MEDICINE

The growth hormone and testosterone myths

 
 
PERLS
PERLS

thperls@bu.edu

Testosterone and other anabolic steroids and growth hormone are not just about cheating and they’re not just a problem to be dealt with by Major League Baseball and other overseers of professional sports. The sale and prescribing of testosterone and other anabolic steroids and growth hormone are illegal for athletic use, body building and anti-aging, and for good reasons.

These drugs, when marketed and used for medically fallacious reasons, can cause financial, physical and psychological harm.

Many clinics that go by various descriptions ranging from anti-aging, age-management and wellness clinics and spas to life extension and longevity institutes cater to young men looking for drugs for body building and of course professional athletes looking for athletic performance enhancing drugs as well as more middle aged and relatively wealthy individuals succumbing to marketed pitches of youth, virility, and weight loss.

This is a cash only business (except for fraudulent insurance claims) because private and public insurers won’t pay for these treatments that are viewed by endocrinologists as outside the scope of the reasonable, safe and legal practice of medicine.

One of the consequences of this being a cash only business is that the clinics, internet sites and compounding pharmacies are ineffectually regulated. Adverse medical events go unreported and some clinics obtain signed contracts stipulating that patients lose their rights to report adverse events or unprofessional behavior to regulatory agencies.

Testosterone in its various forms, including Androgel, can cause impulsive violent behavior and unpredictable rage and precipitate psychotic behavior and mania. One only needs to recall Charlie Sheen’s recent psychotic meltdown to see the profound and scary side effects of this drug. Chris Benoit, a famous pro-wrestler, killed his wife and son and then himself, while, like most other pro-wrestlers, he was taking what amount to toxic hormone soups or what the anti-aging industry euphemistically calls “hormone replacement therapy”.

There are dangerous physical side effects from testosterone as well, including obstructive sleep apnea, irregular heart beat (called atrial fibrillation, which increases the risk for stroke), and problems that all increase the risk for heart attack, including high blood pressure, increased blood viscosity, and very low good (HDL) cholesterol levels. Anabolic steroids taken by mouth, like Anavar, are additionally associated with markedly increased risk of inflammation of the liver and can lead to liver failure.

Over the past five years or so we have been deluged by pharmaceutical advertisements promoting testosterone injections, gels and creams to baby-boomers as the male fountain of youth. One “anti-aging” doctor states that all men as they get older require testosterone supplementation. According to less conflicted experts, somewhere between 2-18 percent of men have age-related declines in testosterone levels and coexisting clinical problems that merit testosterone supplementation even in the face of testosterone’s significant risk profile.

A study appearing this year in the Journal of Sexual Medicine showed that by 6 months of treatment, only about one third of 15,400 men stuck with their testosterone gel and by one year, the rate was down to only 15 percent. Maybe the vast majority of the men who succumbed to the marketing blitz realized it wasn’t worth it or they sustained adverse effects.

But the expensive television ads keep coming bellying the net profits the pharmaceutical companies are experiencing as a result of their marketing campaigns.

In the case of A-Rod, we have mostly heard about his using human growth hormone. The irony is that there is little or no scientific evidence for anti-aging or athletic benefits from “hGH”. A Stanford study of 27 randomized controlled clinical trials demonstrated no significant improvement in strength and exercise capacity. Furthermore, the risks from hGH far outweigh the little or no benefit. In the Stanford study, nearly half of the healthy people who got this drug experienced swelling, and a quarter developed joint pains. In another evaluation of multiple studies of older people there were even higher rates of these adverse events and 25% developed elevated blood sugars with a subset going on to have diabetes. Numerous laboratory studies show that hGH enhances the ability of cancers to metastasize or spread.

So if the risks of hGH far outweigh the little or no benefit, why do clinics con their clients into buying it? The most likely reason is because hGH has a huge profit margin and it is almost always sold in conjunction with drugs that can help build muscle, namely anabolic steroids like testosterone. That way the patient thinks they are getting a muscle building effect from the growth hormone, but it’s really due to the anabolic steroids.

Recently it was reported that a federal grand jury has been formed to determine if criminal charges are warranted against the South Florida anti-aging clinic. Hopefully, the jury will go beyond the pushers and dealers and determine which doctors wrote prescriptions and what pharmacies and wholesalers participated in the distribution ring.

Effectively tackling the production of these drugs that are destined for illegal distribution across the country via many clinics and compounding pharmacies will be a bigger challenge that must be supported by public and Federal Congressional support and pressure.

None of these actions will bring the many pro-wrestlers, body builders, student athletes, firemen, policemen, military, and unknown numbers of other individuals that have died or suffered as a result of the “being big” cult promotion and hormone replacement scams. We can honor these individuals by taking effective actions to stop these tragedies via effective education and protection of the public.

Thomas Perls MD, MPH, Professor of Medicine at Boston University and Boston Medical Center testified in 2008 as an expert witness for the U.S. Congressional Committee on Oversight and Government Reform about the medical misuse of growth hormone prior to hearings on the Mitchell Report and Steroids in Baseball.

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