In previous issues we have explored the hormonal optimization (Interventional Endocrinology) of testosterone and thyroid. Now we are going to move on to what many consider a much more controversial topic, Growth Hormone Replacement Therapy (GHRT). You may have heard or read numerous reports of both the benefits—and risks—of GHRT. Sports enthusiasts have no doubt noticed all the current media hype about its use by athletes (including arrests). More on that later. But what are the facts?
First, what is Growth Hormone (GH)? It is a hormone (chemical messenger) produced by the pituitary gland, which is situated at the base of the brain. GH is largely responsible for growth and development as our bodies mature; this is why a shortage causes dwarfism. But in adult life, GH also helps maintain health and vitality. As we age, its production lessens, as does testosterone, DHEA, thyroid and estrogen (in women); these deficiencies contribute to all manner of illness. Such is the “Neuroendocrine Theory of Aging”, which states we age because our hormones decline, not the other way around.
It makes sense to many, therefore, to supplement GH as we age, thereby treating “Adult Onset Growth Hormone Deficiency”. This is, or SHOULD, be no different than a physician replacing thyroid hormone (see previous article in H&F) in those who are hypothyroid, or insulin in those with insulin dependent diabetes. All cases are merely treating legitimate hormone deficiencies, where the deficiency is well-proven to cause morbidity (illness). Yet, for some reason, GHRT is treated with extreme bias, and, in my professional opinion, to the detriment of the public health.
Studies published in the prestigious New
England Journal of Medicine show GHRT can help you:
Literally hundreds of scientific studies abundantly demonstrate GHRT improves both the quality and the quantity of life, and without any serious or permanent side effects. So what’s the problem?
Many in the conventional medical community insist upon ignoring the restorative benefits of GHRT—while simultaneously greatly exaggerating its risks. For instance, Dr. Schlomo Melmed, who claims to be one of the world’s foremost authorities on hormonal supplementation (he certainly possesses the credentials), recently stated “You can do yourself a lot of harm with GHRT”. And Dr. Thomas Perls, who tries to make similar claims regarding his expertise in this area, even goes so far as to call GHRT “medical quackery”.
What evidence do these “experts” offer to substantiate their position? A look at the scientific studies they argue, when evaluated in a logical, reasonable manner, soon pale to mere examples of inappropriate therapies, unjustifiable comparisons, even outright (and ridiculous) misinformation. The public deserves the truth when medical experts are indeed comparing apples to oranges. Especially given the glowing reports of improvement in QOL (Quality of Life), and health, by those patients who get GHRT.
For instance, studies conducted on mice that either produce no growth hormone, or cannot use that which they do produce, are shown to live longer. Their conclusion is, apparently, that GH is bad for you. If so, why did God put it in us? If you actually read this study, you see they are about a third the size of normal mice, and show little interest in food. So why do GH-deficient mice live longer? Caloric restriction has been shown to extend life in numerous species. But even if caloric restriction allowed us to live to be 200 years old, in the words of Dr. Ronald Rothenberg, “Who wants to be hungry for two centuries”?
And when we look at actual human studies (instead of rodents), those who are GH deficient die at least 20 years before their siblings who are not. A much better comparison, to be sure.
Or how about studies conducted on mice which produce many times the normal output of GH, which is clearly unhealthy in all species. This is comparable to acromegaly (gigantism), which is caused by extremely high natural production of GH, or taking GH at very high doses (like bodybuilders). It’s just not fair, or legitimate, to use the negative effects caused by taking many times the recommended dosages of a drug as evidence that ALL use is detrimental. This is analogous to claiming you should never take two aspirin because taking a whole bottle may kill you.
Another study used to “prove” GHRT is dangerous is one which shows IGF-1 levels (a hormone produced by the liver under GH stimulation) are elevated in men with increased risk of prostate cancer. There is an unwarranted leap in logic in assuming this means GHRT increases the risk of same in the first place. Further, the study shows these men, all into middle age or older, have IGF-1 levels at 500 or higher. I have seen IGF-1 tests on literally hundreds of men that age, and have yet to see a single IGF-1 test that high. Other studies contradict the previously mentioned; indeed, the majority show those with lower levels of IGF-1 (and therefore less GH production) get more cancer.
So the biggest reason offered to NOT administer GHRT is the claim it will increase the risk of cancer. In fact, not one shred of evidence exists to suggest GHRT either causes cancer, or tumor reoccurrence in those previously treated for cancer. Still, the package insert for GH includes this caveat, even though several prestigious physician groups have recommended it be removed due to the totality of evidence to the contrary.
Actually, in GH deficient adults, refusing GHRT is associated with a doubling of cancer risk, and they are four times more likely to die of cancer than the general population. Pretty hard to argue GHRT is a cancer cause then, isn’t it?
The simple fact is there are no substantial adverse effects associated with appropriate GH replacement. But what are the TRUE possible negative side effects of appropriate GHRT? Some may develop tingling or numbness in their fingers or toes (parasthesias). Others may hold a bit of edema (water retention). A few will complain of aching joints. Finally, insulin levels may rise a bit. In all cases, the negative side effects go away when treatment is halted. Usually just reducing the dose a bit is all it takes. Therefore absolutely none of the side effects of appropriate GHRT are serious.
On the other hand, many, many commonly prescribed drugs cause side effects MUCH worse than these—even risk killing the patient--yet are still routinely, and chronically, administered. In all cases, it’s a matter of the risks versus the benefits. But let’s make sure we are comparing similar fruits.
A twenty year old with pituitary disease would certainly be treated with GH. However, a 60 year old with the same level of GH is not. Why should that be? Opponents of GHRT cast dispersions because of the “side effects” of GHRT. So why, then, would they automatically provide it for the 20 year old? Hmmm…
And why would so called “experts”, such as Drs. Melmed and Perls, go to such extraordinary lengths to impugn legitimate GHRT, in the face of these simple and undeniable facts?
In a future article we will look at the use of GH—at high doses--in sports. In particular, the cases of pitcher Jason Grimsley, of the Arizona Diamondbacks, recently busted when a search of his home yielded a large stash of GH; David Segui, who claims high dose GH Therapy restored his life following an injury-plagued fifteen year professional baseball career; and Jose Canseco, who purports a desire to serve as an “ambassador” for the use of steroids and GH for sports injury rehabilitation (frankly, most of us in my field would probably prefer to NOT be associated with the likes of Mr. Canseco). The future of GH Therapy for rehabilitating injuries is indeed bright—but what are the REAL dangers of such high dose therapies, and what effects will same have not only on the sports community in particular, but our society as a whole? We’ll also include an interview I did of my friend and colleague Dr. Mark Gordon (recently featured on the July 3, 2006 episode of ESPN’s “Outside the Lines”), a legitimate expert in GH Therapy, about GH uses in both Anti-Aging and Sports Medicine. Stay tuned!