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I was pretty much under the impression that GH didnt surpress the bodys natural production, but after speaking with a friend that has been on for yrs, he has told me differently and added this article he found...this part in particular...
Injecting growth hormone at night raises the serum
level of growth hormone precisely during the time the pituitary is scheduled
to become active. This high serum level of growth hormone from the injection
can suppress our natural pituitary function by negative feedback. We then
not only lose the benefit of our own endogenous growth hormone, but also run
the risk of surpressing the pituitary, thus making it "lazy". For the most
part, the pituitary has completed its function and is at rest by 5 a.m.
Therefore injecting after awakening in the morning results in injecting "on
top of the peak" of endogenous (our own) growth hormone, so as not to
suppress the pituitary. By the time the pituitary is ready again for its
nighttime activity, the growth hormone given in the morning injection has
been completely metabolized. This eliminates the risk of pituitary
suppression.
Forms of Human Growth Hormone (hGH)
By David Leonardi, M. D.
INTRODUCTION
Growth Hormone is a polypeptide hormone. This means it
is composed of a long
chain of amino acids, 191 to be exact. Under normal
physiologic conditions,
growth hormone is secreted by the anterior pituitary
gland. This is a gland
that lies at the base of the brain in a bony cavity
called the Sella
Turcica. In addition to growth hormone, the anterior
pituitary also secretes
prolactin, thyroid stimulating hormone, luteinizing
hormone, follicle
stimulating hormone, and adrenal corticotropic
hormone. The secretion of
growth hormone by the pituitary gland is initiated by
the hypothalamus,
another gland in the brain that lies right next to the
pituitary. The
hypothalamus initiates growth hormone secretion by
secreting growth hormone
releasing hormone (GHRH); at the same time it stops
secreting a growth
hormone inhibitory hormone called somatostatin. When
somatostatin is turned
off and GHRH is turned on, the pituitary will release
growth hormone in
bursts of activity. These bursts of growth hormone
release occur primarily
during deep stages of sleep, such as stage 3 and stage
4. Once released in
the blood, growth hormone is very short lived. It is
generally completely
metabolized and gone within a half-hour. During that
time, however, it
manages to reach the liver and many other cells in the
body, and induce them
to make another polypeptide hormone called
Insulin-like Growth Factor One
(IGF-1). It is really IGF-1 that travels around to the
various tissues of
the body to effect most of the benefits that we
attribute to growth hormone.
The secretion of growth hormone itself is regulated by
a classic biofeedback
loop. This means when levels of growth hormone in the
blood reach a certain
threshold, growth hormone stimulates receptors in the
pituitary to stop
further growth hormone secretion. It also stimulates
receptors in the
hypothalamus to stop GHRH and turn on somatostatin.
IGF-1, which goes up in
response to growth hormone, also feeds back on the
pituitary and
hypothalamus to help control growth hormone secretion.
This is nature's
system of checks and balances to assure we don't have
too much of any one
hormone.
NOMENCLATURE
The nomenclature for growth hormone is a bit
complicated, but understanding
it from the beginning can save much confusion in the
future. Somatropin
refers to growth hormone of the same amino acid
sequence as the naturally
occurring growth hormone. Somatropin extracted from
the human pituitary
gland was originally designated (hGH, or pit-hGH).
Manufactured growth
hormone is made by recombinant DNA technology. This is
a system of
genetically modifying either bacteria cells or
mammalian cells in tissue
culture so that they include in their genome, the gene
that directs the cell
to make human growth hormone. As the cells in the
tissue culture grow and
function, they will synthesize human growth hormone by
the exact same
process in the human pituitary. Since this is a
natural process, human
growth hormone is not considered a synthetic. The
proper abbreviation for
manufactured (recombinant) human growth hormone is
rGH. Unfortunately, the
abbreviations have been misused even in the medical
community, and
recombinant human growth hormone is commonly
represented by the abbreviation
hGH. The designation is no longer critical since human
growth hormone of
pituitary origin is no longer used in the United
States, or anywhere in the
world that I'm aware of. The term hGH or GH therefore,
refers to human
growth hormone from recombinant DNA technology. It is
pure and 100% free of
any contaminants or micro-organisms.
HISTORY
Prior to the advent of recombinant DNA technology, the
only source of growth
hormone was from human cadavers. More than 27,000
children worldwide were
treated with growth hormone of this source (pit-hGH).
Due to short supply,
children were treated with low doses and interrupted
regimens. As a result,
their response and ultimate height was mitigated.
Distribution of pit-hGH
was stopped in the United States and most of Europe in
1985, with the
emergence of Creutzfeldt-Jakob Disease. This is a rare
and fatal spongiform
encephalopathy, caused by a small pathogen called a
prion. This is the same
pathogen that causes "Mad Cow Disease" recently seen
in Europe from infected
cattle. It is impossible to catch Creutzfeldt-Jakob
Disease or any other
infection from recombinant human growth hormone
because it is not derived
from a human or animal source, but from a purified
tissue culture. For
purposes of this discussion, the term growth hormone,
GH or hGH will mean
growth hormone made by recombinant DNA technology.
The bio-potency of commercially available growth
hormone is typically
represented by either milligrams or units. To put it
simply, 1 milligram of
growth hormone is equivalent to 3 units. The
international units were
developed by the World Health Organization in order to
standardize growth
hormone preparations because of the various production
techniques used early
on in the manufacturing process. By now, the
manufacturing process has been
streamlined and largely perfected so the
bio-equivalency of the various
brands of growth hormone (at least those manufactured
and approved by the
FDA for sale in the United States) are identical.
Therefore, a typical
15-unit vial of growth hormone contains 5 mg, and a
4-unit vial contains
1.33 mg.
USES OF GROWTH HORMONE
Growth hormone was initially used for children of
short stature who are
growth hormone deficient, either because of an
inactive pituitary, a tumor
of the pituitary, or destruction of the pituitary by
surgery or by radiation
to remove a tumor. The other pituitary hormones were
replaced along with GH.
Growth hormone was used only until the children
reached an acceptable adult
height and then it was stopped because it was thought
to be useful only for
growth. The other pituitary hormones, however, which
were thought to be more
critical, were continued throughout adulthood. It
wasn't until much later
that adult growth hormone deficiency was recognized to
be a problem. It was
discovered that adults who were deficient in growth
hormone suffered from
premature cardiovascular disease, reduced bone
density, central obesity,
decreased muscle mass, depressed mood, elevated levels
of LDL (bad)
cholesterol, slower wound healing, fatigue, poor
exercise tolerance and poor
immune function. At that point the use of growth
hormone began in this
unfortunate population, resulting in improvement of
all of the above. It
wasn't until 1990, however, that the benefits of
growth hormone and the
treatment of normal aging were recognized. The most
recent new use of growth
hormone is for the treatment of AIDS Wasting Syndrome.
This is the condition
of weakness, fatigue, and loss of muscle mass in AIDS
patients. Since we at
Cenegenics® specialize in metabolic and hormonal
control of aging, we will
limit this discussion to the use of growth hormone in
the treatment of
normal aging.
SOMATOPAUSE
Somatopause is an extrapolation of the term
"menopause." Menopause is the
condition in women whereby the ovaries atrophy and
cease to produce the sex
hormones Estrogen, Progesterone and Testosterone.
Somatopause signifies the
gradual decline in growth hormone production by the
adult pituitary gland in
both men and women that begins at approximately age 30
and continues at a
steady rate throughout life. The decline in growth
hormone level that occurs
with Somatopause is accompanied by deterioration in
the structure and
functional capacity of our body, which is ultimately
devastating to the
human condition. In fact, there is absolutely no
difference between the
clinical signs and symptoms of aging and those of
adult growth hormone
deficiency described above. The late Dr. Daniel Rudman
first described the
benefits of growth hormone therapy in normal aging
adults. Dr. Rudman
published a landmark article in the New England
Journal of Medicine on July
7th, 1990. In his article, Dr. Rudman showed that by
putting healthy aging
men on growth hormone for six months, he was able to
decrease their body fat
by 14.4%, increase muscle mass by 8.8%, increase skin
thickness by 7.1%, and
increase lumbar bone density by 1.6%. These exciting
findings clearly
inaugurated the movement to supplement growth hormone
in healthy aging
adults, which today is becoming commonplace.
TREATMENT REGIMENS
Growth hormone can be given either subcutaneously or
by intra-muscular
injection with equal therapeutic activity.
Subcutaneous administration is
now used almost exclusively because intra-muscular
administration is fraught
with an increase in side effects without any
additional therapeutic benefit.
Back in Dr. Rudman's time, growth hormone was
typically dosed three times a
week in what we now consider a high dose regimen.
People would typically
receive 12-18 units per week given in injections of
4-6 units, three times a
week. Although great benefits were seen, side effects
were very common, and
much more bothersome than those we see today.
Currently we use only about
half the weekly dose used in Dr. Rudman's study, by
smaller and more
frequent injections, which provide both a better
clinical response and far
fewer side-effects. In one study on growth hormone
deficient children, those
that received daily injections increased their height
during the study
period by 9.7 centimeters more than those who received
thrice-weekly
injections. Besides the low dose-high frequency
technique, the physicians at
Cenegenics® also employ morning injections as opposed
to evening. The reason
for this has to do with the biofeedback mechanism for
growth hormone. Most
of our natural pituitary growth hormone secretion
occurs at night during
deep stages of sleep. Injecting growth hormone at
night raises the serum
level of growth hormone precisely during the time the
pituitary is scheduled
to become active. This high serum level of growth
hormone from the injection
can suppress our natural pituitary function by
negative feedback. We then
not only lose the benefit of our own endogenous growth
hormone, but also run
the risk of surpressing the pituitary, thus making it
"lazy". For the most
part, the pituitary has completed its function and is
at rest by 5 a.m.
Therefore injecting after awakening in the morning
results in injecting "on
top of the peak" of endogenous (our own) growth
hormone, so as not to
suppress the pituitary. By the time the pituitary is
ready again for its
nighttime activity, the growth hormone given in the
morning injection has
been completely metabolized. This eliminates the risk
of pituitary
suppression.
BENEFITS
The benefits of growth hormone use in somatopause
which have been clearly
documented in the medical literature include the
following: a decrease in
body fat, an increase in muscle mass, thickening of
the skin with decreased
wrinkling, improvement in the cholesterol profile, an
increase in bone
density, enhanced feeling of well being, a decrease in
the waist to hip
ratio (meaning fat is removed primarily from around
the waist where it is
associated with a high risk of coronary disease),
improvement in aerobic
capacity, enhanced immune function and a decrease in
the frequency of
illness. The changes that our patients at Cenegenics®
seem to be most
pleased with are the elevation in mood, increase in
energy level, improved
sleep, decrease in body fat, increase in muscle mass
and enhanced ability to
handle adversity with confidence and optimism.
SIDE-EFFECTS
Side effects of growth hormone are generally mild and
are largely associated
with salt and water retention. The minority of
patients that experience this
typically complain of mild weight gain from water
retention associated with
a vague feeling of puffiness. This is sometimes
accompanied by joint
discomfort, particularly in the fingers, with a
feeling of tightness when
making a fist. Other joints may also become
uncomfortable. Carpal Tunnel
Syndrome is a well-known side effect of growth hormone
that was more common
in the early days when growth hormone was given in
higher dose with lower
frequency. Carpal Tunnel Syndrome is also a function
of fluid retention,
which causes water to accumulate in the closed carpal
tunnel compartment of
the wrist, compressing the median nerve. This results
in numbness and
tingling in the palm and fingers. These side effects
are easily remedied by
abstaining from growth hormone for about a week, and
then resuming the
treatment with a 20% dose reduction. Older patients
are more subject to side
effects and are generally started at a low dose of
growth hormone than
younger adults. Another potential side-effect of
growth hormone is the
elevation of blood sugar. Growth hormone mobilizes
body fat, causing our fat
cells to break themselves down and release free fatty
acids into the blood
stream. These free fatty acids are energy molecules
which can be taken up by
organs and many of our organs to be used for energy.
When our muscles are
consuming free fatty acids as a fuel, they are far
less interested in sugar,
therefore they tend to resist the effects of insulin,
and extract less sugar
from the blood. At the same time, growth hormone can
increase glucose output
from the liver to the blood. This combination of
effects can raise blood
sugar and raise insulin levels, neither of which is
good. Fortunately, this
is only a problem in people who eat a diet high in
sugar and starch, and do
little exercise. At Cenegenics® we teach our patients
to eat a low glycemic
diet (low in sugar and starch) and exercise regularly.
The effect of our
nutrition and exercise program in lowering blood
glucose and insulin levels
far outweighs the effect of growth hormone in raising
glucose and insulin
levels. The net effect in our patients, therefore, is
the lowering of
glucose and insulin levels. This is a very
health-promoting benefit that
prevents disease and extends life span.
ACROMEGALY
Acromegaly and giantism are diseases of growth hormone
excess. These are
typically seen by persons who have growth hormone
secreting tumors. Giantism
refers to the condition of growth hormone excess in
children, where their
ultimate height is far above normal because the growth
hormone excess occurs
when the epiphyseal plates of the bones are still open
and the bones are
growing. Acromegaly refers to growth hormone excess in
adulthood after the
epiphyses are closed and the bones are no longer
growing. In these people
the cartilage continues to grow, and the disease is
characterized by
enlargement of the nose, chin, ears, supra-orbital
ridge (eyebrow area),
hands and feet. Patients occasionally ask if
acromegaly can result from
growth hormone supplementation in adulthood. The
answer is absolutely not.
Acromegaly results in growth hormone levels that are
two to ten times that
of a normal adult. Keep in mind that when we
supplement growth hormone in a
controlled and monitored medical program, we bring the
level only up to the
mid-normal range of an adult. In fact, one would have
to use ridiculously
high doses by today's standards to achieve the growth
hormone levels seen in
acromegaly.
MONITORING
Since growth hormone is metabolized so quickly, it is
not easily measured in
a blood test. The levels fluctuate widely, and
measuring growth hormone is
notoriously inaccurate. The best laboratory marker we
have for growth
hormone is the measurement of Insulin-like Growth
Factor One (IGF-1). IGF-1
levels are much more stable in the blood and not only
reflect the average
daily growth hormone level, but directly reflect
growth hormone activity;
because IGF-1 is the hormone that carries out most of
the benefits of growth
hormone. So, despite claims about its shortcomings, it
remains an excellent
marker of growth hormone effect, and certainly the
best one available in the
laboratory. There is one better marker of the benefit
of growth hormone,
however. It's what we call the "clinical benefit".
This is the feedback we
get from patients who are taking growth hormone. How
they are feeling in
terms of energy, well being, body composition,
frequency of illness, their
own physical appearance, etc. is far more valuable a
marker than any blood
test can be. What we really use the IGF-1 level for is
to be certain beyond
a doubt that we're not giving too much growth hormone.
We titrate the dose
of growth hormone to get an optimal clinical response
(a happy patient) even
if the IGF-1 hasn't reached a particular goal range.
This often allows us to
limit the dose and minimize patient costs. After all,
we're treating the
patient, not the blood test.
SECRETAGOGUES
Secretagogues are preparations taken orally that are
designed to stimulate
the pituitary to secret more of our own (endogenous)
growth hormone.
Secretagogues are composed of amino acids or chains of
amino acids called
peptides. The usefulness and benefit of these products
is extremely
variable, with the benefit ranging from moderate to
none whatsoever. A very
large, and unfortunately, very deceptive industry has
grown up around these
products, and we recommend they be used only in a
monitored program because
they often simply don't work. Measuring the IGF-1
level prior to commencing,
and three months after starting a secretagogue program
will give you a much
better idea of its benefit or lack thereof. For more
information on
secretagogues, please visit that document:
<http://www.888younger.com/abstracts/abs3.html>
PREPARATIONS OF GROWTH HORMONE
Although growth hormones is still under patent,
several companies have paid
royalties to the original developers of human growth
hormone for the rights
to manufacture and sell it. There are therefore a
large number of companies
now manufacturing and distributing growth hormone
worldwide. Those available
in the United States are, by brand name and the
manufacturer's name:
Pharmacia and Upjohn -Genotropin
Lilly -Humatrope
Novonordisk -Nordatropin
Genentech -Nutropin
Serono Laboratories -Saizen & Serostim
GEREF
Another option to the use of growth hormone is the use
of growth hormone
releasing hormone (GHRH) now manufactured only by
Serono Laboratories and
branded Geref. GHRH works by stimulating our pituitary
to make our growth
hormone. This seems a more natural and rational
approach because we are
stimulating the endocrine axis at a higher level, and
increasing levels of
growth hormone more naturally. We don't prefer GHRH
however, because we find
it more difficult to achieve adequate levels of IGF-1,
and it is a bit more
expensive.
SUMMARY
Originally taken only from human cadavers, and used
only in children of
short stature, growth hormone has had an interesting
and controversial
history. Fortunately, the understanding of its
importance in adult
physiology came at approximately the same time as
recombinant DNA
technology, which led to greater availability along
with virtual safety.
Soon after this, the comparison was made between
growth hormone deficient
adults and aging adults. Because of the tremendous
similarities, growth
hormone began to be used and soon gained great
popularity in the treatment
of normal aging. Growth hormone is clearly useful and
therapeutic in this
regard as long as it is used in a carefully monitored,
professionally
managed program. Any growth hormone program must
include proper nutrition
and exercise with emphasis on a low glycemic diet
Injecting growth hormone at night raises the serum
level of growth hormone precisely during the time the pituitary is scheduled
to become active. This high serum level of growth hormone from the injection
can suppress our natural pituitary function by negative feedback. We then
not only lose the benefit of our own endogenous growth hormone, but also run
the risk of surpressing the pituitary, thus making it "lazy". For the most
part, the pituitary has completed its function and is at rest by 5 a.m.
Therefore injecting after awakening in the morning results in injecting "on
top of the peak" of endogenous (our own) growth hormone, so as not to
suppress the pituitary. By the time the pituitary is ready again for its
nighttime activity, the growth hormone given in the morning injection has
been completely metabolized. This eliminates the risk of pituitary
suppression.
Forms of Human Growth Hormone (hGH)
By David Leonardi, M. D.
INTRODUCTION
Growth Hormone is a polypeptide hormone. This means it
is composed of a long
chain of amino acids, 191 to be exact. Under normal
physiologic conditions,
growth hormone is secreted by the anterior pituitary
gland. This is a gland
that lies at the base of the brain in a bony cavity
called the Sella
Turcica. In addition to growth hormone, the anterior
pituitary also secretes
prolactin, thyroid stimulating hormone, luteinizing
hormone, follicle
stimulating hormone, and adrenal corticotropic
hormone. The secretion of
growth hormone by the pituitary gland is initiated by
the hypothalamus,
another gland in the brain that lies right next to the
pituitary. The
hypothalamus initiates growth hormone secretion by
secreting growth hormone
releasing hormone (GHRH); at the same time it stops
secreting a growth
hormone inhibitory hormone called somatostatin. When
somatostatin is turned
off and GHRH is turned on, the pituitary will release
growth hormone in
bursts of activity. These bursts of growth hormone
release occur primarily
during deep stages of sleep, such as stage 3 and stage
4. Once released in
the blood, growth hormone is very short lived. It is
generally completely
metabolized and gone within a half-hour. During that
time, however, it
manages to reach the liver and many other cells in the
body, and induce them
to make another polypeptide hormone called
Insulin-like Growth Factor One
(IGF-1). It is really IGF-1 that travels around to the
various tissues of
the body to effect most of the benefits that we
attribute to growth hormone.
The secretion of growth hormone itself is regulated by
a classic biofeedback
loop. This means when levels of growth hormone in the
blood reach a certain
threshold, growth hormone stimulates receptors in the
pituitary to stop
further growth hormone secretion. It also stimulates
receptors in the
hypothalamus to stop GHRH and turn on somatostatin.
IGF-1, which goes up in
response to growth hormone, also feeds back on the
pituitary and
hypothalamus to help control growth hormone secretion.
This is nature's
system of checks and balances to assure we don't have
too much of any one
hormone.
NOMENCLATURE
The nomenclature for growth hormone is a bit
complicated, but understanding
it from the beginning can save much confusion in the
future. Somatropin
refers to growth hormone of the same amino acid
sequence as the naturally
occurring growth hormone. Somatropin extracted from
the human pituitary
gland was originally designated (hGH, or pit-hGH).
Manufactured growth
hormone is made by recombinant DNA technology. This is
a system of
genetically modifying either bacteria cells or
mammalian cells in tissue
culture so that they include in their genome, the gene
that directs the cell
to make human growth hormone. As the cells in the
tissue culture grow and
function, they will synthesize human growth hormone by
the exact same
process in the human pituitary. Since this is a
natural process, human
growth hormone is not considered a synthetic. The
proper abbreviation for
manufactured (recombinant) human growth hormone is
rGH. Unfortunately, the
abbreviations have been misused even in the medical
community, and
recombinant human growth hormone is commonly
represented by the abbreviation
hGH. The designation is no longer critical since human
growth hormone of
pituitary origin is no longer used in the United
States, or anywhere in the
world that I'm aware of. The term hGH or GH therefore,
refers to human
growth hormone from recombinant DNA technology. It is
pure and 100% free of
any contaminants or micro-organisms.
HISTORY
Prior to the advent of recombinant DNA technology, the
only source of growth
hormone was from human cadavers. More than 27,000
children worldwide were
treated with growth hormone of this source (pit-hGH).
Due to short supply,
children were treated with low doses and interrupted
regimens. As a result,
their response and ultimate height was mitigated.
Distribution of pit-hGH
was stopped in the United States and most of Europe in
1985, with the
emergence of Creutzfeldt-Jakob Disease. This is a rare
and fatal spongiform
encephalopathy, caused by a small pathogen called a
prion. This is the same
pathogen that causes "Mad Cow Disease" recently seen
in Europe from infected
cattle. It is impossible to catch Creutzfeldt-Jakob
Disease or any other
infection from recombinant human growth hormone
because it is not derived
from a human or animal source, but from a purified
tissue culture. For
purposes of this discussion, the term growth hormone,
GH or hGH will mean
growth hormone made by recombinant DNA technology.
The bio-potency of commercially available growth
hormone is typically
represented by either milligrams or units. To put it
simply, 1 milligram of
growth hormone is equivalent to 3 units. The
international units were
developed by the World Health Organization in order to
standardize growth
hormone preparations because of the various production
techniques used early
on in the manufacturing process. By now, the
manufacturing process has been
streamlined and largely perfected so the
bio-equivalency of the various
brands of growth hormone (at least those manufactured
and approved by the
FDA for sale in the United States) are identical.
Therefore, a typical
15-unit vial of growth hormone contains 5 mg, and a
4-unit vial contains
1.33 mg.
USES OF GROWTH HORMONE
Growth hormone was initially used for children of
short stature who are
growth hormone deficient, either because of an
inactive pituitary, a tumor
of the pituitary, or destruction of the pituitary by
surgery or by radiation
to remove a tumor. The other pituitary hormones were
replaced along with GH.
Growth hormone was used only until the children
reached an acceptable adult
height and then it was stopped because it was thought
to be useful only for
growth. The other pituitary hormones, however, which
were thought to be more
critical, were continued throughout adulthood. It
wasn't until much later
that adult growth hormone deficiency was recognized to
be a problem. It was
discovered that adults who were deficient in growth
hormone suffered from
premature cardiovascular disease, reduced bone
density, central obesity,
decreased muscle mass, depressed mood, elevated levels
of LDL (bad)
cholesterol, slower wound healing, fatigue, poor
exercise tolerance and poor
immune function. At that point the use of growth
hormone began in this
unfortunate population, resulting in improvement of
all of the above. It
wasn't until 1990, however, that the benefits of
growth hormone and the
treatment of normal aging were recognized. The most
recent new use of growth
hormone is for the treatment of AIDS Wasting Syndrome.
This is the condition
of weakness, fatigue, and loss of muscle mass in AIDS
patients. Since we at
Cenegenics® specialize in metabolic and hormonal
control of aging, we will
limit this discussion to the use of growth hormone in
the treatment of
normal aging.
SOMATOPAUSE
Somatopause is an extrapolation of the term
"menopause." Menopause is the
condition in women whereby the ovaries atrophy and
cease to produce the sex
hormones Estrogen, Progesterone and Testosterone.
Somatopause signifies the
gradual decline in growth hormone production by the
adult pituitary gland in
both men and women that begins at approximately age 30
and continues at a
steady rate throughout life. The decline in growth
hormone level that occurs
with Somatopause is accompanied by deterioration in
the structure and
functional capacity of our body, which is ultimately
devastating to the
human condition. In fact, there is absolutely no
difference between the
clinical signs and symptoms of aging and those of
adult growth hormone
deficiency described above. The late Dr. Daniel Rudman
first described the
benefits of growth hormone therapy in normal aging
adults. Dr. Rudman
published a landmark article in the New England
Journal of Medicine on July
7th, 1990. In his article, Dr. Rudman showed that by
putting healthy aging
men on growth hormone for six months, he was able to
decrease their body fat
by 14.4%, increase muscle mass by 8.8%, increase skin
thickness by 7.1%, and
increase lumbar bone density by 1.6%. These exciting
findings clearly
inaugurated the movement to supplement growth hormone
in healthy aging
adults, which today is becoming commonplace.
TREATMENT REGIMENS
Growth hormone can be given either subcutaneously or
by intra-muscular
injection with equal therapeutic activity.
Subcutaneous administration is
now used almost exclusively because intra-muscular
administration is fraught
with an increase in side effects without any
additional therapeutic benefit.
Back in Dr. Rudman's time, growth hormone was
typically dosed three times a
week in what we now consider a high dose regimen.
People would typically
receive 12-18 units per week given in injections of
4-6 units, three times a
week. Although great benefits were seen, side effects
were very common, and
much more bothersome than those we see today.
Currently we use only about
half the weekly dose used in Dr. Rudman's study, by
smaller and more
frequent injections, which provide both a better
clinical response and far
fewer side-effects. In one study on growth hormone
deficient children, those
that received daily injections increased their height
during the study
period by 9.7 centimeters more than those who received
thrice-weekly
injections. Besides the low dose-high frequency
technique, the physicians at
Cenegenics® also employ morning injections as opposed
to evening. The reason
for this has to do with the biofeedback mechanism for
growth hormone. Most
of our natural pituitary growth hormone secretion
occurs at night during
deep stages of sleep. Injecting growth hormone at
night raises the serum
level of growth hormone precisely during the time the
pituitary is scheduled
to become active. This high serum level of growth
hormone from the injection
can suppress our natural pituitary function by
negative feedback. We then
not only lose the benefit of our own endogenous growth
hormone, but also run
the risk of surpressing the pituitary, thus making it
"lazy". For the most
part, the pituitary has completed its function and is
at rest by 5 a.m.
Therefore injecting after awakening in the morning
results in injecting "on
top of the peak" of endogenous (our own) growth
hormone, so as not to
suppress the pituitary. By the time the pituitary is
ready again for its
nighttime activity, the growth hormone given in the
morning injection has
been completely metabolized. This eliminates the risk
of pituitary
suppression.
BENEFITS
The benefits of growth hormone use in somatopause
which have been clearly
documented in the medical literature include the
following: a decrease in
body fat, an increase in muscle mass, thickening of
the skin with decreased
wrinkling, improvement in the cholesterol profile, an
increase in bone
density, enhanced feeling of well being, a decrease in
the waist to hip
ratio (meaning fat is removed primarily from around
the waist where it is
associated with a high risk of coronary disease),
improvement in aerobic
capacity, enhanced immune function and a decrease in
the frequency of
illness. The changes that our patients at Cenegenics®
seem to be most
pleased with are the elevation in mood, increase in
energy level, improved
sleep, decrease in body fat, increase in muscle mass
and enhanced ability to
handle adversity with confidence and optimism.
SIDE-EFFECTS
Side effects of growth hormone are generally mild and
are largely associated
with salt and water retention. The minority of
patients that experience this
typically complain of mild weight gain from water
retention associated with
a vague feeling of puffiness. This is sometimes
accompanied by joint
discomfort, particularly in the fingers, with a
feeling of tightness when
making a fist. Other joints may also become
uncomfortable. Carpal Tunnel
Syndrome is a well-known side effect of growth hormone
that was more common
in the early days when growth hormone was given in
higher dose with lower
frequency. Carpal Tunnel Syndrome is also a function
of fluid retention,
which causes water to accumulate in the closed carpal
tunnel compartment of
the wrist, compressing the median nerve. This results
in numbness and
tingling in the palm and fingers. These side effects
are easily remedied by
abstaining from growth hormone for about a week, and
then resuming the
treatment with a 20% dose reduction. Older patients
are more subject to side
effects and are generally started at a low dose of
growth hormone than
younger adults. Another potential side-effect of
growth hormone is the
elevation of blood sugar. Growth hormone mobilizes
body fat, causing our fat
cells to break themselves down and release free fatty
acids into the blood
stream. These free fatty acids are energy molecules
which can be taken up by
organs and many of our organs to be used for energy.
When our muscles are
consuming free fatty acids as a fuel, they are far
less interested in sugar,
therefore they tend to resist the effects of insulin,
and extract less sugar
from the blood. At the same time, growth hormone can
increase glucose output
from the liver to the blood. This combination of
effects can raise blood
sugar and raise insulin levels, neither of which is
good. Fortunately, this
is only a problem in people who eat a diet high in
sugar and starch, and do
little exercise. At Cenegenics® we teach our patients
to eat a low glycemic
diet (low in sugar and starch) and exercise regularly.
The effect of our
nutrition and exercise program in lowering blood
glucose and insulin levels
far outweighs the effect of growth hormone in raising
glucose and insulin
levels. The net effect in our patients, therefore, is
the lowering of
glucose and insulin levels. This is a very
health-promoting benefit that
prevents disease and extends life span.
ACROMEGALY
Acromegaly and giantism are diseases of growth hormone
excess. These are
typically seen by persons who have growth hormone
secreting tumors. Giantism
refers to the condition of growth hormone excess in
children, where their
ultimate height is far above normal because the growth
hormone excess occurs
when the epiphyseal plates of the bones are still open
and the bones are
growing. Acromegaly refers to growth hormone excess in
adulthood after the
epiphyses are closed and the bones are no longer
growing. In these people
the cartilage continues to grow, and the disease is
characterized by
enlargement of the nose, chin, ears, supra-orbital
ridge (eyebrow area),
hands and feet. Patients occasionally ask if
acromegaly can result from
growth hormone supplementation in adulthood. The
answer is absolutely not.
Acromegaly results in growth hormone levels that are
two to ten times that
of a normal adult. Keep in mind that when we
supplement growth hormone in a
controlled and monitored medical program, we bring the
level only up to the
mid-normal range of an adult. In fact, one would have
to use ridiculously
high doses by today's standards to achieve the growth
hormone levels seen in
acromegaly.
MONITORING
Since growth hormone is metabolized so quickly, it is
not easily measured in
a blood test. The levels fluctuate widely, and
measuring growth hormone is
notoriously inaccurate. The best laboratory marker we
have for growth
hormone is the measurement of Insulin-like Growth
Factor One (IGF-1). IGF-1
levels are much more stable in the blood and not only
reflect the average
daily growth hormone level, but directly reflect
growth hormone activity;
because IGF-1 is the hormone that carries out most of
the benefits of growth
hormone. So, despite claims about its shortcomings, it
remains an excellent
marker of growth hormone effect, and certainly the
best one available in the
laboratory. There is one better marker of the benefit
of growth hormone,
however. It's what we call the "clinical benefit".
This is the feedback we
get from patients who are taking growth hormone. How
they are feeling in
terms of energy, well being, body composition,
frequency of illness, their
own physical appearance, etc. is far more valuable a
marker than any blood
test can be. What we really use the IGF-1 level for is
to be certain beyond
a doubt that we're not giving too much growth hormone.
We titrate the dose
of growth hormone to get an optimal clinical response
(a happy patient) even
if the IGF-1 hasn't reached a particular goal range.
This often allows us to
limit the dose and minimize patient costs. After all,
we're treating the
patient, not the blood test.
SECRETAGOGUES
Secretagogues are preparations taken orally that are
designed to stimulate
the pituitary to secret more of our own (endogenous)
growth hormone.
Secretagogues are composed of amino acids or chains of
amino acids called
peptides. The usefulness and benefit of these products
is extremely
variable, with the benefit ranging from moderate to
none whatsoever. A very
large, and unfortunately, very deceptive industry has
grown up around these
products, and we recommend they be used only in a
monitored program because
they often simply don't work. Measuring the IGF-1
level prior to commencing,
and three months after starting a secretagogue program
will give you a much
better idea of its benefit or lack thereof. For more
information on
secretagogues, please visit that document:
<http://www.888younger.com/abstracts/abs3.html>
PREPARATIONS OF GROWTH HORMONE
Although growth hormones is still under patent,
several companies have paid
royalties to the original developers of human growth
hormone for the rights
to manufacture and sell it. There are therefore a
large number of companies
now manufacturing and distributing growth hormone
worldwide. Those available
in the United States are, by brand name and the
manufacturer's name:
Pharmacia and Upjohn -Genotropin
Lilly -Humatrope
Novonordisk -Nordatropin
Genentech -Nutropin
Serono Laboratories -Saizen & Serostim
GEREF
Another option to the use of growth hormone is the use
of growth hormone
releasing hormone (GHRH) now manufactured only by
Serono Laboratories and
branded Geref. GHRH works by stimulating our pituitary
to make our growth
hormone. This seems a more natural and rational
approach because we are
stimulating the endocrine axis at a higher level, and
increasing levels of
growth hormone more naturally. We don't prefer GHRH
however, because we find
it more difficult to achieve adequate levels of IGF-1,
and it is a bit more
expensive.
SUMMARY
Originally taken only from human cadavers, and used
only in children of
short stature, growth hormone has had an interesting
and controversial
history. Fortunately, the understanding of its
importance in adult
physiology came at approximately the same time as
recombinant DNA
technology, which led to greater availability along
with virtual safety.
Soon after this, the comparison was made between
growth hormone deficient
adults and aging adults. Because of the tremendous
similarities, growth
hormone began to be used and soon gained great
popularity in the treatment
of normal aging. Growth hormone is clearly useful and
therapeutic in this
regard as long as it is used in a carefully monitored,
professionally
managed program. Any growth hormone program must
include proper nutrition
and exercise with emphasis on a low glycemic diet
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