Youth for Sale

Oct. 13, 2000 -- Get younger! Sexier! Stronger! Thinner! That's the sales pitch for antiaging therapy, a combination of human growth hormone with male or female sex hormones. Could it possibly be worth the $5,000 to $10,000 annual cost?

"For me, it's been kind of miraculous," 83-year-old Fred Gunther of Tacoma, Wash., tells WebMD. "I had terrible lower back pain and had arthritis. I hurt all over. I've always been an active guy, but when I got to hurting, I was very pessimistic -- I thought the end was coming fast. The growth hormone was slow to make any change -- but after about six months, the pains have cleared up and the arthritis is gone. I'm talking about pain that was bugging me so much I could hardly roll over. Now I climb hills and use the chain saw. I can hardly sit at my desk because I'm always fidgeting to get outdoors. My wife and I just got back from climbing up a 1,000-foot mountain."

What's going on here? Posing as a potential patient -- a 49-year-old with a midlife crisis -- this reporter calls an "antiaging" clinic in the Atlanta area. "It's not so much your hormone levels decline as you age, as that you age because your hormone levels decline," explains Chuck Pecor, clinic administrator at Amerimed Medical Clinic. "It depends on the individual, but at your age, it's almost a slam dunk that you need both growth hormone and testosterone. I'm not giving medical advice -- that's just based on statistical data."

Stanley Slater, MD, associate director for geriatrics at the National Institute on Aging (NIA), verifies Pecor's statistics -- but not his interpretation of them. "We know that growth hormone secretion in healthy people declines with age, so levels at age 70 are much lower than they are at age 20," Slater tells WebMD. "Whether that has an important impact on health is unclear."

Also unclear is exactly what a normal hormone level is. Most physicians would consider hormone replacement for people whose levels are significantly low compared to other people their age. But proponents of hormone replacement have a different standard.

Gunther's doctor is Elmer M. Cranton, MD, who established the holistic Mount Rainier Clinic in Yelm, Wash. "I define hormone deficiency as what would be a low level for 30-year-olds," Cranton tells WebMD. "I tell people that if you lived with a certain level for two decades and needed that level [of hormone] for a good quality of life, then to restore it to those levels for age 50 to 70 will also be good for your quality of life and will not do you any harm. Some people say we are supposed to shrivel up and atrophy. Well, some of that is unavoidable, but some we can partially prevent. I prescribe growth hormone for elderly people whose levels are low. I get a lot of inquiries from young people in their 30s and 40s, but I don't recommend it unless their hormone levels are low. I don't prescribe for athletes who want to improve their performance -- only for documented low levels."

Cranton does not run an antiaging clinic as such, but he says Amerimed's Pecor was not far wrong in suggesting that middle-aged men and women might benefit from hormone replacement. He recommends that when people reach "the big five-O," they should have their hormone levels checked.

When asked what a middle-aged man could expect from hormone replacement, Pecor was enthusiastic. "I'm on this myself -- I'm 57 years old, and I went on growth hormone plus testosterone," he says. "My waist is down from 36 to 32 inches. The best thing about this is I just feel better. All our patients report this."

Slater of the NIA confirmed that people receiving growth hormone do indeed get these kinds of results. "Back in 1990, a study of healthy elderly veterans at a VA hospital showed that people who received growth hormone had a change in body composition with more lean mass and less fat mass," he says. "Although all the publications [in scientific journals] are not out yet, the studies we have supported make similar findings -- people get a couple of kilograms less fat and a couple of kilograms more muscle.

"Does this mean you go to the hospital less, look better, and live longer? The questions about health and disease we don't know about yet. The story about looking better, well, we don't know but people assert that," Slater says. "Even so, there is no proven antiaging utility for growth hormone if you are talking about being healthier and living longer. You may look younger -- but it doesn't follow that you necessarily live longer."

Cranton echoes Slater's conclusion. "Aging is a genetic program that the hormones have very little to do with," he says. "Hormone replacement can maintain a better quality of life until older age, but people who say they will extend life are just blowing smoke."

There is nothing new about hormone replacement therapy. Cranton points out that it took 40 years for the medical establishment to accept estrogen replacement for menopausal women, so he's not surprised at the resistance to hormone replacement for men. But the growth hormone fad is not just a male phenomenon.

"Menopausal women are coming in begging me for it," Atlanta internist Kimball Johnson, MD, tells WebMD. "I'm not on the bandwagon yet in prescribing it for healthy folks. But legitimate doctors are looking into it."

Johnson, an HIV specialist, is prescribing growth hormone for two groups of her HIV-infected patients -- those showing signs of wasting, a loss of muscle and/or body fat, and those who are showing signs of the disfiguring problems with fat metabolism linked to AIDS drugs. "It definitely makes a big difference in the HIV arena for a lot of folks," Johnson says. "They still need to work out, they still need to eat -- this is not just a one-stop sort of shot. Growth and sex hormones have made a pretty big impact and are starting to be more recognized among HIV practitioners."

If it works for people with HIV, why not try it in normal people? In the short term, the treatments appear safe.

"When people ask, I tell them not to take growth hormone but to wait until it is clinically established to be useful," Slater says. "There are some side effects that we know about: fluid retention -- which, if you have congestive heart failure, could give you a push toward a heart attack -- and which also can cause joint pain and carpal tunnel syndrome. Also, we have seen worsening of sugar metabolism, so if you have a tendency for diabetes, it might get worse. All of these things get better if you stop or reduce the dosage. Some people may have serious problems, but by and large we don't see terrible results in carefully followed people."

Over the long term -- and hormone replacement is intended to be a long-term treatment -- serious safety questions arise.

"What really worries people is the possibility that it will cause tumors to grow faster," Slater says. "Experiments in the test tube show growth hormone can speed the growth of cancer cells, although there is little evidence that this happens in people. The troubling thing is you have to give growth hormone to people for a long time -- and if you give it to someone for 30 years, nobody knows what will happen. I'm not saying it doesn't make people healthier. It could. But we don't know that now, so for the person who walks by the store and says, 'Hey, maybe this stuff is for me' -- well, maybe it's not. We don't know, that's the major point. The studies we have still don't answer the big question: If I take this for 25 years, will I be better or worse off?"

Unless you've got a lot of cash, one long-term effect of growth hormone therapy will be a substantial lightening of the pocketbook. Unless a person has a demonstrated medical need, insurance will not cover growth hormone (although some plans may help pay for doctor consultations).

Growth hormone comes from two manufacturers. It must be taken by injection using a short needle that goes just below the surface of the skin. Gunther says he takes a shot just before bedtime six days a week -- at a cost of $6,000 per year. "The cost is heavy, but so be it," he says.

At Amerimed, Pecor broke down the cost. For blood work, the cost is $420 -- and new tests should be taken after six months of treatment. Physician consultation is $125. For testosterone in a new gel formulation that is spread directly on the skin, the cost is about $75 per month. For growth hormone, a low-dose, high-frequency regimen costs about $400 per month. "It's like making a moderate-size car payment," Pecor says.

Cheaper alternatives are on the market. Oral tablets, nasal and rectal sprays, and other products currently on the market claim to stimulate growth hormone production. Cranton says that a person soon builds up tolerance to these compounds so that they do no good. Slater says that improvements may one day make these so-called "secretagogues" a viable alternative to injectable growth hormone -- but that their safety still needs to be proven.

"This whole growth hormone thing is about 75% rip-off and 25% real," Cranton says. "Growth hormone will, to some extent, slow the aging process. We may not know the long-term effects of taking it -- but we do know the long-term effects of not taking it."