Seniors seek vitality in growth hormone
Nov. 24, 2003

By ELIZABETH WEISE
USA TODAY

Thousands of seniors believe they’ve found the fountain of youth. They say it makes them leaner and more muscular, gives them more energy and improves their sex lives.
What is this elixir? It’s human growth hormone: The potent substance that has been the subject of a highly charged debate.

The U.S. Food and Drug Administration this summer approved giving the synthetic hormone to healthy kids likely to become very short adults. The ethics of that decision have been questioned by those who fear that it’s part of a quest for designer children.

But there’s growing concern among health experts about older Americans, as many as 50,000 of them a year, who are getting daily injections of the hormone. Some researchers say this practice, for which the users pay between $5,000 and $10,000 a year, can have serious and potentially deadly side effects.

Other researchers are hopeful that it might keep the elderly independent for longer.
“The goal of anti-aging medicine is to maintain our metabolism as youthful as we can for as long as we can,” says Ronald Klatz, president of the American Academy of Anti-Aging Medicine.

And seniors aren’t the only ones hoping for miracles: It’s a hot commodity among high-performance athletes. (But a different thing entirely from THG, the designer steroid at the center of a developing sports scandal.)

Don Catlin, a member of the International Olympic Committee’s Medical Commission, terms growth-hormone use “substantial.”

The IOC, in fact, is paying scientists to find a way to test for growth hormone use. The committee meets next spring to discuss whether that test can be ready for the Athens Olympics next August.

Growth hormone is vital to life. Produced in the pituitary, the body’s “master gland,” it is called somatotropin by scientists. Without it, embryos don’t grow, children don’t thrive and adults can become fat, lethargic and depressed. Peak production is during adolescence. The body makes less of it as the individual ages.

This summer, the FDA approved the use of synthetic growth hormone as a treatment for children of “extremely short stature” — boys likely to become adults less than 5-foot-3 and girls likely to be less than 4-foot-11.

These children are rarely deficient in growth hormone — their stature could be the byproduct of a host of genetic and other factors. So some bioethicists say giving potent drugs to these healthy kids just because they’re going to be short adults is unethical.

But the extra hormone could add three to five inches in height. The FDA concluded that being very short is such a handicap that those extra inches could make a big difference in the quality of a life.

Growth hormone is also approved for children who aren’t growing because of illnesses such as Turner’s syndrome or as a result of kidney dialysis.

Hormone treatment is approved for adults and kids who are deficient because of damage from pituitary tumors, surgery, radiation treatment or trauma.

For patients who’ve stopped producing growth hormone all together, replacement therapy can be a godsend. Mary Lee Vance, an endocrinologist at the University of Virginia in Charlottesville, has seen it help dozens of her patients whose pituitary glands were removed because of tumors.

The hormone is also given to AIDS patients to overcome the muscle wasting and abnormal fat distribution caused by the potent drugs they take.

These are all so-called “on label” uses, meaning they have been approved by the FDA for a specific condition.


’Off-label’ uses

When growth hormone is prescribed for healthy older people, it’s considered “off-label,” meaning the doctor is prescribing a drug that he or she feels will benefit the patient but it’s not for the FDA-specified condition.

Billie Russell, a 79-year-old from the La Jolla section of San Diego, started taking growth hormone shots four years ago, along with estrogen, testosterone, thyroid hormone and vitamins and minerals.

“I was not able to walk a block four years ago. Now I can walk a mile on my treadmill. I just feel great, I have a sex drive again. I feel like a young woman again,” the former model says. “Before I started this I didn’t want to get up in the morning, I wasn’t interested in going anywhere. I was just dull, like so many older women get when you have no hormones raging through your body anymore.”

Growth hormone changed her mood and her energy. “I give large dinner parties, I have a garden, I canned 100 quarts of beets and bread-and-butter pickles this year.

“It’s been a miracle for me,” says Russell. “My husband keeps saying ‘What has happened to you? Where’s the old lady gone?’ “

A San Francisco-area venture capitalist, who asked not to be named, has been taking it for three years and says the effects are “subtle.” The 51-year-old says he’s had a more positive attitude and moister, more elastic skin “that’s a little bit better looking.”

While he doesn’t expect it to make him live longer, “I do expect it to make me feel better during the years I have to live. I expect when I’m 70, 80 or 90 I’ll feel better than I otherwise would.”

But will he?

Forever young?

After almost a decade of research, the answer isn’t clear. One major new study compares people taking the hormone, people exercising and people doing both.

What researchers found, says George Merriam, a professor of medicine at the University of Washington in Seattle, is that while growth hormone “can resculpt your body composition, it won’t get you up out of bed.”

In other words, it can melt some abdominal fat and add some muscle, but it didn’t help subjects on the precise Continuous Scale-Physical Function Performance test, which measures life skills using a simulated bus stop, grocery store, kitchen and bedroom.
Only exercise clearly improved functional status, endurance and strength, researchers found. Their one positive finding was that while the drug alone didn’t improve physical performance, it did appear to stop it from getting worse.

“People are looking for a magic bullet,” says Christine Cassel, an expert on geriatric medicine and the president of the American Board of Internal Medicine. “The message that the key to vigorous old age is activity — physical, mental and social — just isn’t one our society wants to hear,” she says.

Merriam doesn’t think growth hormone is ready for prime time.

“My parents are in their 90s, and I have not recommended it. It’s not the sort of thing where you feel you know enough about the benefits (to know) that it’s worth the high price tag,” he says.

And that price tag may be very high indeed in terms of side effects.

Carl Grunfeld, a professor of medicine at the University of California at San Francisco, did some of the first studies of growth hormone in healthy older people. “They complained a lot,” he says. “They got edema (swelling), aches and pains, carpal tunnel. They did not like it.”

Of the 26 men taking growth hormone in Grunfeld’s study, 22 reported one or more side effects and six had to have their doses decreased because of those side effects. While the men studied lost abdominal fat and gained muscle, they didn’t increase their functional ability. These side effects have shown up in at least some patients in most research studies.

Klatz, however, is contemptuous of “all the baloney about these adverse side effects that just do not occur outside the laboratory.” He makes an exception for joint swelling, which he says disappears when the dose is reduced.

“Our patients and all of the legitimate study patients were outpatients, at home under their normal regimens. They were not ‘in a laboratory,’ “ Grunfeld counters. “Those on growth hormone had significantly more symptoms than those on placebo. No ifs, ands or buts about it.”

But those are just the obvious side effects. There’s also evidence that in older people, high doses can affect blood pressure and blood sugar and perhaps cause diabetes. Children do not appear vulnerable to these ailments.

And then there’s cancer. While research has tended to show that use of growth hormone doesn’t cause new cancers, the jury’s still out on whether it might cause tiny, hidden cancers to grow into something dangerous. One recent British study found an increase in cancer while two others did not.

But not all researchers are against giving the elderly growth hormone. Proponents see it as a way to mitigate the effects of aging, and there are people who report no side effects.

“The next big market to be explored is the treatment of frailty,” says Peter Sonksen, professor emeritus of endocrinology at King’s College London School of Medicine. “If it keeps people a bit less frail and a bit more independent for a bit longer, there’s an enormous potential for a positive there.”

Elixir of power?

While athletes may take high doses, older people tend to be on lower — and cheaper — regimes. The drug comes either as a liquid or a powder that’s mixed with sterile water. Most formulations require refrigeration and all are injected just under the skin, typically in the abdomen. Because our bodies produce most growth hormone at night, patients usually inject themselves before bedtime.

And it’s all perfectly safe, says Klatz. “If this was a dangerous substance you’d be hearing about it. Not from some ivory tower guy, but from the Centers for Disease Control, who would be reporting on all the adverse side effects reported to them from the emergency rooms,” he says.

In children, those problems might not have had enough time to surface, cautions Selna Kaplan, a pediatric endocrinologist at the University of California at San Francisco who was one of the pioneering growth hormone researchers.

Growth hormone wasn’t given to children in numbers big enough to study until 1985, when the synthetic version was first released. Even the oldest patients are only in early adulthood. There’s no way to know what will happen to them in their 40s, 50s and 60s.

“All we can say is that at the moment it doesn’t seem to have any adverse effects,” says Kaplan.

As for adults, it’s been hypothesized that the decline in growth hormone with age actually protects against age-related cancers such as prostate and breast cancer. Perhaps by lowering growth hormone levels, the body is working to slow down the growth of those cancers, notes Mark Blackman, an expert on neuroendocrinology and aging.

Researchers don’t yet know, says Blackman, but it’s something they’re thinking about.