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Is human growth hormone (hGH), the long sought after fountain of youth? Dr. Judith Reichman was invited on the "Today" show to provide medical and legal information about this hormone, and to discuss the various formulations and growth hormone substitutes that are sold by the multi-billion dollar anti-aging industry.
Once upon a time, we grew old gracefully. Well, as a matter of fact, many of us didn’t get to grow old — the average life expectancy for a woman a century ago was only 47. These days, many of us will live well into our 70s and 80s. Our longevity can be attributed to public health policies and the marvels of modern medicine. But is there also a hormonal “marvel” that can increase our “well-gevity,” allowing us to keep our youthful bodies and health?
What is growth hormone? Does it really work to stop aging?
Growth hormone is produced in the pituitary gland of the brain. Once released, it induces the liver to make insulin-like growth factor 1 (IGF-1), and this hormone then triggers the growth of bones and body tissues. HGH is especially important for normal growth in children. Indeed, most of our knowledge of hGH comes from studying children who lack the hormone, and as a result suffer from stunted growth and development. In adults, a true medical deficiency of growth hormone may result from disease, tumors, surgery or radiation that destroys critical areas in the pituitary. This then leads to weight gain, cholesterol abnormalities, heart disease, fatigue, decreased immune response, loss of muscles and osteoporosis.
Growth hormone and IGF-1 levels peak during puberty, then gradually decline after the age of 30, but the normal pituitary never totally stops its production of hGH.
Some investigators feel that diminished levels of hGH may not be a bad thing. Several studies have shown that women with high levels of hGH are more likely to get breast cancer, men more likely to develop prostate cancer, and individuals of both sexes are more apt to die at younger ages than those with naturally low hGH levels. Research has also shown that mice with very high levels of growth hormone have premature brain aging and reduced life spans, whereas their rodent contemporaries who have genetic disorders such as suppressed GH production, or an inability to recognize and utilize growth hormone (GH resistance) have prolonged survival. But to be fair, there are also studies cited by physicians who feel that lower levels of hGH in aging adults results in diminished energy, muscle loss and decreased tissue repair. These studies have shown some positive effects in individuals whose hGH levels are brought up to the levels considered normal for young individuals. The researchers therefore propose that certain individuals who have low levels of IGF-1 (considered a marker for hGH) be treated with hGH injections to achieve a “younger” and improved health status.
How prevalent is the use of hGH for anti-aging?
Hope for longevity springs eternal. And baby boomers are putting their expectations and money into this highly touted and very expensive product. An article published in the October 26th issue of the Journal of the American Medical Association (JAMA) notes that worldwide sales of hGH are estimated to be $1.5 billion to $2 billion, and up to 30 percent of hGH prescriptions in the U.S. are used for anti-aging and “athletic enhancement.” If you enter the terms human growth hormone and anti-aging together on the Google search engine, you will find over 1.7 million sites. There are thousands of clinics and doctors who prescribe growth hormone, calling their practice “anti-aging,” “regenerative” or “age management” medicine.
The financial cost is high. HGH injections are priced from $500 to $1,000 a month. HGH “supplements” in the form of pills and sprays that allegedly contain growth hormones cost between $200 and $300 a month. These “supplements” turn out to be a total waste of money — yes, a scam. Growth hormone in this form is not bio-available, a medical term that means it’s destroyed when taken orally or absorbed through mucous membranes. It can’t “get into” the body in its active form and does absolutely nothing. (Although it does “grow” the bank accounts of the companies and Internet sites that cajole you to purchase the stuff!)
Do hGH injections work to prevent aging?
Here, in the words of Shakespeare, “is the rub.” It depends who you ask. Most orthodox physicians adamantly say “no.” (This is beginning to sound religious, but in this usage, orthodox generally means those who are waiting to get long-term studies to confirm such claims.) They feel that there is little to no conclusive evidence that hGH can prevent aging, and fear that it can cause harm. The hGH supporters point to a few small positive studies ... mostly done on men. One demonstrated an increase in muscle mass, reduction of total body fat and an increase in skin elasticity, as well as diminished bone loss. But this study also showed that hGH did not increase strength, improve exercise capabilities, intellectual skills, memory or prevent depression. Studies have shown that even when hGH was given to adults who had true growth hormone deficiency (as a result of damaged pituitary function), the small decrease in fat content experienced by these individuals (5 percent) disappeared after 24 months of treatment.
In one of the few clinical studies done on healthy older individuals (age 65 to 88) that included women, significant side effects occurred. One third or more of the treated participants developed carpal tunnel syndrome, swelling (edema) and joint pain. Twice as many men on hGH developed pre-diabetes or diabetes as compared to those not treated.
Another study of 510 patients with AIDS wasting syndrome showed that those who were on the drug were two to three times more likely to develop joint pain, muscle pain and swelling.
There is also a concern about the possibility of an increased cancer risk with long-term hGH treatment. The hormone induced by hGH, insulin growth factor-1 (IGF-1), promotes the growth of cells and prevents them from dying. And that’s exactly what cancer cells do — they grow wildly and don’t die.
How is hGH manufactured, and why is it so expensive?
It’s hard to synthesize this hormone. Its large and complex molecular structure involves 191 amino acids. Since 1985 it has been made through recombinant DNA technology in which bacteria or animal cells are given a gene that directs them to make hGH. The cells are then grown in a tissue culture that synthesizes a pure hormone identical to that produced by the human pituitary. We can’t copy this substance using the growth hormones of animals and plants, and molecules of this size can’t be absorbed through skin or mucous membranes. If taken in pill form, hGH will be deactivated by stomach acid and enzymes, so it has to be given as a shot under the skin.
What are the FDA approved indications for use of hGH?
According to the FDA, it should only be prescribed for adults by physicians for the treatment of disease (the wasting syndrome of AIDS) and/or growth hormone deficiency. They generally consider the latter as one that is due to an absolute lack of hGH as a result of pituitary disease, surgery, radiation or trauma. Growth Hormone Deficiency (GHD) also includes grownups that were GH deficient during childhood (children of very short stature and certain genetic syndromes).
In order to make the diagnosis of growth hormone deficiency, an endocrinologist has to give an injection to stimulate production of growth hormone and measure the response. According to the FDA and the American Association of Clinical Endocrinologists, measuring IGF-1 level and stating that this is lower than that of a young adult does not constitute a valid scientific diagnosis of GHD.
Is the prescribing of growth hormones for other reasons (i.e. muscle building, sports enhancement or in individuals who don’t have a deficiency) legal?
NO! According to the FDA, and the penalties chapter of the FDCA (The Food, Drug and Cosmetic Act), “whoever knowingly distributes or possesses with intent to distribute human growth hormone for any use in humans other than the treatment of a disease or other recognized medical condition where such use has been authorized by the Secretary of Health and Human Services under Section 505, is guilty of an offense punishable by not more than five years in prison.” This section also permits courts to impose fines of up to $250,000 for an individual or $500,000 for an organization as well as forfeiture of property used in or derived in violation of the hGH law.
The Federal Trade Commission has filed cases against the “supplement” industry. In one case, two Florida businesses were named in a complaint, along with two individuals involved in the businesses, including one who was a physician. The defendants agreed to a federal court order requiring them to pay up to $20 million in consumer regress (that’s the largest monetary judgment ever obtained in a FTC health fraud case) — to settle charges that “they deceptively claimed that their pills and sprays would increase consumers’ human growth hormone levels and provide anti-aging benefits.”
Obviously, baby boomers have to be advised about anti-aging products.
Yes, if a doctor, clinic or Web site promises you that they have a non-injectable product that will restore your growth hormone level to that which you had when you were young, beware. Products available without prescription are imposters and have no effect. Those that are prescribed and injected are expensive, and we don’t have the long-term studies that give conclusive proof that they work. Know that hGH use for “anti-aging” per se is not FDA approved. If you consult with a physician who prescribes it because the marker for growth hormone (IGA-1) is low, you (and the physician) are entering a world of “off-label” use and you are in essence experimenting with your body and health. In centers where it is prescribed and patient claims are made that it does indeed work (they feel better, lost weight, have more energy etc.), the shots are frequently combined with nutritional counseling, exercise and other forms of hormone therapy (estrogen and/or testosterone). Many doctors who do prescribe this hormone admit that hGH therapy alone is not a “fountain of youth.”
In my opinion, if you want to invest in methods to maintain your health and body and achieve “well-gevity”, you should invest your time, money and energy in attaining appropriate weight control, lipid and sugar control. Exercise and eat properly; don’t smoke and get the testing you need for early disease detection. Most importantly, start any necessary treatment without delay. We baby boomers worked hard to redefine our lives; most of us have learned that there are no simple (albeit how expensive) shortcuts.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .