Risks Outweigh Benefits of Using HGH for Antiaging

SAN FRANCISCO — Growth hormone therapy might help adults with a deficiency, but there's no evidence that it helps normal elderly adults or athletes.

Illegal use in antiaging clinics probably accounts for the largest use of growth hormone in the United States today, Dr. Andrew R. Hoffman said.

The therapy is indicated for adults for the treatment of growth hormone deficiency caused by pituitary disease, hypothalamic disease, surgery, radiation, or trauma. It is the only drug in the U.S. that cannot legally be prescribed off label, he said at a meeting on diabetes and endocrinology sponsored by the University of California, San Francisco.

What's more, its use in normal elderly people may cause harm by inducing glucose intolerance or increasing the risk for cancer, “although we do not know that” for sure, said Dr. Hoffman, professor of medicine at Stanford (Calif.) University and the Veterans Affairs Palo Alto Health Care System.

Interest in treating normal age-related declines in growth hormone secretion and insulin-like growth factor 1 (IGF-1)—dubbed the “somatopause”—zoomed after a 1999 study reported that giving growth hormone injections to male veterans aged older than 60 years for 6 months increased lean tissue mass by 9%, skin thickness by 7%, and lower-back vertebral density by 2%, while decreasing fatty tissue by 14% (N. Engl. J. Med. 1990;323:1-6). The authors described the effects as equivalent in magnitude to the changes that occur during 10-20 years of aging. “This set up a lot of excitement and was the basis for all the antiaging clinics you can find,” Dr. Hoffman said.

It also generated multiple animal studies by the National Institutes of Health, every one of which showed that longevity is associated with lower growth hormone levels, not higher ones. A systematic review of randomized, controlled trials of growth hormone injections in healthy elderly humans reported small changes in body composition and high rates of adverse events (Ann. Intern. Med. 2007;146:104-15).

One of the potential side effects with growth hormone overtreatment is increased edema. “You can't say it increases muscle,” Dr. Hoffman said. “Much of it might be fluid retention.”

The medical literature suggests that treatment probably is helpful for patients with growth hormone deficiency syndrome, Dr. Hoffman said. Treatment produces significant and durable changes in cardiac effects. Bodily fat mass, LDL cholesterol, and total cholesterol levels decrease but insulin and glucose levels tend to increase.

In general, patients treated for growth hormone deficiency syndrome become more physically active, increase their strength and exercise capacity, and slightly increase bone mineral density.

Other data suggest, however, that high levels of IGF-1 over long periods of time could increase the risk for prostate cancer or premenopausal breast cancer.

Dr. Hoffman has received research support, owned stock, or been a consultant to companies that market growth hormone or related products, including Ambryx, LG Life Science, Tercica, Merck Serono, Pfizer, Novo Nordisk, and Teva Pharmaceutical Industries.

SAN FRANCISCO — Growth hormone therapy might help adults with a deficiency, but there's no evidence that it helps normal elderly adults or athletes.

Illegal use in antiaging clinics probably accounts for the largest use of growth hormone in the United States today, Dr. Andrew R. Hoffman said.

The therapy is indicated for adults for the treatment of growth hormone deficiency caused by pituitary disease, hypothalamic disease, surgery, radiation, or trauma. It is the only drug in the U.S. that cannot legally be prescribed off label, he said at a meeting on diabetes and endocrinology sponsored by the University of California, San Francisco.

What's more, its use in normal elderly people may cause harm by inducing glucose intolerance or increasing the risk for cancer, “although we do not know that” for sure, said Dr. Hoffman, professor of medicine at Stanford (Calif.) University and the Veterans Affairs Palo Alto Health Care System.

Interest in treating normal age-related declines in growth hormone secretion and insulin-like growth factor 1 (IGF-1)—dubbed the “somatopause”—zoomed after a 1999 study reported that giving growth hormone injections to male veterans aged older than 60 years for 6 months increased lean tissue mass by 9%, skin thickness by 7%, and lower-back vertebral density by 2%, while decreasing fatty tissue by 14% (N. Engl. J. Med. 1990;323:1-6). The authors described the effects as equivalent in magnitude to the changes that occur during 10-20 years of aging. “This set up a lot of excitement and was the basis for all the antiaging clinics you can find,” Dr. Hoffman said.

It also generated multiple animal studies by the National Institutes of Health, every one of which showed that longevity is associated with lower growth hormone levels, not higher ones. A systematic review of randomized, controlled trials of growth hormone injections in healthy elderly humans reported small changes in body composition and high rates of adverse events (Ann. Intern. Med. 2007;146:104-15).

One of the potential side effects with growth hormone overtreatment is increased edema. “You can't say it increases muscle,” Dr. Hoffman said. “Much of it might be fluid retention.”

The medical literature suggests that treatment probably is helpful for patients with growth hormone deficiency syndrome, Dr. Hoffman said. Treatment produces significant and durable changes in cardiac effects. Bodily fat mass, LDL cholesterol, and total cholesterol levels decrease but insulin and glucose levels tend to increase.

In general, patients treated for growth hormone deficiency syndrome become more physically active, increase their strength and exercise capacity, and slightly increase bone mineral density.

Other data suggest, however, that high levels of IGF-1 over long periods of time could increase the risk for prostate cancer or premenopausal breast cancer.

Dr. Hoffman has received research support, owned stock, or been a consultant to companies that market growth hormone or related products, including Ambryx, LG Life Science, Tercica, Merck Serono, Pfizer, Novo Nordisk, and Teva Pharmaceutical Industries.

SAN FRANCISCO — Growth hormone therapy might help adults with a deficiency, but there's no evidence that it helps normal elderly adults or athletes.

Illegal use in antiaging clinics probably accounts for the largest use of growth hormone in the United States today, Dr. Andrew R. Hoffman said.

The therapy is indicated for adults for the treatment of growth hormone deficiency caused by pituitary disease, hypothalamic disease, surgery, radiation, or trauma. It is the only drug in the U.S. that cannot legally be prescribed off label, he said at a meeting on diabetes and endocrinology sponsored by the University of California, San Francisco.

What's more, its use in normal elderly people may cause harm by inducing glucose intolerance or increasing the risk for cancer, “although we do not know that” for sure, said Dr. Hoffman, professor of medicine at Stanford (Calif.) University and the Veterans Affairs Palo Alto Health Care System.

Interest in treating normal age-related declines in growth hormone secretion and insulin-like growth factor 1 (IGF-1)—dubbed the “somatopause”—zoomed after a 1999 study reported that giving growth hormone injections to male veterans aged older than 60 years for 6 months increased lean tissue mass by 9%, skin thickness by 7%, and lower-back vertebral density by 2%, while decreasing fatty tissue by 14% (N. Engl. J. Med. 1990;323:1-6). The authors described the effects as equivalent in magnitude to the changes that occur during 10-20 years of aging. “This set up a lot of excitement and was the basis for all the antiaging clinics you can find,” Dr. Hoffman said.

It also generated multiple animal studies by the National Institutes of Health, every one of which showed that longevity is associated with lower growth hormone levels, not higher ones. A systematic review of randomized, controlled trials of growth hormone injections in healthy elderly humans reported small changes in body composition and high rates of adverse events (Ann. Intern. Med. 2007;146:104-15).

One of the potential side effects with growth hormone overtreatment is increased edema. “You can't say it increases muscle,” Dr. Hoffman said. “Much of it might be fluid retention.”

The medical literature suggests that treatment probably is helpful for patients with growth hormone deficiency syndrome, Dr. Hoffman said. Treatment produces significant and durable changes in cardiac effects. Bodily fat mass, LDL cholesterol, and total cholesterol levels decrease but insulin and glucose levels tend to increase.

In general, patients treated for growth hormone deficiency syndrome become more physically active, increase their strength and exercise capacity, and slightly increase bone mineral density.

Other data suggest, however, that high levels of IGF-1 over long periods of time could increase the risk for prostate cancer or premenopausal breast cancer.

Dr. Hoffman has received research support, owned stock, or been a consultant to companies that market growth hormone or related products, including Ambryx, LG Life Science, Tercica, Merck Serono, Pfizer, Novo Nordisk, and Teva Pharmaceutical Industries.