What is Human Growth Hormone Deficiency?
Proper Diagnosis is Crucial for Successful Treatment
In order to create and provide a holistic and comprehensive treatment plan to address our patient’s HGH levels we must first understand the cause of their lower HGH levels in addition to how low their levels are. Making the proper diagnosis is the first and perhaps most important step in this process and is usually skipped over by other healthcare providers who just fit their patients into whatever their cookie-cutter treatment protocol is. However, without understanding the cause and the true diagnosis there is no way to create and provide our patient with a plan that minimizes their potential for adverse effects while maximizing their potential for benefits in order to help them reach their full potential health.
Role of Human Growth Hormone (HGH)
HGH is our most potent anabolic hormone. HGH is called “human growth hormone” because scientists first discovered and sought to isolate and use it therapeutically for its effects on growth and puberty in children who suffered from severe HGH deficiency. It quickly became clear that the main role of HGH is not simply to control or cause “growth,” but rather to regulate metabolism throughout the entire body. Normal levels of HGH in fully-grown adults doesn’t cause growth, but does cause the body to repair and regenerate, or remodel itself, on a daily basis, which is most obvious by its effects on the most visible parts of the body, including our face, skin, hair, nails, muscles, and bone structure, although these regenerative effects occur throughout the entire body. Most of the time, unfortunately, we tend to shrink and shrivel as we age, and restoring or replacing HGH to ideal levels can cause regeneration and “growth” as the body is restored to a healthier state.
Normal & Healthy HGH Production & Levels
Human growth hormone (HGH) is a protein hormone secreted episodically from the anterior pituitary gland. In both men and women, the majority of HGH is produced during the latter half of sleep during the hours of deepest sleep. In normal and healthy young men there will be another 3-5 smaller peaks during the day with no HGH otherwise detectable during the day. In normal and healthy young women; however, there are usually no other peaks, but rather a low but detectable and relatively constant baseline level throughout the day.
HGH production peaks in adolescence, reaching about 1,500 micrograms per day. In well-developed young men and women around 25 years of age the production is about 350 micrograms per day.
HGH Production & Levels Decline With Age
HGH is by far the most common pituitary hormone deficiency! The most common cause of HGH deficiency in individuals younger than 30 years old is head injuries. Starting around 30 years of age HGH production declines at a sharper rate than most other hormones do, and this is primarily caused by a significant decrease in the production and release of growth hormone releasing hormone (GHRH) that begins to occur around this age, and secondarily caused by the anterior pituitary’s own internal inability to produce and release HGH. This is due to many factors, including: 1) chronic stress; 2) chronic sleep deprivation and / or chronic sleep apnea; 3) chronic lack of important micronutrients; 4) chronic lack of exercise; 5) overweight and obesity, especially visceral adiposity; 6) insulin resistance with high insulin levels; 6) testosterone deficiency; and 7) thyroid hormone deficiency. Chronic or repetitive exposure to environmental toxins is another common cause. A less common cause of HGH deficiency can be attributed to some cancers and, perhaps, including their treatment
Signs & Symptoms of HGH Deficiency
The most concerning symptoms and signs of HGH deficiency in adults include:
- Lack of inner peace
- Chronic anxiety, without any reason
- Tendency to be depressed
- Lack of self-control
- Tendency towards social isolation
- Fatigue, exhaustion
- Excessive need for sleep, but tired regardless of quantity of sleep
- Decreased motivation
- Decreased libido
- In men, erectile dysfunction is also a common symptom
- In women, female sexual dysfunction is also a common symptom
- Prematurely aged, shrinking, shriveling, drooping, sagging body
- Droopy eyelids, sagging cheeks, thin lips, thin nose, thin jaw bones
- Droopy fat pads of arms, inner thighs, droopy abdomen
- Shrinking, weakening muscles, bones, obesity
Health Problems Caused by Long-Term HGH Deficiency
- High cholesterol
- High blood pressure
- Heart disease, heart failure
- Cardiovascular disease, atherosclerosis
- Metabolic syndrome, diabetes type 2
- Overweight, obesity
- Sarcopenia (muscle loss)
- Osteopenia (bone loss)
- Increased generalized inflammation and pain
- Appearance and experience of acceleration of aging
- Earlier onset of most metabolic and other chronic diseases of aging
What Are Ideal HGH Levels?
For most patients we test IGF-1 levels instead of HGH levels. HGH testing is extremely costly and time-consuming, and has the potential for significant adverse effects. HGH levels are not routinely tested directly as a part of the evaluation for whether someone has ideal HGH levels. We reserve the direct blood testing of HGH levels only for cases in which the patient is being evaluated for treatment with actual human growth hormone and only in cases where IGF-1 blood testing and other HGH stimulation testing via sermorelin acetate has been performed and the results have been consistently equivocal.
IGF-1 stands for insulin-like growth factor -1. This is produced by the liver in response to HGH. IGF-1 is what causes most of the effects of HGH throughout the body and it is a very simple and convenient blood test, making it ideal for routine evaluation of patients with complaints of HGH insufficiency or deficiency.
Like all other hormones, ideal IGF-1 levels can vary significantly from person to person, for various reasons, such as height, weight, how much muscle tissue or fat tissue there is, gender, age, level of physical activity, and etc. The ideal range is very wide because there can be a significant amount of variation, but usually for adults their ideal levels will fall somewhere between 250 – 350 ng/mL.
How is Adult Human Growth Hormone Deficiency Diagnosed?
Relatively Normal HGH & IGF-1
Many of our patients actually have relatively normal levels of HGH measured indirectly as relatively normal IGF-1 levels. Yet many of these patients want to use HGH-increasing therapy to optimize their HGH levels for better aging, and overall health and quality of life.
Secondary HGH Insufficiency
Most of the time it’s not actual human growth hormone deficiency that is being diagnosed; it’s a functional or clinical deficiency or insufficiency, in other words it’s a matter of our patient having lower than ideal HGH and therefore IGF-1 levels. This diagnosis doesn’t require that our patient suffers from any symptoms or signs of lower than ideal HGH. All that is required is that our patient is being treated for other major hormone deficiencies, yet has IGF-1 levels that are below our target range for them. These patients are excellent candidates for HGH-increasing therapy.
Secondary HGH Deficiency
This is HGH deficiency secondary to deficient hypothalamic production of growth hormone-releasing hormone (GHRH). This means the pituitary could produce and release more HGH if it were being stimulated properly. This diagnosis simply requires that our patient continues to suffer from symptoms and signs of HGH deficiency while having deficient HGH levels despite being treated for their other major hormone deficiencies. These patients are excellent candidates for HGH-increasing therapy.
Primary / Severe HGH Deficiency
Also known as “adult growth hormone deficiency syndrome.” This is severe HGH deficiency primarily caused by anterior pituitary dysfunction or disease.
This means that our patient continues to suffer from symptoms and signs of HGH deficiency while having extremely deficient IGF-1 levels despite a standardized protocol of HGH-increasing therapy for at least four to six months, which qualifies as one of the standardized methods of HGH stimulation testing, which is a required part of the diagnostic process. Very rarely, and only in cases where the diagnosis is equivocal, we may require our patient to undergo an additional 8:00 am in-office glucagon growth hormone stimulation test during which we repeatedly test fasting glucose and HGH levels every 30 minutes over a period of 4 hours in the office after administering an injection of glucagon after the patient has been fasting for at least 10 hours on only water.
In addition to IGF-1 and HGH testing, we also perform several other important blood tests, including other hormone tests. We also perform a physical exam and a baseline body composition analysis. For some patients we do also require a pituitary MRI with and without contrast to rule out a pituitary lesion.
This is all done in order to make sure that the diagnosis is correct so that we can create and provide our patient with a plan that minimizes their potential for adverse effects while maximizing their potential for benefits in order to help them reach their full potential health.
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