Adult Growth Hormone Therapy - Clinical Perspectives

Adult Growth Hormone Therapy-Clinical Perspectives
Quality of Life Improves with GH Therapy

By Ron Rothenberg, MD

Ron Rothenberg, M.D. is Clinical Professor in Preventive and Family Medicine at the University of California, San Diego, School of Medicine. Dr. Rothenberg maintains a private practice at California Heathspan Institute in Encinatas, CA USA. Dr. Rothenberg may be contacted by telephone at (760) 635-1996, or by e-mail at info@eHealthSpan.com

In my anti-aging practice, I have about 160 patients being treated with growth hormone therapy (GHRT) for normal aging. One parameter which is often missing from evaluations of medical treatments is "quality of life" . Many factors come together to produce a good quality of life or more simply feeling good or feeling great. Just about every week a patient tells me something like, "This is the best I've felt in as long as I remember." Of course, I'm not just treating them with GHRT. Lifestyle comes first: nutrition, exercise, stress reduction. Beyond lifestyle, GHRT takes my patients to a different level of wellness and quality of life. There are consistent benefits mentioned by my patients.

My patients report improved memory and cognition, a more positive attitude and less depression. Discontinuing prescribed antidepressants is not uncommon. Many patients simply tell me that they feel happier. At times I have been told about an increased esthetic awareness of the beauty of the world. Body composition improves with more lean body mass and less fat mass. This is observed even when patients already had optimized diet and exercise programs before beginning GHRT. More rapid recovery from minor sports injuries is typical. Exercise performance increases. Patients report that they are told they look better, look healthier with better skin and often with reversal of hair loss. Combining GHRT and lifestyle in motivated patients often lead to objective lab values improving. Insulin sensitivity and cardiovascular risk factors including lipid profile and C-reactive protein are optimized. Other benefits mentioned in the medical literature such as reversal of atherosclerosis and improved immune function are difficult for patients to observe one way or the other.

Growth hormone is not a "fountain of youth" or a guarantee of immortality. Patients on GHRT are still prey to illnesses and injuries like anyone else. They are just operating on a younger, stronger, healthier physiological level.

One patient, a 52 year old attorney, explains it this way: When you are in your twenties, you don't get up in the morning and pound your chest and exclaim: I'm twenty and I feel great and I recovered quickly from that basketball game and I'm not gaining fat and sex is great! You just live your life and go with the ups and downs. After being on GHRT for a while that is what it is like. You don t marvel at the effects every day, you just live on a better level.

As anti-aging physicians, our goal is to rectangularize the functionality curve of the human lifespan, helping our patients to stay strong and vigorous as long as possible without gradual and protracted deterioration. We know GHRT is a proven defense against frailty and when added to lifestyle this is our chance to stay stronger and more functional. If we were to stay perfect, why intervene? But since we don't, this is one route to maintaining function while we await the genetic and biochemical therapies that will be available in the near future. Patients treated with GHRT are happier and healthier. Just ask one.

AAMN Editorial Note: There are several recent studies that document the positive effects of GH therapy in adults on quality of life measurements. These include:

NOVEMBER 2001 (KIGS/KIMS Outcomes Research, Pharmacia AB, Stockholm, Sweden): Data concerning visits to the doctor, number of days in hospital, and amount of sick leave were obtained from patients included in KIMS (Pharmacia International Metabolic Database), a large pharmacoepidemiological survey of hypopituitary adults with GH deficiency. Of the 304 patients surveyed, visits to the doctor, number of days in hospital, and amount of sick leave decreased significantly after 12 months of GH therapy. Patients also needed less assistance with daily activities, although this was significant only for the men. After 12 months of GH treatment, Quality of Life (assessed by the QoLAssessment of GHD in Adults questionnaire) improved, as did both the amount of physical activity and the patients' satisfaction with their level of physical activity. Dr. Hernberg and colleagues thus conclude that "GH replacement therapy, in previously untreated adults with growth hormone deficiency, produces significant decreases in the use of healthcare resources, which are correlated with improvements in quality of life."

SEPTEMBER 2001 (Universitat Munchen, Munich, Germany): Dr. Herschbach and colleagues from the Institut und Poliklinik fur Psychosomatische Medizin found scores across numerous psychometric markers improved progressively in adults administered GH replacement therapy.

JUNE 2001 (Royal Liverpool University Hospital, United Kingdom): Dr. Ahmad and team found that weight-based GH replacement resulted in significant improvements in both body composition and quality of life as early as one month after the initiation of treatment, and persisted at three months. Noting that "most importantly, these changes occur in the absence of side-effects," the researchers "therefore suggest the use of low-dose GH therapy, maintaining IGF-I between the median and upper end of the age-related reference range, for the treatment of adult growth hormone deficiency."

During normal aging, men and women experience a decrease of growth hormone secretion of up to 60%. As our abstracts review and Dr. Rothenberg's insights suggest, determination of an individual s suitability for GH replacement therapy must be based on a complete clinical evaluation that identifies declining physical, cognitive, or psychological parameters - either or both of which may cause a decrease in the individual's quality of life. As Dr. Delgado points out, a regimen of low-dose GH treatment coupled with supporting hormones and nutrients can achieve impressive age-reversal results.

Admittingly, the discussion over the long-term efficacy of GH replacement will undoubtedly continue. As an evolving science, it is likely that vacillations of study findings will continue for quite some time, and they reinforce the fact that GH therapy in adults for any reason - including specific disease treatment as well anti-aging purposes - must be conducted judiciously by a physician trained in this treatment.

In closing, we cite one of the newest studies reaffirming the safety of prudent GH therapy. In May 2002, Dr. Kehely and colleagues in the United Kingdom published findings on their two-tier parallel study. In one group of GH deficient adults, they administered a low dose regimen (3 mcg/kg/day for 3 months, increasing to 6 mcg/kg/day for 3 more months) versus conventional dose (6 mcg/kg/day, increasing to 12 mcg/kg/day for 3 more months). The proportion of patients completing low-dose therapy was greater than for the conventional dose group. While both dose groups showed significant increases in lean body mass and decreases in fat mass for all time points, subjects in the low-dose group were better able to maintain the gain in lean body mass for the six-month study period. There also were fewer reports of adverse events (arthralgia) with the low-dose therapy. The lower starting dose with dose titration appeared more favorable, but researchers note that individual variability also requires consideration.

When supervised by a qualified anti-aging physician, evidence to-date indicates that GH replacement therapy is valuable in maintaining both physical fitness and mental acuity in adult men and women.

RESOURCES

Delgado N. Grow Young and Slim 2nd Edn: #1 Way to Fitness. HWS (Las Vegas Nevada), in-publication (anticipated publication date 2003).
Grow Young and Slim, at www.growyoungandslim.com

REFERENCES

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An original article as appeared in Anti-Aging Medical News, Summer-Fall 2002, published by the A4M.