A guide to bioidentical hormone replacement.

 

Growth Hormone: Can it be taken as a spray,

pill, or cream?

Question of the Week:

 

November 2, 2001

“I've been hearing so much about HGH or Human Growth Hormone. I understand that HGH is often taken by injection and is also available in liquids taken orally. Here's my question: If HGH is produced in the human brain, where does the HGH come from that is injected in people or given orally?”

 

I hear one variation or another of this question asked virtually every time I speak with a prospective patient. The two point, “Where does it come from?” and “How is it given?” are inextricably linked. So I thought I’d take this opportunity to clear up a number of misconceptions that plague the field of anti-aging growth hormone replacement therapy.

 

Size Matters: Human growth hormone (hGH) is a relatively large protein molecule produced by the pituitary gland at the base of the brain. The size is important because it effectively limits the ways in which it can be reintroduced to the body when pituitary release is deficient. If you imagine that a hormone such as testosterone or a drug such as Tylenol is about the size of a tennis ball, then hGH would be about the size of a large jungle gym. This size differential makes it impossible for hGH to sneak in through the skin or mucous membranes as many other smaller drugs can.

 

HGH is also a protein hormone, unlike testosterone or estrogen or cortisone, which means that it is made up of a string of amino acids similar to the proteins in the foods we eat. This makes hGH susceptible to breakdown by the acids in our stomach (just as the protein in food is disgested) and even some of the enzymes in our saliva.

 

Unfortunately, these facts leave injection as the only option to get therapeutic amounts of hGH into the circulation. Injectable hGH is produced through recombinant DNA technology in which the gene for hGH is inserted into the DNA of a microrganism or a cell line (cells kept in a petri dish that continue to divide ) and the cell starts to produce large quatities of the protein. The protein is then purified from the medium (the nutritive soup surrounding the cells), crystallised and packaged as a powder, and then reconstituted in a saline solution which is injected into the fat just under the skin. From there the hGH is slowly absorbed into the blood stream just as it would be if released from the pituitary gland—although it is not in the pulsatile pattern that the pituitary creates. The circulating hGH then stimulates the liver, as well as other cells to a lesser degree, to produce insulin-like growth factor I (IGF-I), which in turn circulates throughout the body producing the myriad beneficial effects attributed to hGH. This is why we measure IGF-I when we want to determine if a product is causing an increase in hGH levels.

 

What about all those sprays, drops, creams, and pills? None of the marketers or manufacturers can present any credible scientific data to show that growth hormone or IGF-I levels are increased with any of these products. And that is no surprise because of what we know about hGH’s molecular size and because we know that pharmaceutical companies have been trying for decades to find a delivery system that avoids needles for children.

 

What about the companies that say that their products use “minute amounts” of hGH to simulate the natural release of hGH through out the day with 3 or 4 sprays a day. Again, if it sounds too good to be true, it often is. These companies put on the order of 1/000 the amount of GH into their products and expect that it will cross the skin or mucous membrane barriers without degradation into useless amino acids. Even if this did occur, the amounts are entirely too low to have any therapeutic effect. None of these products have shown valid data that the hGH is getting into the system. Furthermore, some of the growth hormone in these preparations is not plant GH which is not effective in humans.

 

What about all the testimonials? Many times the marketers for these products will show “data” that indicates “66% improvement in skin tone,” or “80% increase in energy,” etc. These are subjective responses at best and fabrications at worst. It is well known that if you tell someone something is going to make him feel better, a good percentage of the time some effect will be reported—it’s call the placebo effect. Yes, these products are less expensive than injectable hGH, but why pay $50 to $150 for a placebo effect—which, by the way, is also notoriously short-lived.

 

The final category of non-injectable growth hormone replacement products are the ‘secretagogues.’ These do not contain any hGH, but are purported to increase your own pituitary release of hGH. It is true that the age-related decrease in hGH secretion is a result of decreased release from the pituitary gland and not deficient production by the somatotroph cells. Stimulation of these cells with, for example, growth hormone releasing hormone (GHRH) can cause a robust secretion of growth hormone in an older individual. One substance similar to GHRH, Geref by Serono labs, is available today, but is more expensive than hGH and also needs to be injected twice a day. Other substances work in a slightly different manner and can be taken orally, but are still in the development stage at large pharmaceutical companies. They may be available in 3 to 5 years, but will not have the wealth of clinical effectiveness and safety data that injectable hGH currently has and continues to accrue.

 

Tests for GH deficiency stimulate the pituitary gland to release hGH, and if the gland doesn’t respond, then the person is medically growth hormone deficient. One of these tests utilizes large doses of the amino acid arginine intravenously and does, in normal individuals, cause a large secretion of hGH. The dose, however, is so large as to be impractical orally and would cause nausea in most patients. In one study, glutamine in a dose of 2 gms showed an increase in hGH secretion that was significant in some, but not in all subjects. The results of this study have not been replicated by another research group.

 

Capitalizing on these facts, companies have created amino acid combinations, usually of arginine, glutamine, ornithine, lysine, and glycine and occasionally others, in a powder or capsule form, and offered them as growth hormone secretagogues. I have not seen well-controlled studies for any of the products, but they may work. Certainly, taking glutamine and arginine in doses of 2 to 6 grams a day can have beneficial effects on your energy levels, immune system, gastrointestinal tract, and cardiovascular system. Therefore, I believe these are reasonable substances to take and may cause you to have an increase in hGH and thereby in IGF-I. The only way to be sure is to have a baseline level of IGF-I done and then repeat it after a month or two of the product.

 

I hope this clears up the misinformation out there about where hGH comes from and effective ways to increase your GH/IGF-I system.