Human growth hormone (HGH) has been approved for treatment of persons with endogenous HGH deficiency or short stature secondary to chronic renal failure. Additionally, HGH is used off label for patients with Turner's syndrome and children born small for gestational age who have not had sufficient catchup growth.118 However, because of its success in treating these conditions, the abuse of HGH as an ergogenic aid has become widespread as well. In a survey of high school sophomores, Rickert et al119 found 5% of respondents had used HGH, with a significant association with AAS use as well.
HGH is known to increase uptake of glucose and amino acids by skeletal muscle, increase protein synthesis, increase lipid breakdown, and increase rate of bone growth. At therapeutic doses of HGH, no studies have reported improvement in exercise performance parameters, including work capacity and strength.118 However, athletes abusing HGH are likely to use doses that surpass the therapeutic range. Known side effects of excess HGH include acromegaly, in which skeletal muscles are weaker. This myopathic effect likely explains the lack of performance enhancement at therapeutic doses. Other side effects of HGH abuse include insulin resistance and cardiomyopathy.72 Healy et al120 studied the use of HGH at doses similar to those in anecdotal reports of HGH abusers. While some "positive" effects such as increased protein synthesis and increased lean body mass were demonstrated, adverse effects were also found, including increased fasting insulin levels and increased insulin resistance. Additionally, no changes in body fat or performance parameters were seen after 4 weeks of HGH use.
In addition to the negative health effects of HGH abuse by athletes, Conrad and Potter121 excellently summarize the ethical dilemma of HGH use for purported antiaging effects and for idiopathic short stature. Consider the potential impact of using HGH for otherwise healthy pediatric patients at the third per-centile for growth, resulting in a vicious cycle as the third per-centile would then shift higher and higher with time. Equally disturbing would be the treatment of the 5 foot 10 inch high school basketball player in the hopes of reaching 6 feet and the perceived benefits of that difference. These possibilities highlight the need for testing for HGH abuse. Although difficulties in direct testing may exist due to similarities between endogenous and exogenous HGH, research has shown dose-dependent changes in markers of bone turnover that may be used for detection of HGH abuse.122 Sports-governing bodies must support further efforts to protect the health of their athletes as well as the integrity of their sport.
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