There has been so much hyperbole about the potential benefits of growth hormone therapy. It is touted as the hormone of youth and the answer to aging. As with the other hormones there is the potential for great benefit in selected patients when dosed appropriately and monitored carefully. Growth hormone is most effective when given with other hormones that support its action. This must be individualized.
Growth hormone is very expensive. It must be administered via a subcutaneous injection on a daily basis. These two facts are daunting for many patients.
Symptoms and Signs that may suggest Growth Hormone Deficiency:
General: lack of vitality, stress intolerance, low energy levels, sleep disturbance, susceptibility to depression, cold intolerance, exercise intolerance and increased susceptibility to infection.
Psychological Symptoms: depression, anxiety, low self-esteem, lack of initiative, emotional liability.
Physical Symptoms:
Consequences of Growth Hormone Deficiency in the Adult:
Musculo-skeletal problems associated with GH deficiency include osteoporosis, increased risk to musculo-skeletal injury and slower recovery from injury. This is significant in that it results in a loss of functional independence. This process is gradual. People with GH deficiency become less active with the typical consequences of a sedentary life style.
Cardiovascular diseases can be improved with GH therapy. GH therapy can have a significant therapeutic benefit in patients with congestive heart failure. GH therapy improves the function of the arterial wall making it more distensible and less stiff. This is likely to result in an improvement in blood pressure. GH therapy has been shown to raise HDL (the cholesterol transport protein that protects from arteriosclerosis). Other risk factors for arteriosclerosis such as elevated triglycerides and elevated fibrinogen (makes the blood stickier) improve with GH therapy.
Growth hormone improves the background parameters that bring on diabetes. GH helps to reduce fat mass, particularly the fat within the abdominal cavity. This may result in improved insulin responsiveness and better handling of glucose by the cells of the body.
Growth hormone therapy, when appropriate, has been beneficial in patients with fibromyalgia and chronic fatigue syndrome.
Factors that Increase Growth Hormone Production:
There is a growing industry that directs its efforts at creating unique products that will signal the pituitary gland to make more growth hormone. These products are collectively known as growth hormone enhancers or agonists. The common ones are the amino acids Arginine, Lysine and Ornithine. When taken together they can have a synergistic effect in raising GH levels. There are combination products available (Growth Hormone Factors) as well. The dose that produces a favorable effect can be large. I believe it is best to take these products under the supervision of a knowledgeable health care practitioner. I find that these products can be useful to augment levels in a person with a healthy pituitary that is capable of producing GH. I will often suggest a therapeutic trial of these agents before going on to GH therapy. My experience is that patients with significant GH deficiency do not respond adequately to these agonists and will ultimately need GH supplementation.
Strategies to Enhance the Effect of Growth Hormone Supplementation:
GH is given as an isolated therapy in research studies. When working with patients in clinical situations this will not result in optimal benefit.
Hormonal Support: Melatonin, thyroid hormone and the sex hormones may be used based on an individual’s unique requirement. Paying careful attention to hormonal balance and synergy allows us to use a lower dose of GH. This increases the safety margin and reduces the cost/benefit ratio.
Nutritional Support: Appropriate nutritional support will improve the benefit from GH therapy. Achieving a reasonable body weight is important. It does not to be optimal. It does not have to approximate the distorted image of perfection promulgated by our media. It just has to be within 15-20% of your ideal weight. Excess adipose tissue disturbs the way your hormones work. Modest weight reduction has a significant benefit. Adequate protein in the diet is recommended (1.0-1.5 grams per kilogram body weight). Food choices are important. We will do Metabolic Typing with our patients in order to create a unique diet and supplementation program.
Exercise: Aerobic exercise, strength training and flexibility training are the three arms of a well-rounded program. If you were going to spend the money and go through the effort of using GH then you would be a fool to ignore the importance of exercise. Moderation is the key to avoiding burnout and injury.
Testing:
Growth Hormone is difficult to measure. The convention is to measure IGF-1. This is molecule that is made in response to GH. It is stable in the serum. We will measure before considering therapy and measure periodically to evaluate the effect of therapy.
Side Effects:
Side effects are infrequent. When side effects occur it can be a sign that the dose is too high or that other hormonal deficiencies have not been recognized. Common side effects can be fluid accumulation (edema), Carpal Tunnel Syndrome (tingling in the fingers and hands), fatigue and malaise (flu-like symptoms).
Theoretically there is a concern about increased risk to cancer. In patients with Acromegaly (a syndrome of GH excess) there is increased incidence of certain cancers. An increased incidence of cancer has not been observed in patients receiving physiologic doses of GH over the last decade. I would not initiate this therapy in a patient with an active cancer or a patient with a recent history of cancer.
Growth hormone therapy is safe and effective when used properly. It can be a useful therapy in patients with a variety of chronic health problems. It is a useful component of a healthy aging program.