Should Adults Receive Growth Hormone Treatment?
The controversy surrounding growth hormone use in adults deepens. Recent editorials in the prestigious New England Journal of Medicine have taken a negative view of growth hormone supplementation for adults. Dr. Mary Lee Vance comments, “general use (sic- of growth hormone therapy in adults) now or in the immediate future is not justified.”
My medical practice has recently received a letter from a major health insurer, United Health Care, stating that growth hormone use in adults will no longer be a covered medical therapy. When asked for justification of this curtailment of financial support for growth hormone therapy health insurers are certain to point to comments from experts such as Dr. Vance.
One of the reasons for the backlash against growth hormone therapy is the explosive proliferation of individuals and companies promoting their own propriety brands of growth hormone substitutes and so-called growth hormone releasers. We receive 10 or more emails daily marketing growth hormone related products. Unfortunately, most of the claims for these products are simply false or at best, unsubstantiated. Only injected prescription growth hormone made by major pharmaceutical companies can be expected to fulfill the goal of growth hormone supplementation. Making matters worse for supporters of growth hormone therapy in adults is that legitimate growth hormone products themselves can be abused for perceived benefits to athletic ability and cosmetic appearance.
Why all the fuss about growth hormone? Is it truly capable of making us stronger, leaner, more energetic, and happier? Dr. Vance and her colleagues point out the lack of large studies which provide the answers to these questions. There are, on the other hand, smaller studies showing improvements in bone density, lean body mass and measures of well being associated with growth hormone therapy. Because of the limited amount of large studies evaluating growth hormone use in adults can we still justify our use of the hormone? As a practicing endocrinologist I have to answer these questions so I can provide my patients with the best existing therapies for their problems.
What exactly is growth hormone? It is a protein based hormone made by the pituitary gland which circulates in our blood in abundant amounts during the first twenty years of our lives but levels then slowly decline as we get older. Growth hormone controls the liver’s production of IGF (insulin like growth factor), formerly known as somatomedin, which stimulates the growth of cartilage which in turn results in increasing size of our bones. Growth hormone also appears to play a role in maintaining muscle mass and probably has multiple functions within the central nervous system (the brain and spinal cord).
If growth hormone is so important to general health why do levels drop off as we age? The decline in growth hormone levels with aging is mirrored by a decline in a host of other critical substances which maintain our health, such as DHEA (from the adrenal gland). One possible reason for the drop in these beneficial substances is for the plain and simple purpose of promoting our aging and eventual death. The survival of our species requires the removal of the old genetic material (use) so it can be replaced by the new (and possibly improved) genetic material (our offspring). Aging and death are required by the laws of evolution and therefore our bodies are programmed to self-destruct. The decline in growth hormone may be one way to serve this purpose.
Growth hormone is expensive. A year’s supply may cost up to 10 thousand dollars making economics another key element in the growth hormone controversy. How can we justify spending this amount of money on everyone who wants to prolong their strength and vitality? Forget about justify…our economy simply can’t afford this expenditure. Who will then decide who gets growth hormone and who won’t? I don’t have the answer either.
In the face of controversy what would be a reasonable approach for the practicing physician to follow? The first principal is to administer growth hormone only to those fail to make a minimum acceptable quantity of the hormone. If a patient is suspected of having growth hormone deficiency based on their history and physical exam a check will be made of the level of morning growth hormone and IGF. If the growth hormone is in the low normal range (below 2) the next step is a stimulation test to see whether the pituitary gland can be forced to release its store of the hormone. There are several tests which stimulate the pituitary release of growth hormone but the simplest is to administer L-Dopa (a prescription drug formerly used to treat Parkinson’s disease) by mouth and measure growth hormone levels in the blood over the next 2 hours. If the level remains below 5, growth hormone deficiency can be diagnosed.
Growth hormone deficient adults are given significantly smaller doses of growth hormone as compared to children being treated to achieve normal height. Even at these lower doses impressive improvements in mood and energy can be achieved. It is hard to measure these effects but statements such as, “Growth hormone changed the quality of my life. The strength and energy I used to have is back in full”, have been use by patients to describe their results.”
What about side-effects from growth hormone treatment in adults? Minor joint pains, carpal tunnel like symptoms, headache, and traces of swelling at the ankle have been described. Unfortunately, experts such as those quoted in the New England Journal use ominous tones when referring to growth hormone side-effects or to the possibility of its causing cancer or cardiovascular disease. These warnings remain largely unsubstantiated by even small studies.
In my practice I generally follow a year or two of treatment with growth hormone followed by 6 months off, simply to defer to the possibility of accumulating negative effects of prolonged GH therapy. The medical community is still waiting the ultimate word on growth hormone therapy in adults but based on reputable studies and my own observations I will continue to offer this treatment to my patients who exhibit the signs, symptoms and blood test evidence of growth hormone lack. As with any medical treatment it is important for each individual to consult with their own physician before embarking on any course of therapy.
I have a silly question. I have been researching about growth hormone treatment in adults (I am 31 years old) but all I have found is that is good to give strength and such- mostly cosmetic issues. Is this treatment also effective for growth?
I have Turner’s syndrome and I am only 4′3″. I am from Ecuador and was there when diagnosed. The doctors recommended this therapy but my mom decided against it. She was afraid of hormone treatments so she did not give me the chance. I know it may be too late- but was wondering if I should pursue any treatment now that I am an adult. Would you take the time and email me a quick answer? Thanks!
Ta Ga
Once the bone has finished growing the use of growth hormone will no longer create increased height.
At the end of all long bones like the ones in your legs, is a “growth plate” where all new growth occurs. During active growth this growth plate is “open”. Once we reach maturity, usually a few years after puberty starts, these growth plates fuse and are then “closed”.
A radiologist can take an x-ray of the wrist and tell whether the growth plate is open or closed. Since all growth plates close more or less at the same time, if the wrist is closed so are the growth plates in the legs which are responsible for height. At the age of 31 unfortunately there is little hope that these growth areas would still respond to growth hormone.
Gary Pepper, M.D.
I am 18 year old male, and i really want to grow taller though for cosmetic purpose only.
i have alrady grown upto 5′9 but seriously want to achive a height of 6 feet . Sometimes i really fell short and that harms my self esteem also. Please tell can i grow with the help of growth harmone therapy ? And if i take the therapy what would b the side effects ?
Please advise me all the pros and cons of the treatment.
Thank You.
i am 19 yr old and i’m 5.3 can i grow taller my father is tall my mother is short… i allways do streching and take vitamins like cherifer….doc wat is your good advice.. tnx
Is there a chemical difference between synthetically produce HGH and the growth hormone produced by the pituitary gland? If so, could this difference be behind the negative side effects of growth hormone treatment?
Also, how prevalent is the occurance of acromegaly in people taking growth hormone injections?
hi i am 16 and i am 4ft 9″. I started my periods when i was 9 and a half years old and would like to grow taller. Is there any chance of me growing at all with the help of growth hormone?
thanx
Hi Samirah,
I’d recommend posting your question in the forums so it can be seen by the experts here at Metabolism.com
Thanks,
Brian
Hi, I’m 5′8 17 1/2 years old and was wondering is it possible for me to reach 6 foot with HGH injections? My mother is 5′1 and my father is 5′6.
Im 22 years old , just 152 cm tall…,I seriuosly am mentally affected that i do not posses at least miniimum average growth, I fail to socialise with people due to this fact and also my relationship in highly affect and my life in dissapointing and imbalance.
I wish to achieve some hieght,,please reply
I so waiting for it
thank you.
Hi I am 20 years old and barely 4ft 10in. I did not start my periods until age 18. I was wondering if there is hope for growth. I am really hoping i can still grow some how. Is it possible to grow any taller
Thanks
hi im going to turn up 21 this year and im barely 5*7 and i cant just live with myself and im thinking of taking growth hormones for height purpuse, i know a few people at my age who have taken some and grew up max about 9, 10 CM should i take it to??
I just found out I have aghd.I am 5′3 and aged 22,and a female will ght make me any taller?
hi im 28 years old im very attractive but im only 5′1 and im still taller than my mom and aunt so im not sure if i can get taller jus by takeing growth hormones but i would like to be about 5′4 atleast what would be the best product for me as a black woman
Hi, I’m 5′6 18 1/2 years old and was wondering is it possible for me to reach 6 foot with HGH injections? My mother is 5′1 and my father is 5′7.
I’m 21 years old and am only 4 “10. Is there any way that HGH injections could help me grow a couple of inches? Please respond back to my question because I need to know if its too late since I already hit puberty.
Lorraine
From the time of birth we grow rapidly in good part due to the action of growth hormone which is released from the pituitary gland.
At puberty the release of testosterone in boys and estrogen in girls begins the process of final bone maturation. Children often experience a period of rapid growth known as a growth spurt at this time. Girls usually complete their growth spurt within a year or two of their first menstrual period. Boys tend to finish their growth phase when they are older compared to girls.
Growth ends because the areas of the bones known as the growth plates become sealed or fused. After that growth hormone has little effect to cause increased height. Bones in the face, feet and hands may still be susceptible to growth effects of growth hormone, with not particularly desirable results.
An adult who has not grown in a few years cannot generally get taller in response to growth hormone due to the fusion of their long bones. Taking HGH at this time is unlikely to give the height you desire.
Growth hormone later in life is likely to have other non-growth related benefits like preserving muscle and soft tissue and perhaps other general maintenance functions in the immune and central nervous systems.
I hope that helps answer your questions.
This information does not substitute for the advice of your own physician and is for general learning purposes only.
Dear Mr. Pepper, First of all thank you very much for this great journal which have already lightened me on the growth issue.
I am 26 years old boy. I am now 173 cm ( 5′7 f). But in deed I was able to reach max up to 160 cm until age 18. But after 20 years old I have started to grow rapidly. In the same time I was using Pharmaton vitamin. And I have continued to grow until 23 years old and reach to 173. Is there any relations between growth and Pharmaton vitamin ?
So I wonder that if the bones growth plates become sealed then, how was I able to grow until age of 23?? .
And if so, I think I can still grow by using GH. Please let me know if it will work or not.
And other question is:
Does GH used for Anti-Aging by keeping the body’s metobolism active? I mean keeping the formation of new cells. Because As I read from a journal, the GH propogates the formation of the new cells, so that slows the aging.
Thank you very much in advance for your kind help and answers.
Dear Dr. Pepper, My daughter is 13 years old and started puberty at 11. But since then, she has not grown and stayed at 150cm. We saw an endocrinologist and was informed that the left wrist bones are 98% fused and has at the most 1cm to grow. MRI showed minor adenoma of 4mm. Father’s height is 177cm and mother is 158cm. So, she has the potential to reach 160cm. Will GH or Bromocriptine help her to grow to reach her potential? Also, the endocrinologist suggest that GH will not help and will only grow cartilages like nose at this point. All her blood tests are normal except for decreased FSH. What is your opinion please?
Bone growth during childhood is controlled by IGF-1 (insulin like growth factor-1) in the blood. Growth hormone from the pituitary gland is the hormone which causes the body to make IGF-1, so if growth hormone is lacking, normal bone growth cannot occur. Once puberty occurs the ability of the long bones (arms, legs, etc) to grow in response to these hormones begins to decline. Around one or two years after puberty in girls, due to maturing of the “growth plate” of the bones, growth hormone even in adequate amounts no longer can cause bones to lengthen.
From what you describe your daughter is 2 years into puberty and past the age where growth hormone can increase height, as explained by your endocrinologist.
What remains unanswered is whether your daughter is actually growth hormone deficient. I imagine she had growth hormone and IGF levels measured, correct? Also, what is the significance of the microadenoma. Many of these have no effect on the pituitary, hormones etc. but sometimes they can produce hormones which can disrupt normal body function. What were you told about your daughter’s case?
As you know these comments are for general educational purposes and are not meant as medical advice.
Gary Pepper, M.D., Editor-in-Chief, Metabolism.com
Dear Dr. Pepper, Thank you so much for your comments. Yes, we did measure her IGF Levels – IGF -1 = 650, IFG-2=800 – which I presume is normal for a girl at 13 years old. But her FSH is below normal range at 0.37. A MRI was conducted to further aid the diagnostics and confirmed the 4mm adenoma. So, it is apparent that she is not growth hormone deficient but the endocrinologist suggest that she may be growth hormone resistant. This is the reason that she has not grown since the beginning of puberty? The questions asked by the endocrinologist include whether there are any nipple discharge or vision problems and all these are negative. Her LH and Cortisol are all normal. Her endocrinologist has ordered test on IGF-1, IGFBP-3, and Prolactin. As there are also ACTH type of adenoma, I am wondering whether it is wise to do that too. Out of curiosity, can stress cause the development of adenoma, especially kids are so stressed out these days? As you indicated, since she is 2 years into puberty, she will probably not respond well to IGFD but should we be hopeful for a limited dose to get the last opportunity for 1-2 inches of growth?
Again, thank you very much for your kind comments, attention and this wonderful journal.
ACTH secreting microadenomas create cortisol excess (Cushing’s disease). This will be relatively easy to detect by obtaining a 24 hour urinary cortisol level. Other ways are measuring salivary cortisol at midnight which should be close to zero normally. High midnight levels favor the diagnosis of Cushings. I favor the urine test myself. Clinical signs of Cushings are central obesity, purple stretch marks on the skin, easy bruising, excessive facial and body hair growth, high blood pressure and high blood sugar. These indications are hard to miss, so if none of these match your daughter’s condition chances are she doesn’t have Cushings.
Whether it is worthwhile to try GH treatment for an inch or two is pretty much a personal decision between your family and your doctor.
If your daughter is having a regular menstrual cycle the low FSH is probably of no clinical significance, in my opinion.
Let us know how things turn out. Best of luck.
Dr. P.
Hi i am 19 years old and am bout 5 foot 9 if i were to under go treatment would i grow any taller?
hi im 19 yrs old i wanted to know if i can reach 5 7 by hgh .. im 5 5 ryt now
thank you