Monthly Archives: April 2007

Human Growth Hormone, Testosterone, Estrogen: Healers or Harmers? Part 1.

Let’s face it, nature wants us dead. We were born to die. That may seem a bit harsh but I don’t make the rules. Can the use of human growth hormone and sex steroids help us delay this inevitability? Maybe.

After birth most living things are programmed to develop physically and sexually, to rise to dominance in their environment, pass on their genetic material as fast and as frequently as they can…then die. The species which masters these simple principles rules the earth. As well they have. I refer to cockroaches, ants and other creepy crawlers. Then comes us, the humans. We lag behind because we are slow reproducers and possess a stubborn refusal to die.

I am imagining most of you nodding your head in agreement as you read the programmed stages of life…develop sexually (yes), dominance (yes, yes), pass on genetic material fast and furious (oh yes, oh yes). Then comes the frown and gnashing of teeth… death you say? Death can’t be part of the plan. How could we be programmed to die?

Scientific support for a natural death wish comes from several angles. For example, there is a suicide gene in our cells. The term for programmed cell suicide is apoptosis. When the genes for apoptosis are turned on in a cell, the cell dies. These genes (some are termed “reaper” genes) are responsible for cell suicide. From another perspective we learn that the machinery for cell repair and replication has a built in limit. After a certain amount of replication the cell machinery runs out of supplies and the cell will die. Together these irreversible features of cells guarantee death.

During the development years (up to age 25 or so) the apoptosis genes mostly serve constructive purposes like removing tissues that stand in the way of growth or to prevent cancer cells from reproducing. The chemical messages of growth and development produced in our endocrine glands (known as hormones) are released into our blood in abundant amounts. These hormones include growth hormone, sex hormones (testosterone and estrogen), and adrenal hormones such as DHEA. After that these hormones gradually decrease and our abilities and physical attributes begin to decline.

The role of growth hormone in the adult remains controversial. Once the bones have grown to full adult size some experts claim that there is no other important role for growth hormone. I disagree. There are many tissues in the body that have “receptors” for HGH so that growth hormone can continue to play a role in maintenance of bone, muscle, brain, immune cells and other tissues. I believe that nature intended “growth” hormones to maintain, sustain and repair the body that it helped create during the development years. Without them the aging process through cell suicide, starvation, or disrepair is unopposed, and decline and death are not far behind.

To cripple the body a good starting place would be elimination of the machinery for making the caretaking hormones. The onset of menopause is the most obvious example of natural ending of the hormone making process. The changes of menopause due to estrogen deficiency that occur in the skin, hair, bone, arteries (arthrosclerosis), are all very well known. Not to mention hot flashes, moodiness and loss of libido which reduce the quality of life. Less obvious but just as critical hormonal declines associated with aging are the steady dwindling of testosterone in men, and the reduction of growth hormone and DHEA levels in both sexes.

The questions before us are whether or not replacement of these hormones will delay aging or improve the quality of our lives.

Important Notice: Hormones such as growth hormone, testosterone, and T3 are prescription drugs to be prescribed by a licensed professional within a doctor patient relationship. Prescribing or using growth hormone for the purpose of enhancing athletic performance, or using these hormones without a prescription is illegal and punished by fines and possibly jail. and Dr. Pepper continue to support a lively debate about the appropriate use of these medications to help patients with true medical needs.

Gary Pepper, M.D.

Dr. Perls, I have been called a liar by better men than you!

The Growth Hormone Controversy Gets Hotter

Dr. Thomas Perls says I’m a liar. He didn’t say it to my face but announced it on the CNN T.V. show last night (April 15). He also didn’t address his comment to me personally but rather explained that doctors who prescribe growth hormone to adults to improve their well being (see important notice below), lie to their patients.

Just for the record, I’ve been called a liar by people I respect a lot more than Dr. Perls. So I can shrug off his loudmouth comment, but it did raise my curiosity.

Why would doctors lie to their patients about growth hormone treatment? According to Dr. Perls it’s because growth hormone treatment in adults is a business and doctors are making lots of money giving growth hormone injections. I suppose not making much money on growth hormone treatment also makes me a lousy businessman. I’ve been accused of that too.

To be sure I heard Dr. Perls correctly, this morning I logged on the CNN website. What I found at the CNN website is the following quote from his interview:

‘….”When [clinicians] indicate they’re not seeing any side effects, I simply do not trust them. They’re running a business.” He (Dr. Perls) sighs deeply. “Everyone should stop, because there really is, I think, significant risk of big problems down the road.”

Apparently the CNN editors decided to leave out the “lying” part of Dr. Perls statement.

I’m always suspicious of people who take heroic stands against the evil doing of doctors. Could Dr. Perls have an angle of his own? So I looked up Dr. Perls on the CNN website and found that he was involved with a private company conducting aging research. In fact if you want to volunteer for his research the CNN article from 2001 informs us, ” Perls would like to hear from you at Centagenetix, the new company he’s forming today.”
According to CNN in regards to Dr. Perls’ role in financing research into the genetics of longetivity; “…. (initial discoveries) have made it possible for MPM Capital, a biotech investment firm, to raise the venture capital for Centagenetix.” Recall that Centagenetix is the company Dr. Perls is forming. Later the article explains that among the altruistic activities in Dr. Perls day starting his own company takes a lot of his time; “… as Perls closes the deal on his new company and fields media and peer questions about his research, ” I’m thinking Dr. Perls is sounding more and more like an aggressive businessman promoting himself and his company.

Dr. Perls also wrote a book and runs a website. His book in entitled, Living to 100, Lessons in Maximizing Your Potential At Any Age and his website is Not that I am critical of people who run websites, write books and start companies but here is a man who accused other doctors of running a business which, in turn, requires the doctors to lie to their patients to make money. I am thinking Dr. Perls may have some experience of his own in these matters.

Perhaps one of our readers has more information about Dr. Perls than the CNN articles provide and can help shed some light on his apparent hypocrisy. I remain curious about this man and what is behind the scenes at CNN.

Important Notice: Hormones such as growth hormone, testosterone, and T3 are prescription drugs to be prescribed by a licensed professional within a doctor patient relationship. Prescribing or using growth hormone for the purpose of enhancing athletic performance, or using these hormones without a prescription is illegal and punished by fines and possibly jail. and Dr. Pepper continue to support a lively debate about the appropriate use of these medications to help patients with true medical needs.

Gary Pepper, M.D.

Coming soon on the blog by Dr. Pepper: Doctors who are creeps; be careful of the company you keeps.

Another Thumbs Down for T4/T3 Combination Therapy

In a recent interview with OB.GYN News, Dr. Hossein Gharib, past president of the American Association of Clinical Endocrinologists, and professor at the Mayo Clinic, weighed in with his opinion regarding use of T3 in combination with T4 to treat hypothyroidism (low thyroid function). The doctor’s opinion was that there is no scientific support for the use of combination T4/T3 treatment. He points to several good studies in the last 5 years that fail to show a measurable benefit of using treatment combining the two hormones versus standard T4 treatment alone.

I suppose that wraps it up. At least as far as the professor is concerned.

But statements scattered through the interview provide hints of the expert’s lingering doubt about what is really going on here. For instance, he notes that although most patients do well on T4 therapy alone some still complain of fatigue, low energy, weight gain, or depressed mood despite adequate levels of T4 replacement. Despite acknowledging this widely observed problem the reason for continued complaints remains unexplained. Later he goes on to say that if the patient insists on trying T3/T4 combination therapy despite adequate T4 replacement therapy, he documents the conversation and adds T3 to the therapy. Does his eventual willingness to add T3 suggest an underlying uncertainty about his “scientific” conclusions.

Why would a patient “insist” on combination therapy in the face of such esteemed advice? According to the interview Dr. Gharib believes this misplaced hope is due to the use of the Internet where patients have read that when treating hypothyroidism, mood improvements can be seen after adding T3 to therapy. We are left to assume health information acquired over the Internet is used only by the gullible or neurotic.

What is missing from the interview is the doctor’s experience when he finally breaks down and adds T3 to T4 treatment. I bet the doctor is frequently surprised by the positive outcome of this intervention. If the patient reports improvement is it due to the neurotic expectations of the patient rather then a physical response? All those “good” studies couldn’t be wrong, after all.

I have analyzed many of the studies which focus on combination T4/T3 treatment. It is my opinion these studies aren’t nearly as good as generally believed. At my reviews of these studies are at the following links: , , ,

I believe the flaw in this controversy lies more with the methods of the medical researchers rather than misguided Internet reading patients. The doctor in this interview is a highly regarded and accomplished endocrinologist but not necessarily unaffected by his peers. I have little doubt at this time our “thought leaders” regard T4/T3 combination treatment of hypothyroidism as the providence of the Internet and the gullible. Endocrinologists who disagree with the influential majority by endorsing T4/T3 therapy for treatment resistant patients face the same fate as the caveman in Geico commercials. No respect.

The statements made by Dr. Pepper and associates at are for educational purposes only and should not be viewed as medical advice. Only you and your personal physician can decide on the best treatment for you.

Gary Pepper, M.D., FACP