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Old 10-01-18, 10:33 AM
HGH - The Good & The Bad
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There is an ageless film from the “spaghetti westerns” genre called “The Good, the Bad and the Ugly” starring Clint Eastwood. In the quest to be “ageless,” many have turned to human growth hormone (hGH) due to the known decline in hGH production as one ages, and the youthful benefits incurred when properly used— including improved soft tissue repair, greater skin elasticity and body composition enhancement.



Body composition enhancement was once called “repartitioning,” as the net effect was an increase in lean mass (e.g., muscle) with a loss in fat mass; the appeal to bodybuilders is obvious. The early days of hGH use for treating aging adults, and its misuse by bodybuilders, was a tragic example of the risks involved with being an early adapter. The error made during the early days was following dosing schemes used to treat children suffering from pituitary dwarfism.1 Children who are deficient in hGH, which is naturally produced in the pituitary gland in the brain, require very high doses of hGH to restore linear growth (height) and other effects seen in the developing body of children and adolescents. Older adults, even healthy young adults, have a lower requirement for hGH, as affecting tissue function rather than structure is the goal.



The “good” of hGH is that it is an essential metabolic hormone that was unfortunately named. Its role in the obvious growth of children and adolescents, particularly how tall one gets, caused this hormone to be named “growth hormone.” Even medical journals commonly refer to this name rather than the more appropriate but less sexy “somatotropin.” While it is true that humans can live with very low, even non-detectable levels of hGH, they certainly do not thrive and are subjected to an increased risk of numerous disease states.2 So, there is an accepted deficiency state, usually associated with a vascular malformation— craniopharyngioma, or a slow-growing tumor of the pituitary gland— adenoma, when the cause is known.Often, the cause is unknown— idiopathic; pituitary hormone deficiencies following head trauma are becoming increasingly common as awareness of this potential consequence grows. There are also mutations that can arise in the hGH-receptor, resulting in similar effects.



The “bad” of hGH refers to consequences of its excess, which can arise “naturally” or due to prolonged treatment that is in excess of the body’s physiologic need. Some people develop an adenoma (a benign tumor) in the pituitary that actually produces hGH. If this happens during childhood, they develop gigantism as their bones are able to lengthen prior to the end of puberty; cases of such people reaching heights over eight feet tall have been reported. If it happens after they become adults, they develop a condition known as acromegaly; the person does not grow taller as the “growth plates” in the bones are fused. Both conditions are associated with shorter life spans; deformities of the facial bones, hands and feet; organ growth and dysfunction; and metabolic consequences.3



The “ugly” of hGH is when the hormone is used illicitly or to pursue a vain goal, and causes one or more harmful side effects. Combating the effects of aging is not a vain pursuit, but many people attempt to overcome consequences of their lifestyle to present a healthier or more youthful appearance. Further, many athletes and bodybuilders fail to recognize their unique limitations, and recklessly attempt to pharmaceutically coerce the body to perform at a higher level or prolong a career well past the point of retirement.



Though it has not been documented, in part due to a lack of a doping test for hGH misuse, one might follow the change in shoe size reported by certain athletes during their pro careers. This should be documented in team records. Imaging scanners could look for changes in facial features arising over the course of time.4 The consequences from such misuse/abuse are far-ranging. In the most extreme cases, there may be increased cardiovascular damage, earlier deaths, type 2 diabetes in persons not otherwise at risk, accelerated cancer growth, cosmetic effects and injection-related abscesses.5



The “Ugly” Role of hGH: Frankenstein Meets the Playboy Playmate

The immediate reaction of the “ugly” is to visualize a Frankenstein-like hulking bodybuilder with “GH belly.” However, the first instance I consider is now-deceased supermodel Anna Nicole Smith. A former model for Guess jeans and 1993 Playboy Playmate of the Year, Smith was known later in her career for extremely dramatic weight gain, followed by equally extreme weight loss. Prior to her demise from a tragic addiction to prescription medications, she served as a spokesperson for a weight-loss product.



According to autopsy findings, in addition to numerous other drugs, two were present that were likely used to promote or maintain her recent weight loss— hGH and topiramate.6 The presumed injection sites for the hGH (and vitamin B-12) were riddled with abscesses and areas of necrotic (dead) tissue. Topiramate is a drug used to treat epilepsy that has only recently been approved as part of a combination drug for weight loss. Smith, with no known history of epilepsy, was using the drug in 2007. The “ugly” role of hGH was not its effectiveness or presence in the autopsy report, but rather its use by an undisciplined person (as demonstrated by the drug addiction and multiple abscesses) to promote an image not supported by her lifestyle, and used to persuade consumers of the effectiveness of an herbal supplement.



Bodybuilding has seen “ugly” too. During the mid-1980s, the appearance of professional and top amateur bodybuilders began to change. The size obtained by the men became even more distorted from the aesthetic proportions that hallmarked the prior decades; the V-taper of the abdomen disappeared to be replaced by a distended “belly” with absolutely minimal subcutaneous fat; hands, feet and facial features were becoming elongated and misshapen. For the mainstream audience, acceptance of professional bodybuilding plummeted as they perceived physiques warping from godlike to grotesque. Thankfully, physiques have trended back toward a more aesthetic form as competitors have gained a greater understanding of hGHs effects and proper dosing— through the costly practice of trial and error.



Health Concerns and the “Anything Goes” Mentality

Given the polypharmacy (multiple drugs used) practices of professional bodybuilding, it is impossible to isolate any particular drug, diet or training program to a specific harm. However, it has been noted that bodybuilders have seen an increase in heart attacks and deaths during the last 20 years, according to anecdotal reports and autopsy series. It is likely that hGH played a role in those who used that hormone as part of their physique-enhancement pharmacopeia.



Many athletes and bodybuilders, such as Dennis Newman, Mike Matarazzo and Lyle Alzado, have attributed hGH as a factor in debilitating or deadly conditions. Few athletes and bodybuilders disclose their drug protocols, but the culture promotes risk-taking and discourages allowing the competition any advantage. This “anything goes” mentality nearly guarantees that more cases will be revealed. It is clear that a growing trend is present in premature deaths and heart attacks among bodybuilders in their 30s and 40s.



How does hGH promote harm or death? In physiological doses, it is a reasonably safe therapy. Long-term treatment of hGH-deficient adults has shown no increase in cardiovascular disease or cancer, though pre-existing cancers can arise more frequently.2 However, recall that hGH has two body composition-related properties that make it attractive to bodybuilders and athletes. hGH is capable of promoting fat loss and increasing lean mass; the two effects occur at different dose ranges. While it is possible to utilize hGH to attain a leaner physique without significantly increasing the risk of heart attacks, cancer or an early death, the doses used to stimulate the exaggerated muscular bulk of modern bodybuilders holds a great potential to cause harm.



Dosing and Monitoring hGH

How is hGH dosed and monitored? hGH is protein-based hormone, and thus is only effective when administered via injection. Dosing begins weight-based, but in general results in the administration of 1-3 IU of hGH daily after individual titration. Some clinicians recommend an every-other-day schedule, or hGH-free weekends. The response is monitored via the IGF-1 response, which should not exceed the “normal” range or a “Z-score” above 1.96. At this dosing, hGH can promote fat release from fat cells, and increase the metabolism and healing slightly. Muscle mass will not be enhanced solely through the drug’s effect. Unless one was hGH-deficient prior to treatment, the greater ability to recover, response to training and improved body composition are generally viewed as significant and favorable.



A physiologic hGH supplementation should avoid the adverse effects of impaired glucose tolerance, edema, carpal tunnel syndrome and organ growth. Anabolic steroid users who combine hGH in their “stacks” face a greater risk of enlarged heart, prostate, gynecomastia and high blood pressure, among other effects.7,8 This becomes a grave concern when combining the two classes of drug at extremely high dose range. The distended “GH belly” is not a result of water retention, but the growth of internal organs (e.g., liver, intestines, kidneys). Although the organs may in time decrease in size toward normal after hGH use is discontinued, the bony growths that result in the characteristic— and not generally considered attractive— facial changes, elongated hands and feet, are permanent.



Trading Health for Momentary Fame

Much like testosterone, hGH and its secondary hormone IGF-1 display distinct negative effects when the dose is either too low or too high. However, as the anabolic and fat-loss effects are related to the dose, reckless bodybuilders will pursue the gains until negative side effects arise that are intolerable. Sadly, they typically monitor weight-room performance or cosmetic changes, missing the internal damage to both organ structure and metabolic function. hGH is an essential treatment for many people, but the consequences of abusing the hormone beyond its “sweet spot” has resulted in disfigurement, contributed to impaired health and likely played a factor in the early death of several bodybuilders and powerlifters who willingly traded away their health for momentary fame.
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