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Harvard Men's Health Watch

Growth hormone, athletic performance, and aging

Published: May, 2010

In 1513, the Spanish explorer Juan Ponce de Len arrived in Florida to search for the fountain of youth. If he got any bene t from his quest, it was
due to the exercise involved in the search.

Few men today believe in miraculous waters, but many, it seems, believe in the syringe of youth. Instead of drinking rejuvenating waters, they
inject human growth hormone to slow the tick of the clock. Some are motivated by the claims of the "anti-aging" movement, others by the
examples of young athletes seeking a competitive edge. Like Ponce de Len, the athletes still get the bene t of exercise, while older men may use
growth hormone shots as a substitute for working out. But will growth hormone boost performance or slow aging? And is it safe?

Human growth hormone: Up close and personal

Growth hormone (GH) is a small protein that is made by the pituitary gland and secreted into the bloodstream. GH production is controlled by a
complex set of hormones produced in the hypothalamus of the brain and in the intestinal tract and pancreas.

The pituitary puts out GH in bursts; levels rise following exercise, trauma, and sleep. Under normal conditions, more GH is produced at night than
during the day. This physiology is complex, but at a minimum, it tells us that sporadic blood tests to measure GH levels are meaningless since
high and low levels alternate throughout the day. But scientists who carefully measure overall GH production report that it rises during
childhood, peaks during puberty, and declines from middle age onward.

GH acts on many tissues throughout the body. In children and adolescents, it stimulates the growth of bone and cartilage. In people of all ages,
GH boosts protein production, promotes the utilization of fat, interferes with the action of insulin, and raises blood sugar levels. GH also raises
levels of insulin-like growth factor-1 (IGF-1).

Therapeutic use
GH is available as a prescription drug that is administered by injection. GH is indicated for children with GH de ciency and others with very short
stature. It is also approved to treat adult GH de ciency — an uncommon condition that almost always develops in conjunction with major
problems a icting the hypothalamus, pituitary gland, or both. The diagnosis of adult GH de ciency depends on special tests that stimulate GH
production; simple blood tests are useless at best, misleading at worst.

Adults with bona de GH de ciencies bene t from GH injections. They enjoy protection from fractures, increased muscle mass, improved
exercise capacity and energy, and a reduced risk of future heart disease. But there is a price to pay. Up to 30% of patients experience side e ects
that include uid retention, joint and muscle pain, carpal tunnel syndrome (pressure on the nerve in the wrist causing hand pain and numbness),
and high blood sugar levels.

GH doping
Adults who are GH de cient get larger muscles, more energy, and improved exercise capacity from replacement therapy. Athletes work hard to
build their muscles and enhance performance. Some also turn to GH.

It's not an isolated problem. Despite being banned by the International Olympic Committee, Major League Baseball, the National Football
League, and the World Anti-Doping Agency, GH abuse has tainted many sports, including baseball, cycling, and track and eld. Competitive
athletes who abuse GH risk disquali cation and disgrace. What do they gain in return? And do they also risk their health?
Because GH use is banned and athletic performance depends on so many physical, psychological, and competitive factors, scientists have been
unable to evaluate GH on the eld. But they can conduct randomized clinical trials that administer GH or a placebo to healthy young athletes
and then measure body composition, strength, and exercise capacity in the lab.

A team of researchers from California conducted a detailed review of 44 high-quality studies of growth hormone in athletes. The subjects were
young (average age 27), lean (average body mass index 24), and physically t; 85% were male. A total of 303 volunteers received GH injections,
while 137 received placebo.

After receiving daily injections for an average of 20 days, the subjects who received GH increased their lean body mass (which re ects muscle
mass but can also include uid mass) by an average of 4.6 pounds. That's a big gain — but it did not translate into improved performance. In
fact, GH did not produce measurable increases in either strength or exercise capacity. And the subjects who got GH were more likely to retain
uid and experience fatigue than were the volunteers who got the placebo.

If you were a jock in high school or college, you're likely to wince at the memory of your coach barking "no pain, no gain" to spur you on. Today,
athletes who use illegal performance-enhancing drugs risk the pain of disquali cation without proof of gain.

GH for aging
Among its many biological e ects, GH promotes an increase in muscle mass and a decrease in body fat. As men age, GH levels fall. During the
same time span, muscle mass declines and body fat increases. And so, the theory goes, the way to arrest these e ects of aging is to inject GH.

Similar claims have been made for other hormones that decline with age, including testosterone and dehydroepiandrosterone (DHEA) in men,
and estrogen in women. Research shows that estrogen replacement does more harm than good in older women, and there is no solid evidence
that testosterone and DHEA are safe and e ective for healthy older men. But that has not stopped the growth of "anti-aging" and "regenerative
medicine" clinics and Web sites.

Expensive injections of growth hormone are o ered by many practitioners, even though the FDA has not approved the use of GH for anti-aging,
body building, or athletic enhancement, and the marketing or distribution of the hormone for any of these purposes is illegal in the U.S.
According to one estimate, 20,000 to 30,000 Americans used GH as "anti-aging" therapy in 2004 alone; according to another, 100,000 people
received GH without a valid prescription in 2002.

To evaluate the safety and e cacy of GH in healthy older people, a team of researchers reviewed 31 high-quality studies that were completed
after 1989. Each of the studies was small, but together they evaluated 220 subjects who received GH and 227 control subjects who did not get
the hormone. Two-thirds of the subjects were men; their average age was 69, and the typical volunteer was overweight but not obese.

The dosage of GH varied considerably, and the duration of therapy ranged from two to 52 weeks. Still, the varying doses succeeded in boosting
levels of IGF-1, which re ects the level of GH, by 88%.

As compared to the subjects who did not get GH, the treated individuals gained an average of 4.6 pounds of lean body mass, and they shed a
similar amount of body fat. There was a slight drop in total cholesterol levels, but no signi cant changes in LDL ("bad") cholesterol, HDL ("good")
cholesterol, triglycerides, aerobic capacity, bone density, or fasting blood sugar and insulin levels. But GH recipients experienced a high rate of
side e ects, including uid retention, joint pain, breast enlargement, and carpal tunnel syndrome. The studies were too short to detect any
change in the risk of cancer, but other research suggests an increased risk of cancer in general and prostate cancer in particular.

Beat the clock

"Every man desires to live long," wrote Jonathan Swift, "but no man would be old." He was right, but the fountain of youth has proved illusory.
And while more study is needed, GH does not appear to be either safe or e ective for young athletes or healthy older men. But that doesn't
mean you have to sit back and let Father Time peck away at you. Instead, use the time-tested combination of diet and exercise. Aim for a
moderate protein intake of about .36 grams per pound of body weight; even big men don't need more than 65 grams (about 2 ounces) a day,
though athletes and men recovering from illnesses or surgery might do well with about 20% more. Plan a balanced exercise regimen; aim for at
least 30 minutes of moderate exercise, such as walking, a day, and be sure to add strength training two to three times a week to build muscle
mass and strength. You'll reduce your risk of many chronic illnesses, enhance your vigor and enjoyment of life, and — it's true — slow the tick of
the clock.

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