Kicking the Hormone Habit

Earlier this year, a parade of star athletes testified before Congress about the misuse of human growth hormone and steroids by professional ballplayers looking for an edge. But human growth hormone (hGH) is not just for big-league players anymore.

While the tainting of our national pastime and the whiff of cheating among baseball heroes may have garnered all the headlines, the illegal use of hGH goes far beyond the clubhouses and training rooms of high-profile athletes. The substance, produced by the pituitary gland at the base of the brain, has been massively marketed and illegally distributed as an antiaging therapy for years, says longevity researcher Thomas Perls, a School of Medicine associate professor of medicine and director of the New England Centenarian Study.

Indeed, many of the baseball players implicated in the performance-enhancing scandal procured their growth hormone from antiaging clinics, according to a report on the problem by former Senate Majority Leader George Mitchell.

The $2 billion a year business is fueled by hucksterism, which touts unsubstantiated benefits, including increased strength and vitality, while ignoring well-documented adverse effects, such as joint pain, carpal tunnel–like symptoms, and increased risk of diabetes and cancer. Despite the high-profile press on the dangers of hGH abuse, the problem continues to get worse, according to a June 2008 Journal of the American Medical Association (JAMA) commentary that Perls coauthored with S. Jay Olshansky, a University of Chicago professor of epidemiology.

Perls has monitored the antiaging industry for the past decade and also is a consultant for the U.S. Department of Justice in cases against illegal hormone and steroid prescription and distribution rings. Three years ago, he coauthored a JAMA article on the deceptive mass marketing and selling of growth hormone for both antiaging and athletic enhancement. Since then, the Food and Drug Administration (FDA) has issued an alert about the illegal prescribing and distribution of hGH, and the government has tried to crack down on the antiaging and bodybuilding industry.

Nevertheless, the antiaging industry adapted its marketing and has continued to supply massive quantities of growth hormone to people with no clinical need for it. Perls’ and Olshansky’s most recent commentary suggests several new measures to curb the illegal, and risky, trade. Perls spoke with BU Today about growth hormone quackery and how to stop it.

BU Today: What are the proper clinical uses of hGH?
Perls: The vast majority of its legal use is for kids with a decreased capacity to produce growth hormone or a resistance to growth hormone that results in short stature, and generally it’s prescribed by an endocrinologist who knows what he or she is doing. In adults, the legal indications are for AIDS wasting syndrome, short bowel syndrome, and adult growth hormone deficiency, which is a very rare syndrome involving damage to the pituitary gland, usually due to a tumor or the treatment of a tumor. Its prevalence is one to three people per 10,000 adults.

So how and when did this hormone become popular for antiaging and athletic enhancement?
It’s actually more a story of hormones in general. I think the real basic problem here is that society generally equates the word hormone with youth, and so the antiaging industry seized upon this preconceived notion. Growth hormone got its big break in 1990 with an article in the New England Journal of Medicine, whose publication in retrospect surprised a lot of people. The article reported a study in which 12 older men tried six months of growth hormone, and it contained a very unfortunate sentence saying that it appeared that those who received the growth hormone knocked about 20 years off their age. The antiaging industry seized on this particular article and produced a bunch of books on the hormone and antiaging.

What claims are made by the antiaging industry?
They make claims like there are 20,000 articles out there supporting the use of growth hormone to enhance people’s health. On the contrary, studies show that the risks of taking growth hormone far outweigh what we perceive as negligible benefits. The articles that do talk about hGH’s therapeutic uses, for the most part, have to do with giving growth hormone to people with a damaged pituitary gland. The risks, meanwhile, are very serious and run the gamut, from high blood pressure to hardening of the arteries to increased cancer risk.

What brought you into this fight?
In 2005, I coauthored an article in JAMA alerting the public to the fact that there are all these antiaging clinics and others prescribing and distributing hGH and that the public and federal agencies needed to be aware that there is a law that growth hormone can be given only for uses approved by the FDA.

But the Drug Enforcement Agency and the FDA are stretched so thin in terms of everything they’re responsible for that this industry kept growing under the radar. Subsequent to our first article, given the huge amount of money being made off of growth hormone for antiaging — we estimate about $2 billion a year — the antiaging industry quickly adapted and said they were no longer giving the drug for antiaging, but instead for growth hormone deficiency. However, they define growth hormone deficiency as simply the decline in growth hormone with aging, which is absolutely a false definition.

If there’s so much risk and no proven benefits, why do people keep buying this stuff?
I review medical records seized by the DEA from antiaging clinics. There are many people who spend a lot of money up front but are such dissatisfied customers that they quickly leave, but don’t go public. So they’ve learned a very expensive lesson, but it’s not passed along. Also, I’ve never seen growth hormone given in isolation; it’s always part of an elaborate drug cocktail that involves at least one anabolic steroid and drugs to counter the side effects of those steroids. It’s like an unbelievable hormone soup, and these guys prescribing it aren’t endocrinologists by any stretch of the imagination. So they get multiple drugs countering multiple side effects, and if the person is experiencing any benefit, such as getting bulked up, that’s due to the anabolic steroid, not the growth hormone.

By the way, these are not people in their 60s and 70s who are taking growth hormone. The typical person is mid 20s to late 40s, and it’s usually a guy going in there for bodybuilding. So, I really view these antiaging clinics as fronts for illegal bodybuilding.

What needs to be done?
We think that it would be good to further enhance and clarify the law. That would include anticipating the next drugs to come down the pike. The industry might switch to growth hormone–releasing hormone, for instance. We already see a number of antiaging clinics offering this stuff. In addition to making it clear that off-label use of this hormone is illegal, the law should say that off-label use includes antiaging, bodybuilding, and athletic enhancement, so there’s no doubt in anybody’s mind.

There are organizations out there that actually provide education credits and therefore get money for holding courses and selling books to advocate the use of growth hormone for health and antiaging. We think those organizations should not be able to offer those courses. We also think the DEA needs a lot more resources to combat this problem — more diversion officers out there to investigate and prosecute these clinics and compounding pharmacies. Finally, I would like to see a law that puts a stop to the marketing and promotion of growth hormone for antiaging and bodybuilding. Really, whatever could be done to make a dent in this illegal industry would be great.

Chris Berdik can be reached at cberdik@bu.edu.