HGH Doctor: Real Medical Facts from Real Medical Journals

GH therapy is best accomplished under the direct supervision of a clinical endocrinologist. Short-term GH treatment is safe in both children and adults. Continued monitoring of side effects and long-term treatment results is needed.

Optimal replacement dosages in adults have not been well defined; studies have suggested 0.1 to 1.0 mg/day. Considerable variability exists, however, in the appropriate GH dose for different patients and the various conditions being treated. A single subcutaneous self-injection of GH into the abdomen, preferably in the evening, is best. The injection site should be rotated to minimize lipoatrophy. Daily administration is more effective in stimulating growth than injections 3 times per week. Although twice-daily GH schedules produce higher GH levels and may be superior to once-daily injections, the inconvenience may compromise compliance.

Physiologic GH replacement must be distinguished from pharmacologic therapy. Replacement therapy of daily GH injections does not simulate the normal, physiologic pulsatile pattern of GH secretion. Starting replacement therapy dosages for GH range from 0.02 to 0.05 mg/kg per day in children and from 0.001 to 0.008 mg/kg per day in adults. For a 70-kg man, the usual starting dosage is 0.1 to 0.3 mg/day, with a maintenance dosage of 0.3 to 0.6 mg/day, or approximately 2 to 4 mg of GH weekly. The dosage should be increased slowly (probably best at monthly intervals), on the basis of clinical and biochemical responses. GH replacement may be given throughout most of the lifetime of some affected patients. Physicians caring for these patients should be aware that dose requirements may decrease with time. Replacement therapy should be monitored carefully as the patient ages, and special emphasis should be placed on perceived and objectively measured benefits and side effects. If the patient receives no benefit, a withdrawal period should be considered. Because the diagnosis of GHD in adult patients, initiation of therapy, maintenance treatment, and monitoring of side effects are complex, these patients should remain under long-term surveillance by an endocrinologist experienced in treating pituitary-related disorders. Such a program of surveillance, which is the cornerstone of successful therapy, can be undertaken in partnership with an internist or family practitioner. Initial follow-up should be at monthly intervals. Thereafter, visits may be less frequent but should never be less than twice yearly. Because reimbursement for testing and treatment is often complex and time-consuming, patient advocacy involves a considerable commitment. The practicing endocrinologist can help the patient achieve appropriate and lasting reimbursement for optimal medical care.

The GH products approved for use in the United States in 2002 are summarized in Table 6 in the original guideline document.