Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Growth Hormone Replacement in Older Men Medication

  • Author: Angela Gentili, MD; Chief Editor: George T Griffing, MD  more...
 
Updated: Dec 14, 2015
 

Medication Summary

According to a 2011 systematic review, GH replacement[16] is effective in reversing some of the changes that occur in older adults (aged >60 y) with GH deficiency secondary to hypopituitarism. The effects of GH replacement in these patients include the following:

  • Decreased waist circumference (by about 3 cm) and waist-to-hip ratio without changing BMI; GH increased lean body mass and decreased total fat mass in 4 studies but not in another 2
  • Reduction in total cholesterol level by 4-8% and low-density lipoprotein cholesterol (LDL) by 11-16% but no change in HDL and triglycerides
  • Improvement in quality of life
  • No consistent improvement in blood pressure or bone mineral density; additionally, no data are available on GH-deficient patients older than 80 years

GH is used in antiaging medicine in an attempt to reverse the decrease of GH levels with age.[17] The American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults make a strong recommendation against the use of GH in older adults because "the impact on body composition is small and associated with edema, arthralgia, carpal tunnel syndrome, gynecomastia and impaired fasting glucose." The only exception is its use as hormone replacement after pituitary gland removal.[18]

Next

Growth hormones

Class Summary

Most studies of GH supplementation in healthy older people (not GH deficient) have shown that in both men and women, GH increases muscle mass and decreases body fat, but it does not improve strength. In a 6-month study, the combination of testosterone and GH also increased total body isotonic strength and aerobic capacity in older men.[19] GH reduced serum leptin and LDL-C and increased triglycerides, with no effect on HDL.[20] Common side effects were arthralgias and carpal tunnel syndrome.

One month of a small dose of GH (ie, 6.25 mcg/kg/d) alone or in combination with transdermal testosterone did not improve strength, flexibility, or percentage of body fat, but it improved certain measures of balance and physical performance in healthy older men. At such a small dose, there were no significant adverse events. In another study, GH did not enhance the positive effect of exercise on muscle strength.[21, 22]

A systematic review of randomized trials of GH therapy in 220 older men and women reported that GH therapy decreased fat mass and increased lean body mass without change in weight. Despite the improvement in body composition, persons treated with GH were significantly more likely to develop soft tissue edema, arthralgias, carpal tunnel syndrome, and gynecomastia. The authors concluded that GH cannot be recommended as antiaging therapy.[6]

GH secretagogues that would produce a more physiological increase in circulating GH levels are under investigation. These include GHRH and the growth hormone releasing peptides (GHRPs) and their analogs. Five months of treatment with daily subcutaneous injections of tesamorelin, an analog of human GHRH (1 mg/d), improved executive function in adults with mild cognitive impairment as well as in healthy older adults.[23] It is postulated that the positive effect was mediated by an increase of IGF-1, which can cross the blood-brain barrier. However, longer trials are needed before GHRH can be recommended to improve cognitive function. An orally active GH secretagogue, MK-0677, was studied in older adults with recent hip fractures.[24] Although it increased serum IGF-1, it did not significantly improve functional performance measures.[25]

GH treatment in frail older people

In a placebo-controlled trial of patients aged 64-99 years who were malnourished, GH caused a rise in circulating IGF-1, an average weight gain of 2.2 kg, and an increase in nitrogen retention.[26] Older individuals are more sensitive to GH replacement than children and young adults; therefore, the dose of GH must be lower. Treating older adults with the amount of GH produced in healthy puberty (ie, 23-35 mcg/kg/d) can cause glucose intolerance, arthralgias, fluid retention, carpal tunnel syndrome, and, rarely, papilledema.

Because of potential adverse effects, experts do not recommend GH replacement to rejuvenate older persons.[27, 18]

Growth hormone; somatropin (Genotropin, Humatrope, Norditropin)

 

Obtained by recombinant DNA technology. Amino acid sequence is identical to that of pituitary-derived hGH. Indicated in pediatrics to treat growth failure due to lack of adequate endogenous GH secretion, growth failure associated with chronic renal insufficiency up to the time of renal transplantation, and short stature associated with Turner syndrome. Indicated in adults to treat a biochemical diagnosis of adult GHD by means of a subnormal response to a standard GH stimulation test; patients who have adult GHD, either alone or with multiple hormone deficiencies (hypopituitarism) as a result of pituitary disease, hypothalamic disease, surgery, radiation therapy, or trauma; or patients who were GH deficient during childhood, confirmed as an adult before replacement therapy with somatropin is started.

Not FDA approved for older patients who do not meet the above criteria of adult GHD. It should not be used for hyposomatotropism of aging.

Previous
 
 
Contributor Information and Disclosures
Author

Angela Gentili, MD Director of Geriatric Medicine Fellowship Program, Professor of Internal Medicine, Division of Geriatric Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center, Richmond, VA

Angela Gentili, MD is a member of the following medical societies: Virginia Geriatrics Society, American Geriatrics Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Adler, MD Chief, Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center, Professor, Departments of Internal Medicine and Epidemiology and Community Health, Virginia Commonwealth University

Robert A Adler, MD is a member of the following medical societies: International Bone and Mineral Society, International Society for Clinical Densitometry, American Society for Bone and Mineral Research, Endocrine Society

Disclosure: Received consulting fee from Amgen.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Don S Schalch, MD Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

References
  1. Waters DL, Baumgartner RN, Garry PJ, Vellas B. Advantages of dietary, exercise-related, and therapeutic interventions to prevent and treat sarcopenia in adult patients: an update. Clin Interv Aging. 2010. 5:259-70. [Medline].

  2. Harman SM, Blackman MR. The effects of growth hormone and sex steroid on lean body mass, fat mass, muscle strength, cardiovascular endurance and adverse events in healthy elderly women and men. Horm Res. 2003. 60(Suppl 1):121-4. [Medline].

  3. Harman SM, Blackman MR. Use of growth hormone for prevention or treatment of effects of aging. J Gerontol A Biol Sci Med Sci. 2004. 59:652-8. [Medline].

  4. Kiel DP, Puhl J, Rosen CJ, Berg K, Murphy JB, MacLean DB. Lack of an association between insulin-like growth factor-I and body composition, muscle strength, physical performance or self-reported mobility among older persons with functional limitations. J Am Geriatr Soc. 1998 Jul. 46(7):822-8. [Medline].

  5. Sherlock M, Toogood AA. Aging and the growth hormone/insulin like growth factor-I axis. Pituitary. 2007. 10(2):189-203. [Medline].

  6. Liu H, Bravata DM, Olkin I, et al. Systematic review: the safety and efficacy of growth hormone in the healthy elderly. Ann Intern Med. 2007 Jan 16. 146(2):104-15. [Medline].

  7. Molitch ME, Clemmons DR, Malozowski S, et al. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2006 May. 91(5):1621-34. [Medline].

  8. Lin L, Saha PK, Ma X, et al. Ablation of ghrelin receptor reduces adiposity and improves insulin sensitivity during aging by regulating fat metabolism in white and brown adipose tissues. Aging Cell. 2011 Dec. 10(6):996-1010. [Medline].

  9. Holzenberger M. Igf-I signaling and effects on longevity. Nestle Nutr Workshop Ser Pediatr Program. 2011. 68:237-49. [Medline].

  10. Stochholm K, Berglund A, Juul S, Gravholt CH, Christiansen JS. Socioeconomic factors do not but GH treatment does affect mortality in adult-onset growth hormone deficiency. J Clin Endocrinol Metab. 2014 Nov. 99 (11):4141-8. [Medline].

  11. Mihaila S, Mincu RI, Rimbas RC, et al. Growth hormone deficiency in adults impacts left ventricular mechanics: a two-dimensional speckle-tracking study. Can J Cardiol. 2015 Jun. 31(6):752-9. [Medline].

  12. Veldhuis JD, Iranmanesh A, Weltman A. Elements in the pathophysiology of diminished growth hormone (GH) secretion in aging humans. Endocrine. 1997 Aug. 7(1):41-8. [Medline].

  13. Topaloglu O, Gokay F, Koparal SS, et al. Visceral fat measurement by ultrasound as a non-invasive method - can it be useful in evaluating subclinical atherosclerosis in male patients with hypopituitarism and growth hormone deficiency?. Endokrynol Pol. 2014. 65(3):195-202. [Medline].

  14. [Guideline] Ho KK. Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol. 2007 Dec. 157(6):695-700. [Medline].

  15. Rudman D, Feller AG, Nagraj HS, et al. Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990 Jul 5. 323(1):1-6. [Medline].

  16. Kokshoorn NE, Biermasz NR, Roelfsema F, Smit JW, Pereira AM, Romijn JA. GH replacement therapy in elderly GH-deficient patients: a systematic review. Eur J Endocrinol. 2011 May. 164(5):657-65. [Medline].

  17. Samaras N, Papadopoulou MA, Samaras D, Ongaro F. Off-label use of hormones as an antiaging strategy: a review. Clin Interv Aging. 2014. 9:1175-86. [Medline].

  18. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015 Nov. 63(11):2227-46. [Medline].

  19. Urban RJ. Growth hormone and testosterone: anabolic effects on muscle. Horm Res Paediatr. 2011. 76 Suppl 1:81-3. [Medline].

  20. Brill KT, Weltman AL, Gentili A, et al. Single and combined effects of growth hormone and testosterone administration on measures of body composition, physical performance, mood, sexual function, bone turnover, and muscle gene expression in healthy older men. J Clin Endocrinol Metab. 2002 Dec. 87(12):5649-57. [Medline].

  21. Elgzyri T, Castenfors J, Hagg E, Backman C, Thoren M, Bramnert M. The effects of GH replacement therapy on cardiac morphology and function, exercise capacity and serum lipids in elderly patients with GH deficiency. Clin Endocrinol (Oxf). 2004 Jul. 61(1):113-22. [Medline].

  22. Haydar ZR, Blackman MR, Tobin JD, Wright JG, Fleg JL. The relationship between aerobic exercise capacity and circulating IGF-1 levels in healthy men and women. J Am Geriatr Soc. 2000 Feb. 48(2):139-45. [Medline].

  23. Baker LD, Barsness SM, Borson S, et al. Effects of growth hormone–releasing hormone on cognitive function in adults with mild cognitive impairment and healthy older adults: results of a controlled trial. Arch Neurol. 2012 Nov. 69(11):1420-9. [Medline].

  24. Bach MA, Rockwood K, Zetterberg C, et al. The effects of MK-0677, an oral growth hormone secretagogue, in patients with hip fracture. J Am Geriatr Soc. 2004 Apr. 52(4):516-23. [Medline].

  25. Papadakis MA, Grady D, Black D, et al. Growth hormone replacement in healthy older men improves body composition but not functional ability. Ann Intern Med. 1996 Apr 15. 124(8):708-16. [Medline].

  26. Kaiser FE, Silver AJ, Morley JE. The effect of recombinant human growth hormone on malnourished older individuals. J Am Geriatr Soc. 1991 Mar. 39(3):235-40. [Medline].

  27. Morley JE. Scientific overview of hormone treatment used for rejuvenation. Fertil Steril. 2013 Jun. 99(7):1807-13. [Medline].

  28. Borst SE. Interventions for sarcopenia and muscle weakness in older people. Age Ageing. 2004 Nov. 33(6):548-55. [Medline].

  29. Blackman MR, Sorkin JD, Munzer T, et al. Growth hormone and sex steroid administration in healthy aged women and men: a randomized controlled trial. JAMA. 2002 Nov 13. 288(18):2282-92. [Medline].

  30. Nutropin (R) [somatropin (rDNA origin) for injection] prescribing information. Genentech Inc. Available at http://www.gene.com/medical-professionals/medicines/nutropin-aq. Accessed: November 13, 2015.

  31. Vitiello MV, Moe KE, Merriam GR, Mazzoni G, Buchner DH, Schwartz RS. Growth hormone releasing hormone improves the cognition of healthy older adults. Neurobiol Aging. 2006 Feb. 27(2):318-23. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.