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Human Growth Hormone


Consultant:Edward M. Lichten, M.D.,P.C.
29355 Northwestern Hwy. Suite 120
Southfield, Michigan 48034
It is a fact that we are going to grow old. In fact, with the ‘baby boomer’ generation approaching their mid 50’s, the number of elderly Americans are substantially increasing. Then, why does it have to remain a fact that we will grow old in exactly the very same way our forefathers did before us: frail, confused, weak, fatigues, depressed, afraid to walk outdoors for fear of falling on the pavement?
There is an old adage that states that...... Youth is wasted on the young.
If this is true, why should it follow that experience and financial security are 'wasted on the old’ because they have lost the energy and enthusiasm to enjoy the 'golden years?'
This does not have to be the case. For we have come to learn that old age is simply a state of hormonal deficiency, a state of lacking the previously bountiful hormones of youth. Then it follows that, these symptoms of ‘old age’ are actually symptoms that can be reversed.
Leading the list of the age-depleted hormones that can be replaced and provide for longer, healthier, and more productive lives is the human growth hormone (HGH). One of the most incredible points to make about HGH is that it is not really incredible! Growth hormone is natural; it is plentiful in the human body during youth. In fact, it is a substance that actually retains the properties of youth, but lessened with age.
Growth hormone is essential to growth. It is a supplement given to children who suffer with abnormally slow bone growth to enable them to grow taller. But HGH levels fall steadily in everyone once they reach adulthood. Since we now realize that HGH is indispensable throughout life, it must be considered a vital hormone for maintenance of the adult body. Studies of its amazing effects in the elderly population supports its primary role in improved longevity and the betterment of the quality of one’s life.
Produced in the anterior section of the pituitary gland deep in the brain, HGH is a microscopic protein substance. Chemically, it is somewhat similar to insulin although it is secreted in short pulses during the first hours of sleep and after exercise; it only remains in the circulation for a few minutes. As such, it is extremely difficult to measure HGH in blood serum. However, the body binds most of the growth hormone in the liver and converts some into Somatomedin-C, another protein hormone also called Insulin-like Growth Factor- I (IGF-I). Since Somatomedin-C remains in the blood stream for 24-36 hours, a blood sample identifying Somatomedin-C will be a more dependable indicator of competent HGH production. Normal Somatomedin-C blood levels in adults range from 200 to 450 ng/ml (nanograms per milliliter). Yet, one-third of individuals over 50 years of age show abnormal levels less than 200 ng/ml. During the growth spurt of youth, HGH levels are maximum and the Somatomedin-C will be measured well over 600- 800 ng/ml. Yet for normal men and women under 40, less than 5% have levels below 250 ng/ml! After 40 many men and women have the same amount of HGH as an octogenerian! And that may be the key to aging as we now know it!
When one’s Somatomedin-C level falls below the adult normal range, his/her muscle and bone strength and energy levels most likely will decrease. Tissue repair, cell regrowth, healing capacity, upkeep of vital organs, brain and memory function, enzyme production, and revitalization of hair, nails and skin will also diminish. While aging and decreasing growth hormone levels go 'hand-in-hand' those who lose their pituitary production of HGH due to surgery, infection or accident, instantly suffer many profound, ill effects.
It is important to reiterate that HGH will decline in everyone as they age!
In those who have no pituitary function, there is a shift in body composition whereby body fat increases by 7-25% while lean body mass decreases similarly. Muscle strength and muscle mass are noticeably reduced. Bone density studies indicate long bone density and spinal bone density decrease as significantly as if the individual had aged 15 years. Pronounced weight gain of 30-50 pounds occur when HGH wanes. Furthermore, there are negative effects on cholesterol; triglyceride levels increase while high density cholesterol (HDL), a ‘good cholesterol’, decreases. Increased risk of cardiovascular disease may be related to vascular wall thickening and changes associated with decreased cardiac output. Such insufficiencies may contribute to these people reporting a rapid decline in exercise capacity and early deaths from heart disease. They also report an impaired sense of well-being and symptoms of fatigue, social isolation, depression and a lack of the ability to concentrate.
New Hope for Growth Hormone Deficiency:
F.D.A. Approves HGH for Adult Use!
Recombinant human growth hormone has been approved by the Food and Drug Administration for adult men and women in the treatment of hypopituitarism and somatotropin deficiency. If one suffers with hypopituitarism, HGH therapy is available as normally payable under an insurance policy. As part of our Hypopituitary Registry, patients receive HGH replacement therapy and testing under supervision. Based on the literature and our experience with HGH replacement, the positive changes noted may also apply to individuals with low growth hormone levels. The term used is somatotropin deficiency syndrome. We also treat individuals with Somatomedin-C (IGF-I) levels below 200 ng/ml with recombinant HGH in our I.R.B. approved registry. But, such individuals personally pay for HGH.
Note that by combining 'global hormonal' replacement therapy of DHEA, pregnenolone, thyroid, testosterone, estrogen, and progesterone when indicated with HGH, the dosage, costs and side-effects are minimized.
Changes with Growth Hormone Replacement
Body Composition
Growth hormone therapy results in profound changes in body composition: fat mass is reduced while lean body mass increases. Growth hormone, at the relatively low dose of 0.003mg/kg was shown to normalize lean body mass over 6 months in 24 adults with HGH deficiency(1). The improvement in lean body mass is associated with increased protein synthesis, muscle mass and muscle function. Total body fat also decreases after 6 months of HGH administration. The decline in fat mass is most significant in the lower abdomen and trunk, compared to the arms, neck and legs. This suggests that HGH replacement therapy may reverse the central abdominal fat mass associated with HGH deficiency and decrease an individual’s cardiovascular risk(6).
*DEHYDRATION..............................................................*IMPROVED FLUID BALANCE
*REDUCED BONE DENSITY.........................................*REVERSAL OF OSTEOPOROSIS?
*PSYCHOSOCIAL DEFECTS:......................................*SENSE OF WELL BEING
*CHRONIC LUNG DISORDERS..................................*IMPROVED LUNG FUNCTION
*VITAL ORGAN SHRINKAGE....................................*REGROWTH OF VITAL ORGANS
.............................................................................................*SPEEDS POST-SURGICAL HEALING

Cardiovascular and Lipid Metabolism
HGH replacement in adults may have a beneficial effect on lipids. In a recent study, it was reported that short courses of HGH reduced LDL (bad) cholesterol(7) while it improved exercise capacity and cardiac function. Patients showed increased oxygen uptake and power output during cycling. HGH is associated with increased muscle mass and longer and stronger action on the treadmill.(8) Recent work by Fazio demonstrated an improvement in heart failure patients given high dose HGH replacement.(9)
Bone Density
One of HGH’s most dramatic effects is on the connective tissue, muscle, and healing potential of the skeletal system. Fragile skin with ulcers, fractured bones that do not heal, and profound gains in muscle strength have been noted. Not only does the skin look younger with less wrinkles, some report a regrowth of hair on the head. For growth hormone, DHEA, and testosterone are clearly anabolic hormones: they build tissue. And with increased age, our bodies break down tissue faster than we can repair them. This is called catabolism. Therefore, HGH tends to reverse the catabolic state.
The potential role of HGH in the maintenance of the skeleton is its ability to make and repair these tissues. HGH stimulates osteoblast (bone) and fibroblast (supporting tissue) proliferation[8]. In a recent study using the sensitive techniques of quantitative tomography and single photon absorptiometry, significant increases of 5% and 4% were demonstrated in spinal and cortical bone density over 12 months of therapy in HGH-deficient adults(4). It thus appears that HGH administration may act to improve skeletal repair of not only bone and skin but all organs as well.
Other anabolic effects include a gain of muscle and renewed appetite, better exercise capacity, increased lung capacity, and faster wound healing. Many report there 'old age spots', skin "senile keratosis" disappear within two months of HGH therapy.
Side Effects with Low Dose HGH Replacement
The dose of recombinant HGH is an important consideration in the therapy of acquired HGH-deficiency. Large, pharmacological doses of HGH are often associated with the clinical signs of HGH excess, including fluid retention, carpal tunnel, and hypertension. However, by incorporating smaller, physiological such symptoms are not noted. At a dose of 0.03mg/kg/week, Bengtsson et al. demonstrated only minor side effects including slight fluid retention and mild joint pain. There was only one reported incident of carpal tunnel syndrome6. In all cases, further reduction of the HGH dosage resulted in the elimination of side effects. In another recent study in which a smaller dose of HGH was used, 0.01 mg/kg was administered three times per week without any reported side effects(8). Multiple studies support the conclusion that low dose HGH replacement is associated with minimal side-effects.
Positive Effects of HGH Replacement
Get Lean: Loss of fat and increase in muscle mass combine for up to 20 pound shift in body composition. This equates to a general feeling of physical well being, a stronger libido, and improved self image.
Get Energetic: Without a need for the afternoon food cravings of sweets, caffeine, stimulants or nicotine, HGH patients have more energy. This improves both their self control image and their general health state (because they exercise).
Get Smart: An interesting yet unproved side-effect of HGH has been the return of mental acuity and a "sharp" memory. Such HGH improves the vascular and intracellular nutrient support for cells, it is not surprizing that this has been reported by many individuals.
Future Directions
Important issues remain as to the precise clinical definition and best treatment of partial vs. complete HGH deficiency. In addition, it is unclear whether some of the observed beneficial effects of HGH replacement will be seen with the low dose, combination therapies. Nevertheless, it is already apparent that even these small doses, unassociated with symptoms of HGH excess, may be enough to achieve desired metabolic results. We hope that our registry and continued research will help define specific recommendations for dosage and any long term beneficial effects of HGH therapy, specifically with respect to cardiovascular morbidity and generalized mortality.

Salomon F, Cuneo RC, Hesp R, et al. The Effects of Treatment with Recombinant HGH on Body Composition and Metabolism in Adults with Growth Hormone Deficiency. New Eng JMed1989;321:1797-03.
Bengtsson BA. The Consequences of Growth Hormone Deficiency in Adults. Acta Endocrin 1993;128:2-5.
Cuneo RC, Salomon F, Wiles CM et al. HGH Treatment in GH Deficient Adults. II. Effects on Exercise Performance. J Appl Physiol 1991;70:695-700.
O’Halloran DJ, Tsatsoulis A, Whitehouse RW et al. Increased Bone Density after Growth Hormone (HGH) Therapy in Adults with Isolated HGH Deficiency. J Clin Endo Metab 1993;76:1344-48.
McGauley GA, Cuneo RC, Salomon F et al. Psychological Well-Being Before and After Growth Hormone Treatment in Adults with HGH Deficiency. Hormone Research 1990;33(Suppl 4):52-54.
Bengtsson BA, Eden S, Lonn L et al. Treatment of Adults with Growth Hormone (HGH) Deficiency with Recombinant (HGH).J Clin EndoMetab1993;76:309-17.
Johnston DG, Bengtsson BA. The Effects of GH and GH Deficiency on Lipids and the Cardiovascular System.Acta Endocrinologica 1993;128(Suppl 2):69-70.
Amato G, Carella C, Fazio S et al. Body Composition, Bone Metabolism, and Heart Structure and Function in Growth Hormone (HGH)-Deficient Adults Before and After HGH Replacement Therapy at Low Doses. J. of Clinical Endocrinology&Metabolism. 1993;77:1671-76.
Fazio S, Sabatini D, Capaldo B, A preliminary study of GH in the treatment of dilated cardiomyopathy. New Engl J Medicine.1996;334:809-14.

The information in this newsletter does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice.

The materials within this newsletter are copyrighted under the statutes of the State of Michigan. For additional copies contact:
Edward M. Lichten, M.D., P.C.
29355 Northwestern Hwy, Suite 120,
Southfield, Michigan 48034
phone 1(248)358-3433. ***

Correspondence by E-mail to:
office fax: 1(248)358-2513

Installed: January 5, 1997
Updated: January 10, 2000
1: Am J Med 1998 Mar;104(3):227-31

A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia.
Bennett RM, Clark SC, Walczyk J
Department of Medicine, Oregon Health Sciences University, Portland 97201, USA.
PURPOSE: The cause of fibromyalgia (FM) is not known. Low levels of insulin-like growth factor 1 (IGF-1), a surrogate marker for low growth hormone (GH) secretion, occur in about one third of patients who have many clinical features of growth hormone deficiency, such as diminished energy, dysphoria, impaired cognition, poor general health, reduced exercise capacity, muscle weakness, and cold intolerance. To determine whether suboptimal growth hormone production could be relevant to the symptomatology of fibromyalgia, we assessed the clinical effects of treatment with growth hormone. METHODS: Fifty women with fibromyalgia and low IGF-1 levels were enrolled in a randomized, placebo-controlled, double-blind study of 9 months' duration. They gave themselves daily subcutaneous injections of growth hormone or placebo. Two outcome measures--the Fibromyalgia Impact Questionnaire and the number of fibromyalgia tender points-were evaluated at 3-monthly intervals by a blinded investigator. An unblinded investigator reviewed the IGF-1 results monthly and adjusted the growth hormone dose to achieve an IGF-1 level of about 250 ng/mL. RESULTS: Daily growth hormone injections resulted in a prompt and sustained increase in IGF-1 levels. The treatment (n=22) group showed a significant improvement over the placebo group (n=23) at 9 months in both the Fibromyalgia Impact Questionnaire score (P <0.04) and the tender point score (P <0.03). Fifteen subjects in the growth hormone group and 6 subjects in the control group experienced a global improvement (P <0.02). There was a delayed response to therapy, with most patients experiencing improvement at the 6-month mark. After discontinuing growth hormone, patients experienced a worsening of symptoms. Carpal tunnel symptoms were more prevalent in the growth hormone group (7 versus 1); no other adverse events were more common in this group. CONCLUSIONS: Women with fibromyalgia and low IGF-1 levels experienced an improvement in their overall symptomatology and number of tender points after 9 months of daily growth hormone therapy. This suggests that a secondary growth hormone deficiency may be responsible for some of the symptoms of fibromyalgia.
Publication Types:
   Clinical trial
   Randomized controlled trial
PMID: 9552084, UI: 98211811