Growth Hormone is a polypeptide hormone. This means it is composed of a long chain of amino acids, 191 to be exact. Under normal physiologic conditions, growth hormone is secreted by the anterior pituitary gland. This is a gland that lies at the base of the brain in a bony cavity called the Sella Turcica. In addition to growth hormone, the anterior pituitary also secretes prolactin, thyroid stimulating hormone, luteinizing hormone, follicle stimulating hormone, and adrenal corticotropic hormone. The secretion of growth hormone by the pituitary gland is initiated by the hypothalamus, another gland in the brain that lies right next to the pituitary. The hypothalamus initiates growth hormone secretion by secreting growth hormone releasing hormone (GHRH); at the same time it stops secreting a growth hormone inhibitory hormone called somatostatin. When somatostatin is turned off and GHRH is turned on, the pituitary will release growth hormone in bursts of activity.
These bursts of growth hormone release occur primarily during deep stages of sleep, such as stage 3 and stage 4. Once released in the blood, growth hormone is very short lived. It is generally completely metabolized and gone within a half-hour. During that time, however, it manages to reach the liver and many other cells in the body, and induce them to make another polypeptide hormone called Insulin-like Growth Factor One (IGF-1). It is really IGF-1 that travels around to the various tissues of the body to effect most of the benefits that we attribute to growth hormone. The secretion of growth hormone itself is regulated by a classic biofeedback loop. This means when levels of growth hormone in the blood reach a certain threshold, growth hormone stimulates receptors in the pituitary to stop further growth hormone secretion. It also stimulates receptors in the hypothalamus to stop GHRH and turn on somatostatin. IGF-1, which goes up in response to growth hormone, also feeds back on the pituitary and hypothalamus to help control growth hormone secretion. This is nature’s system of checks and balances to assure we don’t have too much of any one hormone.
The nomenclature for growth hormone is a bit complicated, but understanding it from the beginning can save much confusion in the future. Somatropin refers to growth hormone of the same amino acid sequence as the naturally occurring growth hormone. Somatropin extracted from the human pituitary gland was originally designated (hGH, or pit-hGH). Manufactured growth hormone is made by recombinant DNA technology. This is a system of genetically modifying either bacteria cells or mammalian cells in tissue culture so that they include in their genome, the gene that directs the cell to make human growth hormone.
As the cells in the tissue culture grow and function, they will synthesize human growth hormone by the exact same process in the human pituitary. Since this is a natural process, human growth hormone is not considered a synthetic. The proper abbreviation for manufactured (recombinant) human growth hormone is rGH. Unfortunately, the abbreviations have been misused even in the medical community, and recombinant human growth hormone is commonly represented by the abbreviation hGH. The designation is no longer critical since human growth hormone of pituitary origin is no longer used in the United States, or anywhere in the world that I’m aware of. The term hGH or GH therefore, refers to human growth hormone from recombinant DNA technology. It is pure and 100% free of any contaminants or micro-organisms.
Prior to the advent of recombinant DNA technology, the only source of growth hormone was from human cadavers. More than 27,000 children worldwide were treated with growth hormone of this source (pit-hGH). Due to short supply, children were treated with low doses and interrupted regimens. As a result, their response and ultimate height was mitigated. Distribution of pit-hGH was stopped in the United States and most of Europe in 1985, with the emergence of Creutzfeldt-Jakob Disease. This is a rare and fatal spongiform encephalopathy, caused by a small pathogen called a prion. This is the same pathogen that causes “Mad Cow Disease” recently seen in Europe from infected cattle. It is impossible to catch Creutzfeldt-Jakob Disease or any other infection from recombinant human growth hormone because it is not derived from a human or animal source, but from a purified tissue culture. For purposes of this discussion, the term growth hormone, GH or hGH will mean growth hormone made by recombinant DNA technology.
The bio-potency of commercially available growth hormone is typically represented by either milligrams or units. To put it simply, 1 milligram of growth hormone is equivalent to 3 units. The international units were developed by the World Health Organization in order to standardize growth hormone preparations because of the various production techniques used early on in the manufacturing process. By now, the manufacturing process has been streamlined and largely perfected so the bio-equivalency of the various brands of growth hormone (at least those manufactured and approved by the FDA for sale in the United States) are identical. Therefore, a typical 15-unit vial of growth hormone contains 5 mg, and a 4-unit vial contains 1.33 mg.
USES OF GROWTH HORMONE
Growth hormone was initially used for children of short stature who are growth hormone deficient, either because of an inactive pituitary, a tumor of the pituitary, or destruction of the pituitary by surgery or by radiation to remove a tumor. The other pituitary hormones were replaced along with GH. Growth hormone was used only until the children reached an acceptable adult height and then it was stopped because it was thought to be useful only for growth. The other pituitary hormones, however, which were thought to be more critical, were continued throughout adulthood. It wasn’t until much later that adult growth hormone deficiency was recognized to be a problem. It was discovered that adults who were deficient in growth hormone suffered from premature cardiovascular disease, reduced bone density, central obesity, decreased muscle mass, depressed mood, elevated levels of LDL (bad) cholesterol, slower wound healing, fatigue, poor exercise tolerance and poor immune function. At that point the use of growth hormone began in this unfortunate population, resulting in improvement of all of the above. It wasn’t until 1990, however, that the benefits of growth hormone and the treatment of normal aging were recognized. The most recent new use of growth hormone is for the treatment of AIDS Wasting Syndrome. This is the condition of weakness, fatigue, and loss of muscle mass in AIDS patients.
Somatopause is an extrapolation of the term “menopause.” Menopause is the condition in women whereby the ovaries atrophy and cease to produce the sex hormones Estrogen, Progesterone and Testosterone. Somatopause signifies the gradual decline in growth hormone production by the adult pituitary gland in both men and women that begins at approximately age 30 and continues at a steady rate throughout life. The decline in growth hormone level that occurs with Somatopause is accompanied by deterioration in the structure and functional capacity of our body, which is ultimately devastating to the human condition. In fact, there is absolutely no difference between the clinical signs and symptoms of aging and those of adult growth hormone deficiency described above. The late Dr. Daniel Rudman first described the benefits of growth hormone therapy in normal aging adults. Dr. Rudman published a landmark article in the New England Journal of Medicine on July 7th, 1990. In his article, Dr. Rudman showed that by putting healthy aging men on growth hormone for six months, he was able to decrease their body fat by 14.4%, increase muscle mass by 8.8%, increase skin thickness by 7.1%, and increase lumbar bone density by 1.6%. These exciting findings clearly inaugurated the movement to supplement growth hormone in healthy aging adults, which today is becoming commonplace.
Growth hormone can be given either subcutaneously or by intra-muscular injection with equal therapeutic activity. Subcutaneous administration is now used almost exclusively because intra-muscular administration is fraught with an increase in side effects without any additional therapeutic benefit. Back in Dr. Rudman’s time, growth hormone was typically dosed three times a week in what we now consider a high dose regimen. People would typically receive 12-18 units per week given in injections of 4-6 units, three times a week. Although great benefits were seen, side effects were very common, and much more bothersome than those we see today. Currently we use only about half the weekly dose used in Dr. Rudman’s study, by smaller and more frequent injections, which provide both a better clinical response and far fewer side-effects. In one study on growth hormone deficient children, those that received daily injections increased their height during the study period by 9.7 centimeters more than those who received thrice-weekly injections.
The reason for this has to do with the biofeedback mechanism for growth hormone. Most of our natural pituitary growth hormone secretion occurs at night during deep stages of sleep. Injecting growth hormone at night raises the serum level of growth hormone precisely during the time the pituitary is scheduled to become active. This high serum level of growth hormone from the injection can suppress our natural pituitary function by negative feedback. We then not only lose the benefit of our own endogenous growth hormone, but also run the risk of surpressing the pituitary, thus making it “lazy”. For the most part, the pituitary has completed its function and is at rest by 5 a.m. Therefore injecting after awakening in the morning results in injecting “on top of the peak” of endogenous (our own) growth hormone, so as not to suppress the pituitary. By the time the pituitary is ready again for its nighttime activity, the growth hormone given in the morning injection has been completely metabolized. This eliminates the risk of pituitary suppression.
The benefits of growth hormone use in somatopause which have been clearly documented in the medical literature include the following: a decrease in body fat, an increase in muscle mass, thickening of the skin with decreased wrinkling, improvement in the cholesterol profile, an increase in bone density, enhanced feeling of well being, a decrease in the waist to hip ratio (meaning fat is removed primarily from around the waist where it is associated with a high risk of coronary disease), improvement in aerobic capacity, enhanced immune function and a decrease in the frequency of illness.
Side effects of growth hormone are generally mild and are largely associated with salt and water retention. The minority of patients that experience this typically complain of mild weight gain from water retention associated with a vague feeling of puffiness. This is sometimes accompanied by joint discomfort, particularly in the fingers, with a feeling of tightness when making a fist. Other joints may also become uncomfortable. Carpal Tunnel Syndrome is a well-known side effect of growth hormone that was more common in the early days when growth hormone was given in higher dose with lower frequency. Carpal Tunnel Syndrome is also a function of fluid retention, which causes water to accumulate in the closed carpal tunnel compartment of the wrist, compressing the median nerve. This results in numbness and tingling in the palm and fingers.
These side effects are easily remedied by abstaining from growth hormone for about a week, and then resuming the treatment with a 20% dose reduction. Older patients are more subject to side effects and are generally started at a low dose of growth hormone than younger adults. Another potential side-effect of growth hormone is the elevation of blood sugar. Growth hormone mobilizes body fat, causing our fat cells to break themselves down and release free fatty acids into the blood stream. These free fatty acids are energy molecules which can be taken up by organs and many of our organs to be used for energy. When our muscles are consuming free fatty acids as a fuel, they are far less interested in sugar, therefore they tend to resist the effects of insulin, and extract less sugar from the blood. At the same time, growth hormone can increase glucose output from the liver to the blood. This combination of effects can raise blood sugar and raise insulin levels, neither of which is good. Fortunately, this is only a problem in people who eat a diet high in sugar and starch, and do little exercise.
Acromegaly and giantism are diseases of growth hormone excess. These are typically seen by persons who have growth hormone secreting tumors. Giantism refers to the condition of growth hormone excess in children, where their ultimate height is far above normal because the growth hormone excess occurs when the epiphyseal plates of the bones are still open and the bones are growing. Acromegaly refers to growth hormone excess in adulthood after the epiphyses are closed and the bones are no longer growing. In these people the cartilage continues to grow, and the disease is characterized by enlargement of the nose, chin, ears, supra-orbital ridge (eyebrow area), hands and feet. Patients occasionally ask if acromegaly can result from growth hormone supplementation in adulthood. The answer is absolutely not. Acromegaly results in growth hormone levels that are two to ten times that of a normal adult. Keep in mind that when we supplement growth hormone in a controlled and monitored medical program, we bring the level only up to the mid-normal range of an adult. In fact, one would have to use ridiculously high doses by today’s standards to achieve the growth hormone levels seen in acromegaly.
Since growth hormone is metabolized so quickly, it is not easily measured in a blood test. The levels fluctuate widely, and measuring growth hormone is notoriously inaccurate. The best laboratory marker we have for growth hormone is the measurement of Insulin-like Growth Factor One (IGF-1). IGF-1 levels are much more stable in the blood and not only reflect the average daily growth hormone level, but directly reflect growth hormone activity; because IGF-1 is the hormone that carries out most of the benefits of growth hormone. So, despite claims about its shortcomings, it remains an excellent marker of growth hormone effect, and certainly the best one available in the laboratory.
There is one better marker of the benefit of growth hormone, however. It’s what we call the “clinical benefit”. This is the feedback we get from patients who are taking growth hormone. How they are feeling in terms of energy, well being, body composition, frequency of illness, their own physical appearance, etc. is far more valuable a marker than any blood test can be. What we really use the IGF-1 level for is to be certain beyond a doubt that we’re not giving too much growth hormone. We titrate the dose of growth hormone to get an optimal clinical response (a happy patient) even if the IGF-1 hasn’t reached a particular goal range. This often allows us to limit the dose and minimize patient costs. After all, we’re treating the patient, not the blood test.
Secretagogues are preparations taken orally that are designed to stimulate the pituitary to secret more of our own (endogenous) growth hormone. Secretagogues are composed of amino acids or chains of amino acids called peptides. The usefulness and benefit of these products is extremely variable, with the benefit ranging from moderate to none whatsoever. A very large, and unfortunately, very deceptive industry has grown up around these products, and we recommend they be used only in a monitored program because they often simply don’t work. Measuring the IGF-1 level prior to commencing, and three months after starting a secretagogue program will give you a much better idea of its benefit or lack thereof.
Preparations of Growth Hormone
Although growth hormones is still under patent, several companies have paid royalties to the original developers of human growth hormone for the rights to manufacture and sell it. There are therefore a large number of companies now manufacturing and distributing growth hormone worldwide. Those available in the United States are, by brand name and the manufacturer’s name:
Pharmacia and Upjohn -Genotropin
Serono Laboratories -Saizen
Serono Laboratories -Serostim
Another option to the use of growth hormone is the use of growth hormone releasing hormone (GHRH) now manufactured only by Serono Laboratories and branded Geref. GHRH works by stimulating our pituitary to make our growth hormone. This seems a more natural and rational approach because we are stimulating the endocrine axis at a higher level, and increasing levels of growth hormone more naturally. We don’t prefer GHRH however, because we find it more difficult to achieve adequate levels of IGF-1, and it is a bit more expensive.
Originally taken only from human cadavers, and used only in children of short stature, growth hormone has had an interesting and controversial history. Fortunately, the understanding of its importance in adult physiology came at approximately the same time as recombinant DNA technology, which led to greater availability along with virtual safety.
Soon after this, the comparison was made between growth hormone deficient adults and aging adults. Because of the tremendous similarities, growth hormone began to be used and soon gained great popularity in the treatment of normal aging. Growth hormone is clearly useful and therapeutic in this regard as long as it is used in a carefully monitored, professionally managed program. Any growth hormone program must include proper nutrition and exercise with emphasis on a low glycemic diet.
Forms of Human Growth Hormone (HGH)
By David Leonardi, M.D.
The average person thinks of the damage of aging as an inevitable process of wear and tear. However, if wear and tear were the primary cause of aging in humans, a 60 year-old should have only twice the signs of aging as a 30 year-old.
Why do most 30-year-olds show few effects of aging, while the effects of aging are so obvious in a 60 year-old person? If wear and tear were the major cause of aging, a 90-year-old person would only have 3 times as much aging damage as a 30-year-old.
At the age of 30, people have spent most of their lives with fairly high levels of human growth hormone (HGH). HGH is responsible for growth during childhood – and for the repair and regeneration of human tissue throughout our lives. By the time we reach the age of 30, our HGH levels are only about 20 percent of their peak levels during childhood, and after the age of 30, they continue to decline at about 14 percent per decade, and often much more. By the time most of us are 30 years old, our bodies no longer produce enough HGH to repair all of the damage that is occurring in our bodies. As our HGH levels continue to decline, the damage that we call aging continues to accelerate.
The decline in HGH is not the only cause of the manifestations of aging. Even if our HGH levels remained at the level of a 25 year-old, we would continue to experience the effects of aging, but those effects would be greatly reduced until we reached a very advanced age. HGH does not affect the root cause of aging, as measured by maximum lifespan, but it can certainly affect many of the manifestations of aging.
By increasing the levels of HGH in our bodies, we can slow, or even reverse, many of the manifestations of aging. Ideally, this HGH replacement should begin at about the age of 30 years, but HGH replacement can be beneficial at any age above 30. In fact, for older people, HGH therapy can reverse the manifestations of aging by 5 to 15 years or more. There is no other single therapy currently available that can have the impact on the aging body that HGH can have.
What HGH therapy can do:
ï¿½?ï¿½ Reduce excess body fat, especially abdominal fat. (The reduction of abdominal fat is the single most profound effect of HGH replacement.)
ï¿½?ï¿½ Increase muscle mass (and physical strength if combined with moderate exercise).
ï¿½?ï¿½ Reduce wrinkling of the skin and some other effects of skin aging.
ï¿½?ï¿½ Re-grow internal organs that have atrophied with age.
ï¿½?ï¿½ Increase bone density.
ï¿½?ï¿½ Strengthen the immune system.
ï¿½?ï¿½ Reverse cognitive decline.
ï¿½?ï¿½ Stimulate production of the bone marrow cells that produce red blood cells.
ï¿½?ï¿½ Reduce the probability that you will spend the last years of your life in a nursing home.
What HGH cannot do:
ï¿½?ï¿½ It cannot eliminate the effects of oxidation damage, although it may alleviate some of it.
ï¿½?ï¿½ It cannot undo the effects of cardiovascular disease, although it sometimes reduces some of its effects. It can also slow its progression by improving one’s cholesterol profile.
ï¿½?ï¿½ It cannot eliminate the effects of the reduction of other hormones. In fact, a deficiency of certain other hormones will decrease the beneficial effects of HGH.
ï¿½?ï¿½ It cannot significantly reverse the damage to human proteins caused by glucose, although it may reverse a little of this damage.
ï¿½?ï¿½ Although it helps skin to look younger, it cannot eliminate all of the damage cause by sunlight and other ultraviolet sources.
ï¿½?ï¿½ It cannot increase maximum lifespan.
HGH is produced by the pituitary gland. The ability of the pituitary gland to produce HGH declines very little with aging in most people. The decline with aging occurs one step back from the actual secretion of HGH. There are at least 3 substances which control HGH secretion:
ï¿½?ï¿½ Growth hormone releasing hormone (GHRH), a substance which declines with age. Increasing levels of GHRH causes the pituitary to increase its output of HGH.
ï¿½?ï¿½ Growth hormone releasing peptide (GHRP) is another substance that declines with age. Increasing levels of GHRP also causes the pituitary to increase its output of HGH.
ï¿½?ï¿½ Somatostatin is a hormone that blocks the release of HGH by the pituitary gland. The natural production of somatostatin increases with age, and causes a corresponding decrease in HGH production by the pituitary gland.
The production of HGH is controlled by GHRH, GHRP, somatostatin, and other substances in the body. The degree to which changes in the levels of each of these substances is responsible for the decline in human growth hormone varies from individual to individual, and is somewhat gender-dependent.
(The only naturally-occuring growth hormone releasing peptide appears to be ghrelin. Ghrelin is a powerful appetite stimulant. When given to laboratory animals, the animals eat huge amounts of food. The weight gain induced by overeating completely overwhelms the fat burning caused by the growth hormone release, and the animals become obese. Pharmaceutical companies have produced synthetic growth hormone releasing peptides, such as GHRP-6 and hexarelin, which stimulate HGH in humans, but do not increase appetite significantly. These substances are not on the market yet, and probably won’t be for many years.)
The effects of HGH in the human body have been studied intensively for decades, but the factors that affect HGH production remain rather complex and mysterious. Part of the reason for this is that the quantities of these substances produced by the body are on the order of a milligram per day in adults. Most people only produce about a teaspoonful of these substances during their entire adult lives.
To make the HGH situation even more complex, HGH is normally released in pulses or bursts throughout the day. There are usually 10 to 20 surges of HGH release, with the largest release occurring shortly after you fall asleep. Is there any advantage to having HGH released in pulses? Or is this simply the body’s most efficient way of producing HGH? Nobody knows the answer to this important question.
There are three basic ways for increasing HGH:
ï¿½?ï¿½ Taking a substance that increases the natural secretion of HGH by the pituitary gland.
ï¿½?ï¿½ Using an injectable human growth hormone releasing hormone (GHRH).
ï¿½?ï¿½ Using injectable human growth hormone.
With current technology, taking a substance that increases the natural secretion of HGH generally works best for those between the ages of roughly 30 to 45 years.
For most people over 45, injectable HGH is most effective – and usually the only effective – option (although sermorelin, discussed below, can also be very effective). But let’s look at these three methods in greater detail.
(Unfortunately, some of these details get rather complicated because of the ever-changing legal situation surrounding this subject. I try to keep this chapter written as clearly as possible, but the number of re-writes that I have to do because of the ever-changing whims of governments makes this a very difficult subject to explain clearly.)
There are a number of substances that increase the natural secretion of HGH. Most of them are amino acids. The most effective and economical way of causing this HGH release seems to be taking 2 grams of the amino acid L-glutamine in the morning and taking 10 to 30 grams of the amino acid L-arginine before bedtime. Both of these amino acids must be taken on an empty stomach.
There has been only one scientific study showing that L-glutamine causes HGH release, but there is a large body of anecdotal evidence from anti-aging physicians and their patients that L-glutamine is actually effective in persons under about age 45.
There is a large body of scientific study on the effects of L-arginine on growth hormone release. In fact, the administration of a large dose of L-arginine is the standard test for the ability of the pituitary to release growth hormone. (Another test using insulin is actually more effective, but it is not accepted as the standard test by the U.S. Food and Drug Administration.) Most scientists believe that L-arginine promotes HGH release by inhibiting somatostatin. L-arginine has many other benefits in addition to being a growth hormone releaser. See the chapter of this manual on Arginine for additional information about using arginine as a growth hormone releaser and for safety warnings about the use of arginine.
There are several problems with the use of amino acids as HGH releasers. Their effectiveness generally diminishes with age, and with continued use. This has led some people to the opinion that amino acids such as L-arginine are weak HGH releasers. This can be a dangerous assumption. In some young people, L-arginine may actually cause dangerously high levels of HGH release. Many young people use L-arginine, but it should not be used by anyone until at least 5 years after they have completed their long bone growth (unless they are under close medical supervision).
For most people, the doses of amino acids mentioned above (2 grams of L-glutamine and 10-30 grams of L-arginine) are about right for maintaining youthful levels of HGH beginning at about age 30, and continuing into the 40’s, and sometimes (but very rarely) beyond 50. In order to maintain its effectiveness, these amino acids should be used for about 6 weeks, then stopped for 2 or 3 weeks. The same 6-week ON, 2 or 3 weeks OFF cycle can be continued indefinitely. This cycling helps to maintain the effectiveness of the HGH release.
Unfortunately, the effectiveness of HGH release with amino acids is highly variable from individual to individual. For some people, it is not a very effective means of HGH release for any long period of time. For a few (very few) others, it maintains its effectiveness until the age of 60 and beyond.
For these amino acids to be effective, certain other substances must be present, and other substances must not be present.
In order for your body to naturally produce HGH, or to produce HGH in response to certain amino acids, the following things must NOT be present:
ï¿½?ï¿½ Anti-cholinergic medicines. This includes most medicines that make you drowsy or dehydrated. The most common of these medicines are the antihistamines that make you drowsy, including Benadryl (or any other brand of diphenhydramine), Sominex, Nytol, Tylenol-PM, and Zyrtec. (Claritin, Clarinex and Allegra probably do not affect the HGH-releasing effect of amino acids or natural HGH release.)
ï¿½?ï¿½ Alcohol, in any appreciable quantity, blunts the HGH-releasing effect of amino acids and also suppresses natural HGH release. An ounce or less of alcohol two or three hours before taking a HGH releaser will have little effect on HGH release, but using alcohol to get to sleep can dramatically suppress your natural HGH release during sleep.
ï¿½?ï¿½ Eating protein or carbohydrate within 3 hours before (or one hour after) taking an amino-acid HGH releaser will significantly blunt the growth hormone release induced by these amino acids.
There are many commercial products that are advertised to promote HGH release. Many of them are simply extremely expensive versions of the amino acids known to cause HGH release. Some of these products do work, but often at an extremely inflated price. Most of these products (especially the heavily advertised ones) are simply very expensive scams. As the U.S. Food and Drug Administration has made it more difficult to obtain real human growth hormone, the number of HGH scams has grown by an incredible amount. If you search for information on HGH on the internet, you will find hundreds of these frauds and scams.
Many products are currently being advertised as Oral HGH sprays. The advertising for nearly all of the so-called “oral HGH sprays” is fraudulent. These products could not possibly work. They don’t contain enough HGH to have any biological effect, and all of the scientific evidence indicates that the HGH molecule is far too large to be absorbed through the membranes of the mouth. If HGH is swallowed, it is destroyed in the digestive tract before it can be absorbed into the blood stream.
Many “oral HGH” products advertise their HGH levels in nanograms. Keep in mind that the average daily injectable dose of HGH is 333,333 nanograms, whereas the advertised amount of HGH in “oral HGH sprays” is 600 to 2000 nanograms per day. Also, without refrigeration, more than 90 percent of the HGH in an ordinary liquid solution is lost every 24 hours.
The technology for getting a molecule as large as HGH to be absorbed through the membranes of the mouth or nose is a technology potentially worth billions of dollars. No company that develops such an advanced technology is going to use it on an over-the-counter product. At least one pharmaceutical company has developed a novel technology with the potential to enable the absorption of HGH through the membranes of the nose. The product is in phase 1 clinical trials by Nastech Pharmaceutical Company, Inc. If this product does make it to market, it won’t be for several years, and it will be available only by prescription.
The technology used to make an inhalable form of insulin was originally developed for use with human growth hormone. Genentech spent about $4 million on the use of this technology for an inhalable version of growth hormone between 1986 and 1989, but decided not to spend additional money to take the technology to market. Other companies have been sporadically working on an inhalable version of growth hormone, but it is a very technologically difficult project. Don’t expect an inhalable growth hormone to be on the market for several years.
The one way to enhance your HGH levels regardless of age, or other factors, is to use injectable HGH. For most people past the age of 45 years or so, this (or possibly sermorelin) is the only HGH option that really works well. The use of injectable HGH has been a subject shrouded in mystery for most people.
Any licensed physician can prescribe HGH, but few are willing to do so. It is best to find a physician who is familiar with HGH, and who has other patients using it. There are 3 excellent sources for locating an anti-aging physician, and these three sources are also the best for finding a physician to prescribe HGH therapy. Those lists of physicians are at the following web sites:
The American College for Advancement in Medicine
The Life Extension Foundation
The American Academy of Anti-Aging Medicine
Not all of the physicians on the above lists are familiar with HGH therapy, so ask before making an appointment.
Because of the news stories about athletes using excessive doses of HGH, and of bodybuilders who use high doses of HGH in an highly-experimental and medically-uncontrolled environment, governments at the state and federal levels in the U.S. have cracked down on many physicians who write too many HGH prescriptions. This has scared many physicians away from prescribing HGH for new patients and has made finding a physician much more difficult in the past year or two. Lawmakers at all levels of government in the United States believe that it is more important to prevent athletes from cheating than it is to keep ordinary adults healthy and out of nursing homes.
In addition, a number of prominent and powerful individuals have attacked all forms of anti-aging medicine in recent years. If you would like to see the kind of future that these people want for you, visit a local nursing home. A nursing home for the elderly contains the largest concentration of severely growth-hormone-deficient people that you will find anywhere. If you want to see how ill-informed are the opponents of the use of HGH against age-related conditions, do your own research at the National Library of Medicine web site referenced just below.
Because of the confusing way that the laws are written regarding the use of HGH, there has been a debate during the past few years among various attorneys and physicians about whether it is legal to prescribe HGH as an anti-aging treatment in the U.S. Since the FDA does not regard aging as a disease, and since HGH does not seem to affect the fundamental cause of aging, it is probably not legal to prescribe HGH for the nebulous diagnosis of “aging.” Prescribing HGH for specific symptoms (or clusters of symptoms) of aging is an entirely different matter. A very large body of scientific evidence exists that HGH is useful against various manifestations of aging. You will have more success getting a prescription for HGH if you have such symptoms. If you have reached middle age or later, and you have no more symptoms of aging than you did when you were 25, and if you have no genetic tendency to suffer any ill effects from aging, then you will probably have considerable difficulty in getting a prescription for HGH.
The FDA rules regarding the prescribing of HGH are ever-changing, and are usually written in a way that nobody can really understand. As of mid-2007, the strangely-worded FDA guidelines are increasingly being interpreted in a way that would prohibit all use of HGH in adults except for those who are so deficient that they are nearly ready for a nursing home. Under the current conditions, only a few doctors in the U.S. are willing to prescribe HGH for “off-label” conditions, even if they believe that the patient would clearly benefit from HGH replacement. Many older U.S. residents may have go outside the U.S. to get a legitimate prescription from a doctor and have the prescription filled by a pharmacy in that country. Even if you have a legitimate prescription from a physician in another country, and you clearly have a medical need for HGH, there is no guarantee that U.S. customs will allow you to bring back your prescribed medication. This situation may change, though. The increasing oppressiveness of the FDA is causing a backlash against that agency. The latest physician to get in to trouble with the FDA regarding his use of HGH has been acquitted of all charges – and he reportedly was subsequently hired by the FDA to help develop guidelines for the legal “off-label” use of HGH in adults. It is difficult to keep FDA information up-to-date in this chapter because it changes so frequently, and so many people within the FDA have different interpretations of their own rules.
You can do your own research on published scientific studies, starting at the National Library of Medicine web site at:
Unfortunately, there are not yet any really long-term clinical studies on the use of growth hormone replacement therapy. Most of the longer studies in persons suffering from only age-related conditions have used bizarre dosing regimens for HGH. This was understandable in the early studies, when the proper dosage in humans was unknown. It does NOT make sense that so many clinical studies continue to use such large doses. Overdosing on any hormone will inevitably lead to adverse effects. Most people using HGH to replace declining levels of growth hormone use one unit per day or less.
Since most physicians who will prescribe HGH are maintaining a very low profile, they are very difficult for most people to find. One additional very valuable source of information can be a local compounding pharmacy. Type the phrase “compounding pharmacy” and the name of your city (or a nearby city) into a search engine such as Google. Ask the compounding pharmacy for the name of a physician who prescribes human growth hormone or who prescribes other bio-identical hormones. There are a few large compounding pharmacies that distribute their prescriptions nationally, and even around the world. These large compounding pharmacies can often recommend doctors all over the country.
There are some very good physicians in other countries, especially Mexico, who will prescribe HGH. It will be necessary to have the prescription filled by a pharmacy in that country. In many countries, HGH is available without a prescription, so you should be able to buy the HGH from any legitimate source in the country where you get the prescription from a physician, then you should be able to bring up to a 90-day supply with you when you re-enter the United States. With the current restrictions on HGH in the United States, you may not be allowed to bring HGH across the border unless you have a doctor’s prescription; and even with a prescription, the medicine that you need may be confiscated by U.S. customs.
Most of the physicians who prescribe any hormone for you will want to do a comprehensive physical examination on your first visit. You will find that this initial consultation is well worth the money. Ask about cost first, though. With many physicians who prescribe natural hormone replacement, this initial exam will cost about $200 plus the costs of routine blood tests. The typical cost is often much higher in the coastal population centers, especially in New York, Florida and California. (A few “high-end” anti-aging clinics will charge $1,500 or more for an initial exam. The more expensive clinics may also want you to buy HGH directly from them for a highly inflated price – 4 or 5 times the price you would pay at your local drugstore.)
For preventive medicine, the ACAM physicians as the most likely to offer excellent service at a very reasonable cost, although most ACAM physicians are not comfortable prescribing HGH unless you are an established patient and the physician is thoroughly familiar with your medical history.
The physician who prescribes HGH will probably want to measure your IGF-1 levels before prescribing HGH, and again a few months after you begin taking HGH. IGF-1 is an abbreviation for Insulin-like Growth Factor 1. It is also known as Somatomedin-C. IGF-1 is a marker for HGH. Since natural HGH is released in surges, and it has a very short lifetime in the body, it is not practical to measure your HGH levels directly. Much of the HGH is used by the body to produce IGF-1, which has a fairly long lifetime in the body. An IGF-1 test generally costs about $100.
It was once thought that the effects of HGH were due to only to IGF-1. We know that IGF-1 has important effects, but the advantages that one gains with HGH are often not proportional to the increase it causes in IGF-1 levels. Some people on HGH therapy have only a small increase in IGF-1 levels, yet have large positive results from using HGH.
In spite of what a few government officials may say, there is no one universal medically-accepted test for measuring growth hormone deficiency in adults. It requires the judgement of a physician based upon a number of factors, and such judgements are always controversial.
Which brand of HGH?
The sharp reduction in the price of HGH during the 1990’s was due to the fact that several companies began producing it. Since the beginning of 2004, however, prices at most pharmacies have jumped by about 25 percent. The price is still going back up by a few percent per year. In the United States, injectable human growth hormone is available in the following brands:
ï¿½?ï¿½ Humatrope (from Eli Lilly). This was the first brand of HGH to become widely available.
ï¿½?ï¿½ Genotropin (from Pharmacia/Upjohn).
ï¿½?ï¿½ Saizen (from Serono Laboratories).
ï¿½?ï¿½ Norditropin (from Novo Nordisk)
ï¿½?ï¿½ Nutropin (from Genentech)
In addition, Omnitrope, manufactured by the Sandoz division of Novartis, was approved by the FDA on May 31, 2006.
Serono also makes two additional brands of HGH, Serostim and Zorbtive, for special uses in diseases that require high doses of HGH.
All of these brands contain real high-quality injectable HGH made with recombinant DNA technology. Each of the brands is a little different in the packaging and mode of delivery, though.
In countries where Omnitrope is sold, the price has been about 25 percent less than the other brands. Despite its FDA approval more than a year ago, Omnitrope has not penetrated the U.S. market well at all.
Tev-Tropin is a form of HGH that is manufactured in Israel and approved for sale by the FDA in the United States. It is not completely identical to human growth hormone since it contains an extra amino acid. (Tev-Tropin contains 192 amino acids while natural HGH contains 191 amino acids.) Tev-Tropin is less expensive that other forms of HGH, though, and has undergone extensive safety testing.
Originally, the HGH package consisted of two vials. One vial contained powdered freeze-dried HGH. The other vial contained sterile water with a bacteriostatic preservative. When the user was ready to begin using the contents of the package, a certain amount of the sterile water would be drawn out of the second vial (with a needle and syringe) and injected into the first vial to dissolve the powdered HGH. The solution would then be ready for injection. The unused portion would have to be kept refrigerated. The entire vial of dissolved HGH would have to be used within 2 or 3 weeks.
The HGH is dissolved by the patient because HGH powder is much more durable than dissolved HGH. The dissolved HGH is very susceptible to being attacked by bacteria and degraded by proteolytic enzymes. HGH is always normally refrigerated, but if HGH powder is is left at room temperature for a few hours, no harm is done as long as the room is not too warm. Recently, some brands have developed formulations that can be kept outside of a refrigerator for extended periods, as long as they don’t get too warm. (Sterile powdered HGH can even be left in a cool room for days or weeks, but this is not a good idea.) After being dissolved in water, the un-refrigerated HGH solution ordinarily loses its much of its potency after a few hours, and becomes completely unusable in a day or two, especially if the room is warm. The HGH solution must be kept refrigerated (unless you have one of the newer special formulations that state otherwise).
HGH is still often sold with the HGH powder separate from the sterile water, but there are now several more convenient options for the mixing process.
In the Genotropin Intra-Mix cartridge, the HGH powder and the sterile water are in separate compartments of the same cartridge. Turning a knob on the handle at one end of the cartridge (until it screws all the way in – three turns) automatically mixes the HGH and the sterile water. Since there is no mixing needle exposed to the room air, better sterility is obtained, and the Intra-Mix cartridge is advertised to last 3 weeks after mixing. (In the past, most other brands were advertised to last only 2 weeks, but this situation is changing. The Norditropin Pen and the Genotropin Miniquick are both newer products with much longer lifetimes.)
Another nice thing about special devices such as the Genotropin Intra-Mix cartridge is that it is very expensive to counterfeit such packaging. Counterfeit medicines are always a potential problem, and the older conventional two-vial HGH package is very easy to counterfeit – and very profitable for any counterfeiter.
Genotropin Intra-Mix cartridges also have the most concentrated solution of HGH. With the 5.8 mg. (17.4 unit) cartridge, one unit of HGH is only 0.06 cc. This is about two drops. (This can be a significant psychological advantage when you’re first learning to inject HGH.)
Most HGH packages require you to inject the HGH using insulin syringes. (The same ones used by diabetics.) Usually, you will use the smallest size syringe. This is a 0.3 cc. syringe with an 8 mm. 31 gauge needle. This is a very short, very thin needle. The B-D Ultra-Fine II insulin syringe with the 31-gauge needle is far superior to the syringes with the 30-gauge needles that were the best available until rather recently.
Some HGH packages use a pen with a built-in needle. For those who wish to avoid needles completely, Saizen is available in the CoolClick cartridge which blasts the HGH through the skin in a very narrow jet. Buying Saizen with the CoolClick cartridge will increase the cost, though.
Depending upon where they are purchased, both the Genotropin Miniquick and the Norditropin Pen may actually cost less than the more conventional packaging.
HGH is sometimes measured in international units, and sometimes measured in milligrams (mg).
3 International Units = 1 milligram
Different doctors have different recommendations for the amount of HGH you should inject. The dose may depend upon your age and overall health. It is best to start with a low dose, such as one-half unit per day, and work up from there. Most physicians recommend taking 1 unit per day, 4 to 7 days a week.
Adverse effects from injectable HGH therapy are very rare as long as the amount of HGH used averages 1 unit or less per day. Most physicians familiar with adult HGH replacement therapy believe that 1.5 units per day reaches the point of diminishing returns, and more than 2 units per day begins to put you at some risk of side effects. (The clinical studies that resulted in frequent side effects from HGH used much larger doses. In fact, all the the most frequently-quoted clinical studies have used doses that we now know are ridiculously high doses.) In general, side effects of HGH are very rare in doses of 1 unit per day or less and common in doses above 2 units per day.
When you increase or decrease your dosage, it is best to do it very slowly. Even at doses below 2 units per day, abrupt changes in dosage can cause temporary problems such as water retention and headache in some people.
Many people experience increases in blood glucose levels when starting HGH. This effect usually goes away with time, but there appears to be a definite advantage to taking the prescription medicine metformin along with HGH to keep glucose levels under control. (Also, there is evidence that metformin can slow the aging process at a more fundamental level than HGH.) Alpha Lipoic Acid, a nutritional supplement, can also help to keep blood glucose levels under control.
Blood tests for thyroid function should be performed about three months after starting HGH. Growth hormone restores the ability of the body to convert the thyroid hormone T4 to T3, which is the active form. For this reason, it may decrease the need for thyroid, especially T3 replacement, in individuals with hypothyroidism (underactive thyroid). On the other hand, a recent medical study reported that growth hormone may unmask a previously undiagnosed thyroid problem. When the rest of the body begins functioning better, an aging thyroid gland may require assistance in the form of thyroid hormone supplementation. So your thyroid requirements may go up or down. There is no way to know without testing.
Anyone on any kind of hormone replacement therapy needs careful medical monitoring and frequent blood tests.
Since the largest natural HGH release in healthy young people occurs shortly after the onset of sleep, most doctors originally suggested that HGH be injected just before bedtime. Some people (especially those between 40 and 65 years old) report better results taking the HGH in the morning (or at some other time of the day), and letting their pituitary gland supply the nighttime HGH dose.
Most people over the age of 65 or 70 have a very small natural production of HGH after sleep onset, so injecting HGH just before bedtime is probably best for these older people.
There appears to be a definite advantage to dividing the HGH into a few smaller injections taken throughout the day. The advantage is usually not a large one, though, and most people find this far too inconvenient.
For most people, convenience outweighs the small advantages of one dosing schedule over another. Most people inject their growth hormone once a day at whatever time is the most convenient.
HGH requires a somewhat larger dose in women to achieve the same effectiveness as in men. Exactly why this is true is not well understood. It is known that taking oral estrogen cuts the effectiveness of HGH in half as compared with transdermal estrogen. Women taking oral estrogen should consider switching to patches or gels.
People who do not start HGH replacement until after the age of 70 may have to remain on a lower dosage than younger individuals in order to avoid adverse effects. Many people who do not begin HGH until after they are 70 should not go above about one-half unit per day. This will, of course, vary by individual.
For more information about the practical aspects of using HGH, and other hormones, the following book is one of the best available on the subject: Elmer Cranton, M.D. Resetting the Clock: 5 Anti-Aging Hormones That Are Revolutionizing the Quality and Length of Life. (M. Evans and Co. 1997)
More excellent information can also be found at Dr. Cranton’s web site. Dr. Cranton’s web site also includes updates of the book mentioned above.
The thymus gland: a target organ for growth hormone.
Savino W, Postel-Vinay MC, Smaniotto S, Dardenne M.
Laboratory on Thymus Research, Department of Immunology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro,
Scand J Immunol. 2002 May;55(5):442-52.
Age-associated loss of bone marrow hematopoietic cells is reversed by GH and accompanies thymic reconstitution.
French RA, Broussard SR, Meier WA, Minshall C, Arkins S, Zachary JF, Dantzer R, Kelley KW.
Laboratory of Immunophysiology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
Endocrinology. 2002 Feb;143(2):690-9.
An excellent technical book on HGH for scientists and health care professionals:
GROWTH HORMONE IN ADULTS: Physiological and Clinical Aspects, edited by Anders Juul and Jens O. L. Jorgensen. Cambridge University Press: 2000. (Very highly recommended)
From another site i use from time to time guy named blni did it. If its any use to you when you want to read about it.
But no doubt bushy and others will know more