United Health Care, stating that growth hormone use in adults will no longer be a covered medical therapy. When asked for justification of this curtailment of financial support for growth hormone therapy health insurers are certain to point to comments from experts such as Dr. Vance.
One of the reasons for the backlash against growth hormone therapy is the explosive proliferation of individuals and companies promoting their own propriety brands of growth hormone substitutes and so-called growth hormone releasers. We receive 10 or more emails daily marketing growth hormone related products. Unfortunately, most of the claims for these products are simply false or at best, unsubstantiated. Only injected prescription growth hormone made by major pharmaceutical companies can be expected to fulfill the goal of growth hormone supplementation. Making matters worse for supporters of growth hormone therapy in adults is that legitimate growth hormone products themselves can be abused for perceived benefits to athletic ability and cosmetic appearance.
Why all the fuss about growth hormone? Is it truly capable of making us stronger, leaner, more energetic, and happier? Dr. Vance and her colleagues point out the lack of large studies which provide the answers to these questions. There are, on the other hand, smaller studies showing improvements in bone density, lean body mass and measures of well being associated with growth hormone therapy. Because of the limited amount of large studies evaluating growth hormone use in adults can we still justify our use of the hormone? As a practicing endocrinologist I have to answer these questions so I can provide my patients with the best existing therapies for their problems.
What exactly is growth hormone? It is a protein based hormone made by the pituitary gland which circulates in our blood in abundant amounts during the first twenty years of our lives but levels then slowly decline as we get older. Growth hormone controls the liver’s production of IGF (insulin like growth factor), formerly known as somatomedin, which stimulates the growth of cartilage which in turn results in increasing size of our bones. Growth hormone also appears to play a role in maintaining muscle mass and probably has multiple functions within the central nervous system (the brain and spinal cord).
If growth hormone is so important to general health why do levels drop off as we age? The decline in growth hormone levels with aging is mirrored by a decline in a host of other critical substances which maintain our health, such as DHEA (from the adrenal gland). One possible reason for the drop in these beneficial substances is for the plain and simple purpose of promoting our aging and eventual death. The survival of our species requires the removal of the old genetic material (use) so it can be replaced by the new (and possibly improved) genetic material (our offspring). Aging and death are required by the laws of evolution and therefore our bodies are programmed to self-destruct. The decline in growth hormone may be one way to serve this purpose.
Growth hormone is expensive. A year’s supply may cost up to 10 thousand dollars making economics another key element in the growth hormone controversy. How can we justify spending this amount of money on everyone who wants to prolong their strength and vitality? Forget about justify…our economy simply can’t afford this expenditure. Who will then decide who gets growth hormone and who won’t? I don’t have the answer either.
In the face of controversy what would be a reasonable approach for the practicing physician to follow? The first principal is to administer growth hormone only to those fail to make a minimum acceptable quantity of the hormone. If a patient is suspected of having growth hormone deficiency based on their history and physical exam a check will be made of the level of morning growth hormone and IGF. If the growth hormone is in the low normal range (below 2) the next step is a stimulation test to see whether the pituitary gland can be forced to release its store of the hormone. There are several tests which stimulate the pituitary release of growth hormone but the simplest is to administer L-Dopa (a prescription drug formerly used to treat Parkinson’s disease) by mouth and measure growth hormone levels in the blood over the next 2 hours. If the level remains below 5, growth hormone deficiency can be diagnosed.
Growth hormone deficient adults are given significantly smaller doses of growth hormone as compared to children being treated to achieve normal height. Even at these lower doses impressive improvements in mood and energy can be achieved. It is hard to measure these effects but statements such as, “Growth hormone changed the quality of my life. The strength and energy I used to have is back in full”, have been use by patients to describe their results.”
What about side-effects from growth hormone treatment in adults? Minor joint pains, carpal tunnel like symptoms, headache, and traces of swelling at the ankle have been described. Unfortunately, experts such as those quoted in the New England Journal use ominous tones when referring to growth hormone side-effects or to the possibility of its causing cancer or cardiovascular disease. These warnings remain largely unsubstantiated by even small studies.
In my practice I generally follow a year or two of treatment with growth hormone followed by 6 months off, simply to defer to the possibility of accumulating negative effects of prolonged GH therapy. The medical community is still waiting the ultimate word on growth hormone therapy in adults but based on reputable studies and my own observations I will continue to offer this treatment to my patients who exhibit the signs, symptoms and blood test evidence of growth hormone lack. As with any medical treatment it is important for each individual to consult with their own physician before embarking on any course of therapy.
