Human Growth Hormone (HGH) – Increasing Therapy
What Makes Our Approach Special
HGH-increasing therapy is indicated for either “Secondary HGH Insufficiency” or “Secondary HGH Deficiency.” HGH-increasing therapy is one of the additional services that we offer our hormone replacement therapy patients. This type of therapy can be tremendously beneficial for patients, but only if it is prescribed by a doctor who has experience and expertise, in order to minimize potential adverse effects and maximize the potential benefits. Unfortunately, most doctors are unaware of this type of therapy or have no idea how to prescribe it. We have been prescribing HGH-increasing therapy since 2015.
We monitor IGF-1 levels instead of HGH levels when considering HGH-increasing therapy, because HGH is usually only produced at night and it’s mostly if not entirely out of your system during the day, while IGF-1 levels are consistent throughout the day.
We consider adding HGH-increasing therapy when our patient’s IGF-1 levels continue to be below ideal despite being stable on testosterone or hormone replacement therapy. This therapy involves the prescription of one or two special hormone peptides: sermorelin acetate and growth hormone releasing peptide -2 (GHRP-2). These peptides have been proven to strengthen the pituitary’s ability to produce HGH.
Just like our approach to other hormone replacement therapy and other therapies, we initiate HGH-increasing therapy very carefully at a dose unlikely to cause significant adverse effects and most likely to cause significant benefits. The initial dose must be customized for each patient. Its determination requires significant experience and expertise.
Sermorelin acetate is bio-identical to the growth hormone releasing hormone (GHRH) that is produced by the hypothalamus and sent to the pituitary gland to stimulate the production of HGH.
Growth hormone releasing peptide -2 (GHRP-2) is bio-identical to the ghrelin that is produced in the gastrointestinal tract and send to the pituitary gland to stimulate the production of HGH. It also profoundly stimulates appetite, making this peptide more helpful when HGH levels are lower than ideal along with poor appetite, and muscle or body wasting. This peptide is not indicated when there is a normal appetite.
These peptides work very well to stimulate the production of HGH because the ability of the hypothalamus to produce GHRH significantly declines starting around age 30 and is primarily responsible for the significant decrease in HGH that begins to occur around this age.
When prescribed properly and taken consistently long-term (4-6+ months) these peptides have a cumulative effect and can profoundly increase HGH production and therefore IGF-1 levels. Our patient is more likely to experience a cumulative overall benefit when they adhere to their TRT or HRT regimen, and when they take certain supplements and adopt a diet and lifestyle that supports the pituitary to produce more HGH.
We prescribe sermorelin as sublingual troches or subcutaneous injections to be taken or injected each night at bedtime. We prescribe GHRP-2 only as sublingual troches. These peptides can be combined in troche form. Higher doses of sermorelin acetate must be dissolved sublingually to achieve the same therapeutic effect as the same amount of injected sermorelin acetate. We usually recommend that patients initiate HGH-increasing therapy with sermorelin acetate with sublingual troches since they’re much more convenient. If sublingual troches don’t work, then we prescribe the injectable form instead.
Our direct care model makes it easy and convenient for our patients to message their doctor online, or schedule a phone call or office visit if they’re experiencing any adverse effects or have any questions or concerns, so that we can help them right away. This is another way that we work to minimize adverse effects and maximize benefits of HGH-increasing therapy.
What is the Cost of HGH-Increasing Therapy?
This service is only available for our current testosterone or hormone replacement therapy patients paying monthly membership dues of $222 (debit) or $230 (credit). The additional cost of HGH-increasing therapy is different for each patient, but is usually in the range of $150 – $300 per month, depending on how much of the medication they need.
What if HGH-Increasing Therapy Doesn’t Improve IGF-1?
If sermorelin acetate and / or GHRP-2 doesn’t improve our patient’s IGF-1 levels so that they’re in a healthy or ideal range, even after consistent dosage for at least 4-6 months, then we consider this a failure of a growth hormone stimulation test, which is a major sign of growth hormone deficiency. Our patient can either continue to use the peptides for whatever benefit they’re able to provide in terms of increased growth hormone production or they can schedule a more comprehensive evaluation for growth hormone deficiency.
Potential Benefits of HGH-Increasing Therapy
- Improved energy
- Improved mood
- Improved motivation
- Decreased anxiety
- Improved confidence
- Improved self-control
- Improved concentration
- Improved memory
- Improved sleep
- Growth and increased strength of muscle tissue
- Growth and increased strength of heart muscle tissue
- Increased aerobic capacity
- Reduced body fat
- Increased bone density and strength
- More youthful facial features
- Increased hair growth, thicker hair
- Improved skin tone, thickness
- Improved strength of fingernails
- In men: improved erectile function
- In women: improved sexual function and satisfaction
- Prevention of onset of chronic diseases of aging
- Potential improvement of chronic diseases of aging
Potential Adverse Effects of HGH-Increasing Therapy
It is uncommon for our patients to experience adverse effects from using these peptides, because they work by stimulating the pituitary gland to produce more HGH, and there are various negative feedback loops that prevent the pituitary from producing more HGH than ideal.
When these peptides are prescribed properly there is not a lot of potential for adverse effects. The most common adverse effect is a local hypersensitivity or allergy reaction at the site of injection, if the medication is being injected. This problem is often solved by having our patient switch from subcutaneous to intramuscular injections. Other than this, the most common adverse effects that patients report are weight gain from water retention; numbness and tingling of their fingers and hands, sometimes their nose; and swelling of their hands, feet, and possibly their nose, lips, or eyelids. These will happen if HGH and IGF-1 levels are higher than ideal levels are maintained for a week or more. If levels are a lot higher than ideal for one or more months then there can be excessive muscle development, especially of the muscles of the shoulders and pelvis. If levels are a lot higher than ideal for 6-12 or more months, then it can increase insulin resistance and blood sugar levels, which can cause weight gain, and acromegaly, which is increased growth of the fingers, hands, toes, feet, nose, and other extremities and body tissues. This is extremely rare, but possible.
Be aware that due to the differences between individuals there is no way that we can guarantee that HGH-increasing therapy will not cause you to experience significant adverse effects or other long-term risks.
Who Should Not Receive HGH-Increasing Therapy?
- No one who is acutely ill or who has just undergone major surgery or who is suffering from acute respiratory failure should receive any therapy that increases HGH.
- Patients who have intracranial hypertension or proliferative retinopathy are not candidates for any therapy that increases HGH.
- We are not willing to prescribe any therapy that increases HGH to anyone who has an uncontrolled problem with high blood pressure.
- We are not willing to prescribe any therapy that increases HGH to anyone who has active cancer or to anyone who has been in remission for less than five years.
Does HGH-Increasing Therapy Increase Risk of Cancer?
Overall, studies have consistently demonstrated that individual adults who suffer from severe growth hormone deficiency have an increased risk of cancer and all-cause mortality, and that normalization of HGH levels not only does NOT increase their risk of cancer, but that it actually reduces their risk of cancer and reduces all-cause mortality. However, we do not prescribe HGH to any patient with a history of cancer until it has been at least 5 years of complete remission of the cancer, and only after discussing the benefits versus the risks, and only after obtaining documented informed consent from our patient for treatment. If at any point during HGH therapy our patient is diagnosed with a new or recurring cancer, then we immediately discontinue HGH therapy for our patient.
With all of our medical treatments we operate knowing that each patient is different from any other patient. We don’t operate with the idea that simply because a treatment has been shown in large studies to cause certain results over a large population that this means that we can guarantee that an individual patient will experience the same result, although it is tempting to think that it will. Unfortunately, human beings are just more complicated than that. With this in mind, any patient who initiates HGH replacement therapy or any hormone therapy must be aware that there is no way to guarantee that for that particular patient that the treatment will not contribute to or cause them to experience any medical event, including cancer. This understanding is a required part of our documented informed consent.
In 2021, the Growth Hormone Research Society held a consensus workshop with 55 international experts from 16 countries representing 10 professional societies, with the aim of addressing the safety of rhGH therapy in survivors of cancer and intracranial tumors and in patients with cancer predisposition syndromes .
Regarding rhGH replacement in GHD adults, the main conclusions of the panel were (Table 1):
[I] the therapeutic effect on secondary neoplasia risk is minor compared to host- and tumor treatment-related factors;
[II] studies on tumor recurrence in cancer survivors treated during adulthood are scarce, but current safe-related data are generally reassuring
[III] therapy should be discontinued if clinically significant tumor progression or relapse is observed;
[IV] patients harboring pituitary tumor or craniopharyngioma remnants should be treated and monitored in the same way than those not treated;
[V] there is a contra-indication for therapy in GHD patients with active malignancy, but rhGH might be considered in adult cancer survivors (either with childhood or adult-onset cancer) in remission after careful risk/benefit analysis by the endocrinologist, the patient, and the oncologist;
[VI] GHD patients with breast, colon, prostate, or liver cancer should be in remission for at least 5 years and therapeutic decision should be individually based and shared with the oncologist .
Our results suggest that growth hormone replacement therapy reduces risk of cancer in adult. In addition, the association was also consistent in sensitivity analyses.
The association between GH-IGF-1 and tumor shows a huge difference among vitro, animal experiments and epidemiological investigation.
In vitro, growth hormone can stimulate lymphocytes to lymphoblast, growth hormone and its receptors were expressed in almost cancer cells. Over-expression of growth hormone could promote cell proliferation and apoptosis reduction for breast cancer. The IGF-1 also has proliferation and anti-apoptosis property for all types of cell. IGF-1 induces human leukemia cell proliferation and increased DNA replication of liver cell tumor in rat. This function can be inhibited using related antagonist inhibits . Besides, IGF-1 in circulation can be combined with all kinds of binding protein, such as insulin-like growth factor binding protein 3 . With different from IGF-1, insulin-like growth factor binding protein 3 can limit the bioactivity of IGF-1, and exerts its action of inhibiting tumor cell growth . In animal experiments, selective knockout of IGF-1 gene causes reduction of IGF-1 level in circulation, and occurrence rate of breast cancer significantly decreased. Also, IGF-1 has a potential of promoting neoplasm metastasis . Many epidemiology studies also mentioned IGF-1 level in plasma is associated with an increased risk of cancer [9, 10].
However, epidemiology studies did not found such an association in human investigation. All of studies included in the meta-analysis reported that growth hormone therapy is not associated with an increased risk of tumor occurrence or recurrence. Child et al found that the overall primary cancer risk in 6840 patients receiving growth hormones adults did not increase, but elevated standardized incidence were found for subgroups in the USA cohort defined by age <35 years . Hartman conducted a prospective study with 1988 growth hormone-treated and 442 untreated GHD patients, and there was no evidence for a growth hormone therapy effect on cancer . Buchfelder also found growth hormone substitution should not be withheld in deficient patients. But a period of 5 years may not have been long enough to verify this influence on recurrence potential . In parallel with these above study, the latter study found unrelated results . On the contrary, our results even found that growth hormone therapy is associated with a decreased risk of the whole group. This finding is the same as the Olsson and his colleagues’ report that long-term (10 years) use of growth hormone in hypopituitarism may be considered to be safe in patients with residual pituitary adenomas . Although we do not exactly how this results happen, the present findings hinted that growth hormone therapy are acceptable and safety under the evidence.
In conclusion, our results suggest that growth hormone replacement therapy reduces risk of cancer in adult with growth hormone deficiency. Future study with more long-term follow-up are needed to explore the association between GHRT and recurrence of cancer or other types of tumor.
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