Human Growth Hormone (HGH) Replacement Therapy
What Makes Our Approach Special
HGH replacement therapy is one of the additional services that we offer our hormone replacement therapy patients that we have diagnosed with growth hormone deficiency. Proper diagnosis of and treatment for growth hormone deficiency is complex. It is extremely important that this diagnosis is made and the treatment prescribed by a doctor who has experience and expertise in order to minimize the potential adverse effects and maximize the potential benefits. We have been diagnosing growth hormone deficiency and prescribing HGH since 2015.
Once we have diagnosed our patient with growth hormone deficiency we can initiate a therapeutic trial of HGH replacement therapy to see if it can resolve their symptoms and improve their health and quality of life.
Just like our approach to other hormone replacement therapy and other therapies, we initiate HGH replacement 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.
We carefully increase HGH doses in a step-by-step manner for a few important reasons: 1) It can take at least two months for our patient’s lab results to show the cumulative effect of a dose, 2) It can take at least four months for our patient to experience the full effect of a dose, 3) HGH replacement therapy will improve the body’s ability to produce and metabolize other hormones and we often must adjust the doses of those hormones simultaneously, 4) HGH replacement therapy will improve the body’s ability to produce and metabolize HGH, meaning that often less HGH ends up being required, and often the HGH dose is reduced in a step-by-step manner once our patient has been on HGH replacement therapy long-term, and 5) It is extremely important that we not dose our patient to cause them to have higher than ideal HGH and IGF-1 levels in order to minimize the potential for adverse effects and long-term risks. Our goal is to find the minimum dose necessary to help our patient to experience their full potential health and quality of life.
In addition to HGH replacement therapy and other hormone replacement therapy we also recommend various supplements to improve our patients’ own production of HGH. We also provide counseling for our patients on diet and lifestyle practices that will help them to produce more of their own HGH. These adjunctive recommendations are important because they help us to minimize the dose required for our patient to have ideal HGH and IGF-1 levels which increases the safety of the therapy while reducing its cost.
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 replacement therapy.
What is the Cost of HGH Replacement Therapy?
This service is only available for our current hormone replacement therapy patients paying monthly membership dues of $222 (debit) or $230 (credit). The charge for the initial evaluation and consultation for growth hormone deficiency is $225. Sometimes we require additional pituitary MRI to rule out pituitary lesions prior to initiation of treatment. Very rarely, we require our patients to undergo an additional in-office glucagon growth hormone stimulation test. Once HGH replacement therapy has been initiated the monthly membership dues are $65 (debit) or $67 (credit). This does not include the cost of prescription HGH or shipping, which usually costs another $225 – $375 per month.
Potential Benefits of HGH Replacement 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 Replacement Therapy
When HGH is 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. 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 replacement therapy will not cause you to experience significant adverse effects or other long-term risks.
Who Should Not Receive HGH Replacement 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.
- We do not prescribe HGH replacement therapy to any patient solely for the purpose of bodybuilding, or athletic performance enhancement, or for solely “anti-aging” purposes. The only indication or diagnosis for which we prescribe HGH is “adult growth hormone deficiency syndrome” which is a syndrome caused by severe long-term IGF-1 deficiency. We do not prescribe HGH for any other uses, including any off-label uses, under any circumstances. If we determine that a patient is abusing HGH for any of these purposes we will be forced to terminate their treatment.
Does HGH-Replacement 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.
Be aware that simply because large double-blinded placebo-controlled studies or meta-analyses of these studies show that patients are extremely unlikely to experience a new cancer and not likely to experience a recurrence of a past cancer, due to the differences between individuals, including genetics, life experiences, and medical history, there is still no way that we can guarantee that HGH replacement therapy will not cause you to experience a new cancer or a recurrence of an old cancer.
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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