Earlier this year, Major League Baseball started talks with its union to investigate adopting a new test for human growth hormone.
The issue of hGH testing has picked up considerable steam in the wake of what can best be described as a "perfect storm" of media events: The highly anticipated admission by former St. Louis Cardinals slugger Mark McGwire that he used both anabolic steroids and hGH throughout his career, including the historic 1998 season when he broke Roger Maris' long-standing single season home run record; and the United Kingdom Anti-Doping authority announcing a two-year ban for rugby player Terry Newton for testing positive for hGH.
Shortly after the UK ruling, the first of its kind for hGH use in professional sports, a statement was issued by Major League Baseball and reported by the New York Times:
"We are consulting with our experts concerning immediate steps for our minor league drug program and next steps for our major league drug program. The commissioner remains committed to the position that we must act aggressively to deal with the issue of hGH."
It's a fair assumption that MLB has been anxiously awaiting a reliable test for hGH so it can finally begin rebuilding its once-proud image as America's game, an image that has been tarnished by a seemingly endless series of doping scandals.
Who could forget former Arizona Diamondbacks pitcher Jason Grimsley, caught by authorities accepting a shipment of hGH in 2006, who would go on to finger fellow player David Segui as another hGH user? Or Houston Astros pitcher Andy Pettite, who admitted he'd used hGH while a member of the storied New York Yankees?
Or perhaps the biggest lightning rod of all, former Oakland A's bruiser Jose Canseco, who continually dodged hGH rumors throughout his career before performing an about-face to sing the praises of the drug in his tell-all book, Juiced, subsequently throwing fellow players Rafael Palmeiro, Jason Giambi, Iván Rodríguez, Juan González, and Big Mac himself under the ever-expanding hGH bus?
Given the media maelstrom, it wasn't surprising that former US Senator George Mitchell's 21-month investigation into the use of anabolic steroids and human growth hormone in Major League Baseball concluded that hGH is the new "drug of choice."
Yet the question many in the know are asking is: does it even deserve to be, for baseball players or even strength and physique athletes?
Before we discuss the possible benefits of growth hormone for athletes, let's first take a look at what it is.
Human Growth Hormone (hGH) is produced and secreted in the brain by the pituitary gland. Once released, it stimulates the liver to make insulin-like growth factor 1 (IGF-1), and this hormone then triggers the growth and repair of bones and body tissues including muscle, skin, organs, and more.
The body's natural growth hormone production is controlled by the neurohormone Gonadotropin-releasing hormone (GHRH), Growth hormone-releasing peptide (GHRP), and somatostatin, and is normally released in pulses or bursts throughout the day. There are often as many as 20 daily surges, with the largest release occurring shortly after you fall asleep.
HGH is especially important for normal growth in children, and hGH levels rise sharply throughout puberty, peak at about age 20, and then slowly decrease throughout adulthood; although a healthy pituitary never totally ceases hGH production.
The historical roots of human growth hormone therapy are like something lifted from the pages of Mary Shelley's Frankenstein. Growth hormone was originally developed in the 1950s to treat dwarfism in children, and the first preparations were extracts of the raw hormone from the pituitary of cadavers. This early form of growth hormone was known as cadaver-GH.
Unfortunately in 1985, four cases of Creutzfeldt-Jakob Disease (CJD) were diagnosed in patients who had been treated with cadaver-GH in the 1960s. CJD is a fatal degenerative brain disorder in which healthy brain tissue deteriorates into an abnormal protein that the body can't break down. Patients suffering from CJD experience rapidly declining neurological function resulting in dementia, paralysis, slurred speech, incontinence, blindness, coma, and eventually death.
Following the discovery of the similar GH treatments that each CJD-diagnosed individual had received in their youth, the use of cadaver-GH to treat dwarfism quickly ceased.
However, in 1981 American pharmaceutical company Genentech pioneered the first use of recombinant human growth hormone for human therapy and by 1985, biosynthetic human growth hormone replaced cadaver-GH for therapeutic use.
Since then, hGH therapy has expanded to treating adults determined to have an hGH deficiency, and it was this expansion of treatment applications that helped plant what would become the hGH money tree.
With the development of a safe alternative to cadaver-GH, scientists began to expand the scope of treatment beyond dwarfism to include other forms of GH deficiency.
In adults, true medical deficiency of growth hormone may result from disease, tumors, radiation, or any trauma that damages critical areas of the pituitary. This can lead to some significant health challenges like weight gain, cardiovascular disease, cholesterol abnormalities, fatigue, decreased immune response, arthritis, increased insulin resistance, adult onset diabetes, hair loss, sarcopenia (loss of muscle), and osteoporosis. Not surprisingly, hGH therapy has proven to be very helpful for these GH-deficient individuals.
(Of interest, baseball player Segui reportedly had a legitimate prescription for hGH to treat GH deficiency; a diagnosis that drew criticism from authorities who questioned how a professional athlete of normal height and weight could possibly be GH deficient.)
But over the last decade, an increasing number of physicians have started to legally administer hGH to treat the most widespread medical "problem" of all: aging.
As stated, endogenous growth hormone levels slowly decline as part of the natural aging process, and slowing or stopping this decline has numerous anti-aging benefits. Increased energy, improved sexual performance, reduced bodyfat, increased muscle mass, thickening of the skin, improved sleep, enhanced bone strength, improved cognitive performance, and increased lifespan are just some of the benefits being shopped to aging men looking to add years to their life and life to their years.
However, baby boomers take note: if the ad copy has you believing that hGH is the fountain of youth, think again. Experts and researchers alike agree that a decline in hGH is not the cause of aging, and maintaining youthful levels of hGH will not make you the next Dick Clark. Even if hGH levels remained at the level of a 25 year-old, you would continue to experience the effects of aging, although to a reduced degree.
But not at a reduced price. Prescribed hGH injections range in price from $500 to $1,000 a month, and not surprisingly, there are thousands of clinics and doctors who prescribe growth hormone, calling their practice "anti-aging," "regenerative" or "age management" medicine.
An article published in the Journal of the American Medical Association notes that annual worldwide sales of hGH are estimated to be $1.5 billion to $2 billion, and up to 30 percent of hGH prescriptions in the U.S. are used for anti-aging and "athletic enhancement."
The main attraction to hGH for athletes (apart from until recently, the lack of a reliable test) is its ability to aid in the recovery of injuries. HGH stimulates collagen synthesis, which is necessary for strengthening cartilage, bones, tendons, and ligaments.
Combining hGH with anabolic steroids amplifies its regenerative effects. Jason Grimsley reportedly stacked hGH with the joint-friendly anabolic steroid Deca-Durabolin to recover from ligament replacement surgery and was back on the field in only nine months, slashing his estimated recovery time in half.
Dr. Hector Lopez is with Performance Spine and Sports Medicine, a progressive sports medicine practice with facilities in Ocean and Mercer counties, New Jersey. Lopez specializes in athletic performance and consults with numerous professional athletes, and isn't surprised that athletes are looking at taking hGH and anabolic steroids as a way to extend their playing careers. He says,
"My radar is always tuned into my patients' endocrine and metabolic status as a potential limitation in their rehabilitation from injury. It's quite clear that the hGH-somatomedin axis is critical for improving recovery from the day to day micro-trauma that these tissues experience."
But these are professional athletes, making six or seven figures to perform at their absolute best. Surely this hasn't trickled down into the amateur ranks?
Strength coach Christian Thibaudeau trains many amateur athletes from a variety of sports. He's seen the interest rise in hGH even in recreational athletes, and he's not surprised Major League Baseball is taking hGH use as seriously as it is.
"Until now, hGH has been undetectable, so it's become popular in sports where drug testing has been implemented. The fact that it helps with recuperation makes it even more attractive."
"But part of it is just locker room hype. HGH does not burn fat as well as a good fat burner, and it's not as good a mass builder as Testosterone or insulin.
"Still, athletes are insecure. They hear whispers that other guys are using it and they think, 'Maybe I should too.' Athletes always want as much edge as the next guy."
"It's still underhanded. Detectable or not, in baseball it's cheating. But in bodybuilding it's kind of open season."
"Jared" is an aspiring pro bodybuilder with an impressive string of amateur wins.
He started weight training to be a powerlifter, but decided to give competitive bodybuilding a try when fellow lifters recognized his Herculean physique and subtle lines could make big waves on the bodybuilding stage.
Five years and several first place finishes later; Jared has a legitimate shot at turning pro by 2011. Suffice it to say, hGH has played a part in his success.
Or has it?
"I use hGH, but to be honest, I really don't think that it's all that effective on it's own, at least compared to insulin or high doses of Testosterone. But hGH just seems to make other drugs work better."
Jared takes hGH year round, cycling the dosage and frequency depending on his goals and his budget.
"It's not cheap, at least for the real stuff. Five hundred to $1000 bucks per 100 IU kit is the norm. I usually take 12-15 IUs a couple days a week in the off season, and 4-6 IUs a day pre-contest.
"I always stop three weeks out from a show because it can make you hold water. But it's a great dieting tool – you get leaner, stay fuller," he says.
Although medically approved dosages of hGH are under 2 IUs a day, Jared insists his dosages are nowhere near excessive.
"I heard of pros taking 20 IUs a day or more, although usually not on a daily basis."
Christian Thibaudeau agrees.
"From what I've read, intermittent higher doses may be better for anabolism, while low doses over a longer term appear to be better for fat loss. So, 15 IUs, three times a week for mass versus 2-4 IUs daily for fat loss."
According to Thibaudeau, the anabolic effect of hGH is dependent on IGF-1 release, while the fat burning effect is a result of the actual hGH. IGF-1 release is tricky business however, and very much dose dependent.
"You need a pretty hefty dose of hGH to generate an IGF-1 release that will result in anabolism."
The intermittent high dose is preferred over the daily high dose to mitigate both costs and negative side effects, which Thibaudeau says are very real.
At medically approved dosages, the side effects of hGH are considered relatively mild, including bloating, carpal tunnel syndrome, gynecomastia, increase in blood pressure, swelling of the optic nerve, and a decrease in thyroid hormone production.
Even long term, reasonable usage seems to be relatively safe. A two-year, large group study posted in The Journal of Clinical Endocrinology found that patients treated with hGH experienced beneficial effects on body composition, metabolic parameters, and general well-being, with only adverse side effects being fluid-related.
Another ten-year study of hGH treatment published in the Journal of Endocrinology and Metabolism was equally glowing. The test subjects experienced significant increased lean body mass and decreased fat mass, a less atherogenic lipid profile, reduced carotid intima media thickness (an indication of plaque in the carotid), and improved psychological well-being. Granted, the study consisted of only 10 subjects, but the results are still worth noting as they were all relatively young subjects (mean age = 38).
Still, these were low doses to correct sub-clinical hGH concentrations, not supra-physiological doses commonly used in bodybuilding applications; an important designation.
Inflated levels of hGH in adults can cause acromegaly, a disease characterized by excessive growth of the head, feet, and hands. The nose, jaw, and forehead increase in size and the fingers and toes grow. The organs and digestive system may also increase in size, resulting in the distended abdomens seen on some bodybuilders.
Jared feels his intermittent approach has spared him these ill effects. Well, most of them.
"My hair grew faster, same with my nails. I've got some carpal tunnel symptoms now, nothing major. Again, this is all dose related. If you keep dosages reasonable, sides should be minimal."
There's also a concern about the possibility of an increased cancer risk with long-term hGH treatment. Insulin-like growth factor-1 promotes the growth of cells and prevents them from dying, which is what cancer cells do – they grow out of control and don't die.
Several studies have shown that women with high levels of hGH are more likely to get breast cancer, and men with high levels of hGH are more likely to develop prostate cancer.
But proponents of hGH counter that while correlations have been found between IGF-1 levels and certain types of cancer, correlation is not the same as causation. Further, recent evidence suggests hGH's beneficial impact on the immune system could (in theory) help reduce the risk of cancer.
"There's some limited yet interesting data on hGH improving Natural Killer (NK) cell activity and immunosurveillance of neo-plastic cells," says Lopez. "Hence, decreasing the incidence of certain cancers."
Despite these findings, Lopez is not prepared to dismiss any link between hGH and cancer, and continues to screen for cancer before embarking on hGH therapy.
"I would be very cautious prior to administering hGH in someone with a hormone-sensitive cancer."
Certainly, this is an area that warrants more study.
It seems clear that for the average lifter, hGH's ability to build muscle is definitely not worth the exorbitant price, at least if true US pharmaceutical sources are used. To consider this drug an even remotely cost effective anabolic requires stacking it with Testosterone and/or insulin or ratcheting up the dosage into realms that even the most dedicated athlete wouldn't consider cost-effective; again, if legitimate US pharmaceuticals are used.
It should also be noted that hGH's ability to grow "lean body mass" at high dosages includes everything that is not fat or water, namely the organs and viscera; certainly not what the typical physique-minded athlete has in mind. Granted, this condition is now considered reversible, but bodybuilders should still consider these unwanted effects.
The usefulness of hGH as a fat burning tool, especially when combined with Testosterone, is undeniable.
Even at relatively modest dosages, dramatic reductions in bodyfat and improved retention of lean body mass seem to be achievable, and much more when combined with anabolic steroids and fat burners.
The recuperative properties of hGH appear to be second to none. For professional athletes earning six or seven figures, a few thousand dollars a month is a pittance, and even athletes earning much less might consider judicious use of hGH as a way to help extend their training careers.
Bodybuilder Jared also swears by hGH's regenerative properties.
"I suffered a significant triceps tear a while back and was told I was done for the year. But I ended up healing so quick that I was back in the gym in two weeks. My physiotherapist wanted to use me as a poster boy for his clinic."
"I didn't have the heart to tell him I was on hGH."
While hGH's safety record is acceptable, it bears repeating that the longitudinal studies performed used hGH in isolation and at dosages far below what an athlete or bodybuilder would likely consider efficacious. The evidence is clear that increasing the dosage decreases the safety.
Another factor that significantly lowers hGH's safety profile is stacking hGH with anabolic steroids, a practice required to get the impressive effects that many hGH users swear by. "Administering hGH in isolation is often disappointing," says Dr. Lopez. "But frankly, (stacking hGH with anabolic steroids) decreases its safety profile."
So, is hGH safe to use for any populations? Lopez says,
"Ultimately, it's about weighing potential risk with potential benefit in light of the individual's co-morbidity, personal and family medical history, goals, and needs."
Aside from hGH's ability to facilitate healing and return an athlete to the field, it has little apparent ability to improve athletic performance. Any potential strength gains to an athlete with normal GH levels is minimal, at best.
Secretagogues are substances that cause another substance to be secreted. There are several hGH secretagogues under study right now, and recent restrictions placed by regulatory bodies on physicians writing prescriptions for hGH have sparked renewed interest in them. One such substance is Sermorelin Acetate, an analog to natural growth hormone that stimulates the pituitary to step up endogenous production.
Many physicians prefer modalities that restore natural hormone levels rather than replace them, and on paper, Sermorelin is very promising. It's been around for years, has a well-established safety record, and unlike hGH therapy, Sermorelin poses no long-term risk to pituitary gland function, nor is there any risk of overdose.
There are downsides of course. Sermorelin is expensive, and at effective dosages can approach that of hGH therapy. It also has an extremely short half-life, thereby limiting its ability to maintain elevated serum levels of growth hormone. These factors alone were enough for some physicians to shift their attention squarely on growth hormone replacement, not restoration.
However, the development of a new, long-acting growth hormone releasing factor has rekindled interest in growth hormone restoration. Is hGH therapy soon to be a thing of the past? Only time will tell.
At first glance, the reported benefits of human growth hormone sound too good to be true, and except for its near-magical recuperative abilities, that first glance assumption seems to be correct.
When comparing the anabolic properties of hGH to simple Testosterone – at reasonable doses and without the inclusion of other drugs – hGH pales in comparison, as it does in both safety and cost-effectiveness.
Even so, with the introduction of cheaper Chinese pharmaceutical versions like Jintropin and even cheaper (and often questionable quality) generic versions, many younger or recreational athletes may consider emulating their professional idols and take the hGH plunge. Still, Thibaudeau won't be advocating hGH for his athletes anytime soon.
"It's not a miracle drug. It's just a piece of the puzzle, the same way that steroids and insulin are pieces of the puzzle. And it's a small one at that."
"If a reliable test is developed, I'd be surprised if any professional baseball players ever bother with hGH again."
It's a different story for bodybuilders like Jared, who plans on using hGH throughout his upcoming prep, where he hopes to make his dream of turning pro a reality.
"I wouldn't use hGH before Testosterone or insulin. But it works, and basically everyone that I'll be competing against will be using it. Strange as it may sound, in bodybuilding you have to kind of keep up with the Joneses'."
"Maybe all these ball players figure they have to keep up with the Canseco's?"
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