Growth hormone therapy in adulthood is used specifically in cases of confirmed growth hormone deficiency (GHD) to correct metabolic and functional deficits — not to promote growth (which is already completed), but to improve quality of life, body composition, bone health, and cardiovascular parameters.

Growth Hormone Therapy in Adulthood

Substance

• Recombinant human growth hormone (rhGH)
• Commercial products include: Norditropin®, Genotropin®, Omnitrope®, Saizen®

Initiation of Therapy & Dosage

Start low!

Initial dose:

• Premenopausal women: 0.3–0.5 mg/day
• Men / postmenopausal women: 0.2–0.3 mg/day
• Elderly patients: possibly 0.1–0.2 mg/day

Goal: “Low and slow” – gradual titration to minimize side effects

Therapy Management & Adjustment

Target parameters:

• Serum IGF-1 in age-appropriate normal range
• Improvement in:
  • Body composition (less visceral fat, more muscle mass)
  • Lipid profile
  • Quality of life
  • Bone density (over time)

 Monitoring intervals:

• First check after 4–8 weeks: IGF-1 and side effects
• Then every 3–6 months
• After any dose adjustment: recheck after 6 weeks

 Regular Laboratory Monitoring

 GH can worsen latent hypothyroidism – adjust thyroid medication if necessary

Side Effects (mostly dose-dependent)

• Joint and muscle pain
• Edema, weight gain
• Carpal tunnel syndrome
• Headache (rarely pseudotumor cerebri)
• Glucose intolerance / diabetes (in at-risk patients)
• Rare: skin reactions, antibody formation

 Side effects are often due to rapid dose increases → slow titration is key

Contraindications

• Active tumor or recurrence
• Uncontrolled diabetes mellitus with complications
• Pregnancy
• Severe untreated psychiatric disorders (relative contraindication)

Conclusion: Therapy Principles

Therapy Management Plan – GH in Adults

• Before Starting Therapy

Confirm diagnosis with:

At least one pathological stimulation test

• IGF-1 measurement
• Pituitary MRI (if not already done)

Exclude contraindications:

• Active tumor
• Untreated adrenal or thyroid insufficiency
• Pregnancy

2. Starting Therapy

• Initial dose:
  • 0.2–0.3 mg/day
  • For elderly patients: 0.1–0.2 mg/day
  • Subcutaneous, in the evening
• Inform about potential side effects and the need for regular lab checks

3. Follow-Up Monitoring

4. Therapy Goals

• IGF-1 within age-specific reference range (±1 SD)
• Improvement in:
  • Energy and quality of life
  • Muscle/fat distribution
  • Lipid profile
  • Bone metabolism

5. Dose Adjustment

• Increase or decrease according to IGF-1 and tolerability (adjust in 0.1–0.2 mg steps)
• If side effects occur: reduce dose or consider a temporary pause

6. Documentation

• Regularly justify and document GH therapy (e.g., for insurance or pension claims)
• Maintain a treatment log with IGF-1 trends and clinical response

Why Is GH Problematic in Sports?

GH is banned by international anti-doping agencies:

• WADA (World Anti-Doping Agency) includes GH on its list of prohibited substances
• Banned at all times — in and out of competition, in all sports

Why Do Some Athletes Use GH?

Some hope for:

• Increased muscle mass (hypertrophic effect)
• Fat reduction (lipolytic effect)
• Faster recovery or injury healing

 However, studies show minimal or no performance-enhancing effects, especially in healthy individuals

Legal and Medical Assessment: Unapproved Use

• GH may only be prescribed for medically approved conditions (e.g., GHD, Turner syndrome)
• Any prescription without clear indication is off-label and may carry legal consequences under pharmaceutical law

Detectable in Doping Tests

• GH can be detected using specific blood tests (e.g., isoform or marker-based tests)

Health Risks from Misuse

• Acromegaly-like symptoms in overdose
• Edema, joint pain
• Insulin resistance, diabetes
• Cardiac hypertrophy
• Increased cancer risk with long-term high-dose use

Conclusion