Growth hormone therapy can improve heart contractibility, reduce the effects of osteoporosis, and increase the overall quality of life.
In 1996, growth hormone replacement therapy (GHRT) was approved for use in adults with a growth hormone deficiency (GHD). Since that time, there has been considerable interest in what GHRT can do for adults with clinically diagnosed GHD.
Recent research into GH use in adults has produced tangible results. Patients have increased muscle mass, decreased fat content, improved bone density, and mood, lowered cholesterol, strengthened heart function, and increased quality of life.
HGH therapy has historically been used in patients with panhypopituitarism (pituitary gland produces no GH) or hypopituitarism (pituitary gland does not produce enough GH). But as a person ages, somatopause, or a growth pause, occurs between age 40 and 50 when there is a natural decline in growth hormone production.
When a 60-year-old patient feels like a 90-year-old, HGH therapy can drastically improve not only their quality of life but also their overall health.
When the FDA approved GH for use in adult patients with GHD, the only approved indication was a pituitary disease from known causes, including pituitary tumor, pituitary surgical damage, hypothalamic disease, irradiation, trauma, and reconfirmed childhood GHD. Most patients considered for GH therapy are in one of these categories, according to an article in Endocrine Practice.
A few patients with definite GHD, however, have other kinds of pituitary-hypothalamic disease. These include patients with Sheehan’s syndrome, autoimmune hypophysitis, or hypophysitis associated with other inflammatory conditions such as sarcoidosis.
Most adults selected for GH therapy should have an easily recognized cause, clear-cut clinical features of the adult syndrome, and non-refundable laboratory evidence of GHD. Such patients clearly have GHD and would most likely benefit from GH replacement therapy.
At this time, the only effective and approved method of application for GH is through injections. Creams and pills are not GH; this represents the delineation between medicine and marketing.
Symptoms and Diagnosing
Darwin’s Theory of Evolution found through natural selection that older organisms make way for newer and better organisms. It is for this reason that the human body naturally slows its production of GH due to “apoptosis, or programmed cell death.” Decreased production of GH is central to people’s ability to pass on their genetic code. Once people reach a certain age, their genetic code is subpar and not essential for the evolution of the human race.
As GH levels naturally decline, the functioning parts of the body begin to decline as well. However, should the patient shows signs and symptoms of a GHD due to a disorder in the pituitary gland, it is necessary to replace what nature is no longer providing. That being said, Pepper, along with the other experts, are not advocates of the cosmetic use of GH to improve skin, muscle tone, or performance; they only deem its use necessary if a pituitary tumor or disorder is present.
In children, GH is most often associated with linear growth, however, linear growth is not the issue. Instead, adults with GHD are fraught with symptoms they may consider signs of old age, including lack of energy, fatigue, muscle weakness, weight gain, sleep problems, and decreased libido.
On the psychological side, they may exhibit shyness, withdrawal, nervousness or anxiety, feelings of sadness or depression, and a sense of hopelessness. An examination of the pituitary gland could find a growth hormone deficiency. In these patients, HGH therapy could make a tremendous difference in their lives.
Because GHD symptoms may mimic that of old age, an endocrinologist must determine the patient’s GH production. Several GH tests stimulate the pituitary gland beyond what it normally produces. These include the use of or a combination of insulin, arginine, clonidine, glucagon, and levodopa.
Another necessary screening test is the insulin-like growth factor (IGF-1), which determines the concentration and adequacy of GH production, according to the American Association of Clinical Endocrinologists (AACE).
There is some debate as to what constitutes a GHD, but the AACE says, “A peak value of less than 5 micrograms per liter after stimulation indicates a growth hormone deficiency. Without clear diagnostic and clinical evidence of GHD, the patient will not be eligible for HGH therapy.”
A GH reading of greater than 5 mg/l (micrograms per liter) appears to be the standard definition of abnormal, but for some, that determination can be as low as 3 mg/l.
If a patient shows a level of 4.8 mg/l of GH, it is generally recommended that a patient undergo an MRI (magnetic resonance imaging scan) to discover or rule out any abnormalities within the pituitary gland. HGH therapy is not something to dispense lightly; great care should be taken before beginning treatment.
GH Dosages
HGH therapy should begin once it has been determined that a patient has definitive clinical evidence of a pituitary disorder resulting in decreased GH production. A patient beginning treatment should start with a low dose to monitor adverse reactions closely.
The usual starting dose is between 0.1 and 0.3 milligrams per day, with doctors assessing their patients monthly and titrating the usual daily doses in increments of 0.1 to 0.2 milligrams per day to the predetermined endpoint, according to the AACE guidelines.
For some, HGH therapy may become a permanent part of their life; for others, a finite treatment regimen may be all that is necessary. A doctor will administer GH on a short-term basis at a certain dosage until the patient has improved their cholesterol, muscle strength, and their general well-being has returned.
Once this has been achieved, they will reduce their dosage to a maintenance level with treatment lasting one to two years.
Before administering the first dose of GH, it is imperative to consider the patient’s age as a determining factor in the susceptibility of side effects, according to the AACE. The AACE’s guidelines for dosages are as follows:
- younger patients require higher doses;
- women require more than men;
- higher doses are needed for oral vs. transdermal or endogenous administration in women taking estrogen;
- the presence of side effects necessitates that dose be reduced;
- transition patients (discontinued GHRT for childhood indications and are being considered for adult GHRT) require the highest dose.
While the patient is undergoing treatment, the physician must exercise good clinical judgment by assessing side effects, serum IGF-I levels, and changes in body composition to determine the appropriate maintenance dose. Serum-free thyroxine and lipid levels should be assessed initially and at six to 12 months.
Side Effects
Expected side effects when beginning HGH therapy include transient headaches, muscle aches, and tissue swelling in the hands and feet. Patients are advised to take over-the-counter pain medication, and if the side effects persist, the GH dosage will be altered to reduce the side effects.
Further Information and Support
An important point to convey to doctors is that it is currently necessary to have a legitimate cause to treat an adult with GH. It is imperative to separate the cosmetic need from the medical need.
If you need some more information on HGH therapy or other hormonal or anti-aging treatments, be sure to contact us now.