THE BOOK--Playing The Percentages In Baseball

Tuesday, December 18, 2007

The Truth About HGH

One version, anyway:

HGH has some definite and proven medical benefits. It is currently approved medically in the United States for 2 primary indications, short-stature in children and growth hormone deficiency in adults.[2] All of these HGH benefits, however, are in individuals with growth hormone deficiency. In people with normal GH levels, HGH does not improve athletic performance in terms of muscle strength, flexibility, and endurance. In fact, several placebo-controlled studies have been negative.

A 4-week, double-blind Swedish study using 2 doses of HGH and placebo found no differences in subjects exercising on a bicycle in terms of power output and oxygen uptake.[3] In another study, a single injection of HGH increased plasma lactate and reduced exercise performance.[4]

Indeed, in the classic HGH excess experiment in nature, acromegalic subjects have increased muscle mass but histologic evidence of myopathy with muscle weakness and pain.[5]

In addition to the lack of effectiveness for enhancing athletic performance, HGH has a downside. It can cause dose-related side effects including diabetes, carpal tunnel syndrome, fluid retention, joint stiffness, muscle pain, and high blood pressure.[6]

It turns out that, like Paul Bunyan, the athletic benefits of HGH is a myth.

That’s my opinion. I’m Dr. George Griffing, Professor of Medicine at St. Louis University and Editor in Chief of Internal Medicine for eMedicine.

References

  1. United States. (1989). Drug misuse: anabolic steroids and human growth hormone. Report to the chairman, Committee on the Judiciary, US Senate, Washington, DC.
  2. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML. Endocrine Society’s Clinical Guidelines Subcommittee. Stephens PA. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab.2006; 91:1621-1634.
  3. Berggren A, Ehrnborg C, Rosen T, Ellegard L, Bengtsson BA, Caidahl K. Short-term administration of supraphysiological recombinant human growth hormone (GH) does not increase maximum endurance exercise capacity in healthy, active young men and women with normal GH-insulin-like growth factor I axes. J Clin Endocrinol Metab. 2005;90:3268-3273.
  4. Lange KH, Larsson B, Flyvbjerg A, et al. Acute growth hormone administration causes exaggerated increases in plasma lactate and glycerol during moderate to high intensity bicycling in trained young men. J Clin Endocrinol Metab. 2002;87:4966-4975.
  5. McNab TL, Khandwala HM. Acromegaly as an endocrine form of myopathy: case report and review of literature. Endocr Pract. 2005;11:18-22.
  6. Woodhouse LJ, Mukherjee A, Shalet SM, Ezzat S. The influence of growth hormone status on physical impairments, functional limitations, and health-related quality of life in adults. Endocr Rev. 2006;27:287-317.

(Hat tip: Rob Neyer)

And the responses:

jwhinnery   - 12:31pm Dec 12, 2007     (#1 of 4)

So why do some of Olympic Class athletes that have made the news continue to use HGH? Of all the athletes that have access to information and medical consultants these elite athletes evidently believe it enhances performance? Also if it is not a performance enhancing drug why is it banned for athletes (the short time adverse effects are apparently not severe enough to prevent a first place Olympic finish)? Very good Webcast ....Thank you James E. Whinnery Ph.D., M.D.

 

ajc   - 04:56pm Dec 12, 2007     (#2 of 4)

As an elite athlete who has actually used GH, I can tell that Dr. Griffing has never personally used the drug himself otherwise he would not hold his stated opinion.  First let me preface this little blurb with this:  the commonly held belief among elite athletes is that the medical community, in general, is so far removed from real world application of performance enhancing drugs that opinions such as these are at best laughed off and at worst taken by those “in the know” as proof that legitimate medical consultation is to be avoided like the plague.  So, by the medical community not doing its due diligence WRT this topic (yet promulgating such biased opinions), it is doing the elite athletic community a great disservice.  That’s MY opinion, now let’s move on with some facts… “So why do some of Olympic Class athletes that have made the news continue to use HGH?”  Great question Dr. Whinnery!  The fact is this drug, although definitely not as anabolic as testosterone, or synthetics like nandrolone, methenolone, trenbolone, etc., still possesses some anabolic properties as far as net nitrogen gains go.  It certainly is “better than nothing.”  Tested athletes know they can’t load up on the injectibles listed above and this is why hGH is a great substitute.  You can use as much as you want and it will remain undetectable via the piss test.  Based upon my research, I don’t think there will EVER be a reliable urine test for this drug.  That’s why it’s the drug of choice.  Now, of course, all of the athletes would love to shoot 1-5 grams/wk of androgens.  It’s actually cheaper and incredibly more effective, but you just can’t do that because you’ll get popped on the tests every time.  The only way to do it is to create an unknown synthetic (since the test only tests for KNOWN metabolites) ala THG (BALCO).  Of course you’ll pass every time because the metabolic signature of that drug is not known.  But doing so will open the athlete up to a host of unknowns that I won’t get into in this discussion. Regarding the viability tests mentioned, they’re irrelevant because they’re testing for the wrong result.  Of course GH is not going to positively impact your cardiovascular efficiency.  If you want that, use EPO, LOL!  GH does not provide immediate benefits to the athlete because the androgenicity of the drug is non-existent.  You will never feel “jacked” on GH because that’s not the way it works.  What GH will do for the non-tested elite athlete who can use any and all anabolic androgenic steroids without fear of being caught (pro bodybuilders, Strongman competitors, most powerlifters) is (1) allow the athlete to eat a surplus of calories, yet retain very low levels of bodyfat, (2) accelerate the healing of almost every injury imaginable, (3) counteract the adverse effect of most AAS on collagen synthesis, thereby helping to prevent soft tissue/connective tissue injuries attributable to high levels of androgens and aggressive strength training, and (4) work synergistically with exogenous testosterone, insulin, and IGF-1 to dramatically decrease the recover time from intense exercise and substantially increase the lean body mass of strength athletes. Number four is really the reason why today’s IFBB pro bodybuilders are SO much bigger and leaner than their 1970’s counterparts.  Yes, guys today are taking 10x the amount of androgens that they took 30-40 years ago.  And that goes a long way at explaining some differences.  But it’s that magical threesome (T, HGH, and insulin) that has built the physiques of today.  Although the pro’s don’t usually disclose their dosages, I have seen references to as much as 20 IU’s daily!  What’s the result of that dosage?  A 1990’s pro who, to this day, is heralded as having the most chiseled physique ever. The relationship between GH and bodyfat really should come as no surprise to anyone anyway.  The FDA did not come out and specifically contraindicate HGH solely for combating obesity for

 

ajc   - 04:57pm Dec 12, 2007     (#3 of 4)

...no reason whatsoever.  They did it because the relationship definitely exists and athletes have known this for decades.  It’s no coincidence that generally, we can get away with eating crap daily at 16-18 years of age and not gain an ounce of bodyfat.  But try that when you’re 40 and the story is VERY different.  By 40, your endogenous HGH levels have plummeted to equal that of the elderly, which the anti-aging doc’s have argued is the very definition of GH deficiency.  So there’s your FDA approved off label prescription “OK” of GH right there. Regarding adverse side effects…almost all of them can be eliminated by supplemental drug therapy.  Hypertension, edema, numbness…all of the superficial problems can be eliminated with other meds.  Additionally, the dosing schedule can be modified to eliminate many of these noted side effects.  Through trial and error, I was personally able to work up to a dosage that caused a ton of problems for me previously simply by injecting very small amounts (0.4 IU’s) multiple times per day.  Of course the general public would never do this, but we’re talking about athletes already deep into the pharmaceuticals. But it’s the longer-term side effects, especially LVH/cardiomyopathy, that pose the real risk.  And this is where the medical community could lend some real insight if it ceased from the useless scare and denial tactics that clearly failed 30 years ago and instead embraced the fact that these drugs really do work very well but possess some very real long term risks that the athlete should weigh against the rewards he/she is trying to achieve.  In that sense, these PED’s are no different than any other drug such as hormonal oral contraception, the risks of which have recently come to light although they have been postulated for decades.  So, would you rather POSSIBLY live 5-10 years longer and birth out 20 kids or lose your marriage due to abstinence from sexual intercourse because you refuse to take a measurable amount of risk with reliable/convenient oral contraception; or would you rather take an acceptable level of risk for the convenience of maintaining your lifestyle?  (We already know which angle Big Pharma is going to argue in light of this newly discovered risk.)  To the pharmaceutically enhanced athlete, the logic is identical.

 

 

stuartwarren   - 06:09am Dec 13, 2007     (#4 of 4)

Hello all, I would suggest that the message is appropriate coming from a public health and sporting ethics viewpoint rather than that suggested by the basic science and growing body of evidence. The obvious difficulty in resolving the conflicting viewpoints is the same for anabolic/androgenic steroid usage in sports. Gaining ethics approval to administer many times supra-physiologic doses to healthy individuals is rightly not going to happen. The argument that there is NO conclusive evidence to support the performance enhancing effects of exogenous HGH is becoming thinner as the results of studies using modest doses trickles in. The elite athletes and body builders will continue to hold the medical profession in low esteem, and they will continue to rely on advice from the the most successful in their field. The reported doses of AAS’s and HGH in the elite body building world are terrifying. The notion of the medical community trying to become involved in this world in an effort to minimise harm is unlikely to succeed due to a hesitancy to reduce or change regimes that have been successful in the past. Ten minutes on pubmed produced the following abstracts that point to an athletic advantage. Increased lean body mass and decreased fat mass would predict inproved performance in any activity in which power to weight is significant. The two worlds need not necessarily collide, in fact they probably won’t, as an olympic gold medal is not a desired health outcome. However, a better understanding of the usefulness of HGH in pathologic states is desired. Stuart Warren B.Ex.Sc/B.Phty/M.Sc.Med(Pain Mgmt)/2nd year med student References: Healy ML, Gibney J, Russell-Jones DL, Pentecost C, Croos P, Sönksen PH, Umpleby AM. High dose growth hormone exerts an anabolic effect at rest and during exercise in endurance-trained athletes. J Clin Endocrinol Metab. 2003 Nov;88(11):5221-6. D. M. Crist, G. T. Peake, P. A. Egan, and D. L. Waters. Body composition response to exogenous GH during training in highly conditioned adults. J Appl Physiol, Aug 1988; 65: 579 - 584. Juhn M. Popular sports supplements and ergogenic aids. Sports Med. 2003;33(12):921-39.