Major Concerns with HGH Therapy: Part 3

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Major Concerns with HGH Therapy: Part 3

One major concern with growth hormone therapy is that the most appropriate diagnosing guidelines, dosing levels, and monitoring guidelines for adults with age-related GH deficiency have not been fully established.

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The study of growth hormone replacement in adults with growth hormone deficiency is a rather new field. Synthetic growth hormone was first synthesized in 1985, and interest in the area became popularized in the early 1990s. Compare this time period to that of the field of surgery, which has existed for literally thousands of years.

The relative newness of GH replacement in adults means that the most appropriate diagnosing protocols, dosing regimens, and monitoring protocols for GH therapy have not been fully standardized. Quite simply, the process of finding the most appropriate set of practices takes time, and the field of GH replacement is too young to have fully identified its set of “best practices”.

Ultimately, the relative newness of the area leads to confusion and debate among physicians and consequently to reluctance in diagnosing and treating growth hormone deficiency. Additionally, the inconvenience of provocative testing along with the high cost of therapy limit the use of GH replacement.

If you pursue GH replacement therapy for GH deficiency, it is important to be a well-informed patient. The most recent clinical practice guidelines by the Endocrine Society on treatment of adult growth hormone deficiency are as follows:1

Diagnosing:

The insulin tolerance test (ITT) or the growth hormone releasing hormone (GHRH)-arginine test is the preferred test for establishing the diagnosis of growth hormone deficiency.

Dosing :

Patients Aged 30-60 yr:

Starting Dose:  300 μg/day. The starting dose should be increased by 100-200 μg/day every 1-2 months with the goal of achieving an appropriate clinical response with an avoidance of side effects and an IGF-1 level in the age-adjusted reference range.

Patients Aged > 60 yr:

Starting Dose:  100-200 μg/day. The dose should be increased more slowly from starting in this population with the goal of achieving an appropriate clinical response with an avoidance of side effects and an IGF-1 level in the age-adjusted reference range.

Monitoring:

Patients should be monitored at 1- to 2-month intervals during dose adjustment and semiannually thereafter with a clinical assessment and an evaluation of adverse effects and IGF-1 levels.

1. Molitch ME, Clemmons DR, Malozowski S, et al. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. May 2006;91(5):1621-1634.