Talk:Growth hormone therapy

Terminology

There is a chemical entity known as growth hormone. This does differ chemically between species (bovine, ovine, human Growth Hormone). Human Growth hormone is a single chemical entity, and there is no difference between the growth hormone secreted by the pituitary, cadaver growth hormone, or any of the commercial brands currently available. They may differ in source or contaminants, or in the solutions used to dilute them for injection, but the hormone is identical. The formerly available met growth hormone was chemically different, but not biologically different. Be cautious of any site or person using the plural and saying "growth hormones". There are other hormones involved in growth, such as insulin, thyroxine, and testosterone, but it is misleading to refer to these as "GROWTH HORMONES", and this pharase is often used to hide the fact that you are not getting human growth hormone at all, but some other hormone. There is no "natural" growth hormone, and this term is a throwback to vitalism. A substance either is or is not growth hormone.Pustelnik 14:40, 8 July 2007 (UTC)

To be nitpicky, there is at least one important difference between secreted and recombinant GH. GH is secreted by the pituitary in a variety of isoforms (the two major ones are 22 and 20 kD) whereas recombinant products are a single 22 kD isoform. The importance of this is that GH in the blood can be measured, and detection of an abnormal ratio of 22 to 20 is the most promising method for detecting athletic doping. Green GA (2006). "Doping control for the team physician: a review of drug testing procedures in sport". The American journal of sports medicine. 34 (10): 1690–8. doi:10.1177/0363546506293022. PMID 16923823. alteripse 14:58, 8 July 2007 (UTC)

to whoever wants to emphasize cost inflation

I agree with including the criticism of continued high cost of human GH. I changed the wording for a couple of reasons. "Extremely inflated" is a value judgement and I would rather provide enough info for a reader to decide.

• Can you provide a ballpark price per mg for animal GH?
• I have not heard of any animal GH but bovine. Are you sure that synthetic GH is being given to poultry and you are not confusing GH with steroids or antibiotics?
• I suspect it is not entirely true to claim that production costs for human and animal products are the same, as the FDA has fairly detailed rules on pharmaceutical plants, safety trials for new indications, and such processes as record keeping that are not applicable to animal products but are legitimately part of the production price. alteripse 06:05, 18 Dec 2004 (UTC)

I receive daily injections of recombinant GH. According to my endocrine nurse it costs (the NHS) approximately £3,000 Sterling per annum. One must then factor in the cost of monitoring the condition. 80.6.30.24 23:20, 30 September 2005 (UTC)

Well I take humatrope (somatropin (rDNA origin) as injections and every month I get (3) 24mg boxes and they cost close to $4000 per month!

effects

Does growth hormone treatment have any readily visible effects? Weight loss aside, I know that it is supposed to help restore reduced bone density, cholesterol levels, blood pressure, etc., but does it have many visible/noticeable superficial benefits? (For instance, in increasing bone mass, would it make a person look simply bigger/larger/bulkier/thicker; would it make a person's skull and skeleton bigger?) - March 27, 2006

No immediate visible effects. Over several months it will cause an obvious increase in a deficient child's appetite, can visibly reduce subcutaneous fat, and can cause obvious growth (a cm a month or so, making it obvious the child is outgrowing clothes). Effects in adults are not as well documented and I am speculating somewhat: no immediate effects would be visible during the first months of treatment of a deficient adult, but occasionally there is a mild reduction of excess body fat. Effects in a non-deficient adult would probably be even more subtle. Prolonged use of excessive doses (over years) would presumably begin to thicken soft tissue (hands, feet, nose, etc) and perhaps coarsen the jawline and cause other features of acromegaly.

then do anabolic steroids increase the body's size (skeletally, that is), muscle mass apart?

Jintropin

This is a huge story and the article is incomplete without it's mention. As has been the case in so many other industries (automotive is likely next), the Chinese have built a lower-cost mousetrap. Jintropin is about 1/10th the cost and is readily available on the internet. It's the FIRST significant price drop EVER since gH became the drug d'jour for the anti-aging set.

As an example, someone said they paid 4 grand for THREE 24mg boxes. Google "Jintropin" and you'll see numerous suppliers offering the equivalent of greater than FOUR 24mg boxes for $500.

Question:If a 15 year old kid with the body weight of 68kg and his height is 172 cm tall,what would be the effects to his body?if he taken these gh and after a while he stoped what would happen?Would he shrink?get a disfunctioned body?If he did have kids wen he was older, would the effect of his son or daughter be normal or different to other kids?Would they disabilities to thier body's?These are questions i do not no....it would be a great help to me if u got answer them...please...thank you.

At that height and weight, he probably should not take growth hormone at all. Jintropin states that it is recombinant, but it is sold in "units" not milligrams. I'm not sure what the conversion factor is, but with the NPA growth hormone, a "unit" was approximately 0.5 milligrams,Pustelnik 13:46, 8 July 2007 (UTC)

Better answers to anonymous questions: 1 Can't tell possible growth response without bone age and pubertal data. 2 He would have less of whatever good or bad things the GH had been doing; effect on growth would depend on BA. 3 Yes he would shrink, but usually not until after age 40 unless he had severe untreated deficiency and osteoporosis. 4 There is no known effect of GH on offspring. alteripse 14:16, 8 July 2007 (UTC) PS Units are still commonly used in Europe-- North American doctors changed to mg about 1985. alteripse 14:16, 8 July 2007 (UTC)

The head of the Chinese FDA just got sentenced to death for corruption. The makers of Jintropin have not submitted any safety or efficacy data to the US FDA or the equivalent in the European Union, have they? Since the vast majority of people buying Jintropin over the internet are not GH deficient, and have no doctors monitoring their responses, how do you know what is in those vials? I sure as hell would not give it to my child if he had only a few years of remaining growth. Add it to the article when the company begins to play by the rest of the first world's rules. alteripse 14:16, 8 July 2007 (UTC)

A question?

"If we treat a child to protect him from the disadvantages of social heightism, is that like lightening skin or straightening hair to protect from racism?" Why is this a significant question/issue, isn't the answer obvious? This is a social issue at best, and has nothing to do with Growth hormone treatment. Not to mention this could easily be restated as fact 'If we treat a child to protect him from the disadvantages of social heightism, that *is* like lightening skin or straightening hair to protect from racism.' ANONYMOUS COWARD0xC0DE 04:04, 11 August 2006 (UTC)

No analogy matches all points unless it is a tautology. There are many laws and social customs to inhibit racism or reduce its effects. There are almost none to reduce the effects of "heightism". Since this is in fact the most common reasons parents seek treatment with growth hormone, this issue has everything to do with Growth hormone treatment. alteripse 23:46, 12 August 2006 (UTC)

"lightening skin" and "changing height" are both actions, "heightism" and "racism" are both forms of discrimination, if these assumptions are taken to be true then they are both similar in that each is an action to prevent discrimination, and thus the analogy is true via shared abstraction, and if the statement is true then it is a tautology. ANONYMOUS COWARD0xC0DE 06:26, 14 August 2006 (UTC)

"This is a social issue at best, and has nothing to do with Growth hormone treatment." ANONYMOUS COWARD0xC0DE "[...] this issue has everything to do with Growth hormone treatment." alteripse I agree, my statement was incorrect. ANONYMOUS COWARD0xC0DE 06:26, 14 August 2006 (UTC)

If there are no further complaints, I will remove this question.ANONYMOUS COWARD0xC0DE 19:08, 23 August 2006 (UTC)

Removing Question ANONYMOUS COWARD0xC0DE 21:49, 16 September 2006 (UTC)

Replacing question. It belongs there and is a legitimate ethical question about which reasonable people might differ. alteripse 23:57, 16 September 2006 (UTC)

Do you find the analogy to be false? Perhaps you are not referring to the article's question as a question? The answer is yes with regard to shared abstraction, however if the question is more like "is hightism (like/less important than/more important than) racism", then I would rephrase the question to be more direct or insert an additional sentence to make the meaning of the question more clear. ANONYMOUS COWARD0xC0DE 08:26, 24 September 2006 (UTC)

I simply do not understand your fixation on this question. The question is one of a series of rhetorical questions briefly posing ethical issues for which reasonable people might differ on the answer. Many parents seek treatment for their children to reduce social disadvantages of anti-shortness prejudice (termed "heightism" by others). Other people think we should consider shortness as part of normal variation and teach short children to deal with social prejudice in other ways, not by feeling like they have to change themselves. What part of this don't you get? alteripse 12:05, 24 September 2006 (UTC)

I enjoy constructive arguments. There is only one question we are dealing with, and I am not concerned with the ethical issues at the moment. You may disagree with my view that there is only one correct answer to this question. However, the logical answer to this question is "yes", as I have already demonstrated. I believe that most reasonable people would not differ on this assessment, but it does not mater what most people believe to be true, if the common answer can be disproved. I do not understand how anyone can come to the conclusion that the answer to this question is "no".

The question "If we treat a child to protect him from the disadvantages of social heightism, is that like lightening skin or straightening hair to protect from racism?" is a well formed question, but it is a redundant question as it is a recognizable yes/no question with a decidable and verifiable answer. ANONYMOUS COWARD0xC0DE 02:29, 26 September 2006 (UTC)

Ah, now I understand. You were not quibbling over ethics but over the syntax of how the issue was described. Now that you point it out, I agree, the only answer is "yes, it is like that". I will rephrase it. alteripse 20:07, 26 September 2006 (UTC)

Question:If a boy at the age of 15 and at the height of 172cm and his weight was 69kg,what would be the effect to his body if he'd taken growth hormones?

If he had taken them and then stoped taking them after a while,what would be the effects to his body?

If he had kids when he was older,what would happen to his daughter or son in apperance etc?would they be different compared to other kids?would they have disabilites eg:speaking, looking, smelling like those things?Would they have disadvantages...if that man took growth hormones when he was at the age of 15?

If there wasnt any major effect taking growth hormones?Could dna scientists find out if u did take them when you were 15, 10 years later?

where are all the references?

I see one reference on the bottom of the page. Is any of this info legitimate??

I found a few internal references that weren't formatted as references, and I remedied that. However, more references are needed.--SidP 10:50, 29 September 2006 (UTC)

By David 10th of april 2007 12.42am

I notice there's a references needed bar now at the top of the article. How long are these posted until articles or large portions of articles are deleted for lack of references? I would hate to see that happen because obviously a lot of thought has gone into this article but the lack of references is outrageous. Iushad 13:34, 27 August 2007 (UTC)

Methylphenidate

I recently started taking methylphenidate (aka ritalin) and I did some reading about the endocrine effects of the drug. In a study by Joyce PR et al in 1986 showed that methylphenidate increased growth hormone levels. This did vary between patients and the increase was higher in men. According to a graph each person had less than 2 ug/l to start and they did say that each person was under 5ug indicating they did not have "elevated GH." After treatment it went up ti 13.2 +-2.8 ug/l in the male patients. They took .3 mg/kg of the drug. For my weight that would be ~25 mg. I am on an extended release dose of 54 mg (concerta). I was just curious if this was enough to notice any physiological difference if I took the drug every day (which I actually don't). Thanks a lot for any insight to this problem.

As a followup question, is this enough that if I or someone else were to take it on a regular basis that it should be somewhat cycled to prevent a deminished GH output after cessation? Or, would having elevated levels throughout the day effect the natural diurnal variation? Thanks again, I really appreciate any input. Rjkd12 16:03, 15 January 2007 (UTC)

Category:Human reproduction

I propose removing this article from Category:Human reproduction. I have proposed narrowing the scope of that category at Category talk:Human reproduction. Please comment on the category talk page. Lyrl ^Talk _C 15:01, 17 March 2007 (UTC)

Go ahead, GH is certainly not necessary for reproduction. alteripse 15:17, 17 March 2007 (UTC)

Sources?

An article such as this one which relies on scientific evidence in discussing medical issues and ethical questions needs to be referenced fully and specifically for the sources of its claims. The section on "Ethical issues" is particularly irritating in this respect because it makes claims that are, in my opinion, both economically and ethically questionable. For example: "A high cost was originally justified by the new technology and unusually extensive clinical trials." Economic liberals could justifiably object that it is only supply and demand which justified the price and patent opponents that it is the monopoly granted by government force which caused, but did not justify, the cost. In other words, it is very far form a factual statement and must be attributed as the opinion of some commentator, bioethicist, or such.

A further problem is that the "Questions and dilemmas" subsection, despite its claim to be based on the "previous facts", asks no questions at all based on the critical 'facts' about pharmaceutical companies but simply takes the high cost of synthetic growth hormone as a fact of life and discusses the ethical implications of that high cost. The paper by Allen and Fost in .pdf format referenced at the end of "Ethical issues" is on topic but supports few, if any, of the claims made in "Ethical issues". Since it does not specifically support this section I think it belongs in the "External links" section at the bottom of the article. I have no special knowledge of this subject myself so the help I can offer is limited to these issues of desirable Wikipedia form. —Blanchette 07:37, 24 April 2007 (UTC)

There are several meanings of justified, and I deliberately chose that word because more than one meaning may be considered applicable. The GH companies justified the high cost by the research involved and eventually it was accepted and paid for by insurance. Some people felt that such a high cost over production costs for the next 20 years was not justified by the research. It seems clear to me if not to you. So how would you like to express that? As far as your second paragraph, it seems a non-sequitur. If you feel an ethical objection to the high cost is missing, put it in. The issues that are posed are the issues that are currently real, since it does continue to be expensive. alteripse 01:34, 29 April 2007 (UTC)

Growth hormone plasma levels during treatment

I was trying to look up what plasma levels of GH are after treatment for a deficiency and I can't find anything. I can find doses (mg/kg) of GH, I can find IGF-1 levels and how GH effects many other hormone/protein levels execpt the circulating levels of GH. I ask because of the above mentioned ritalin question and curiosity if those levels are high enough to ellicit any physiological changes. If anybody has anything I'd appreciate it. Thanks again, Rjkd12 20:59, 27 April 2007 (UTC)

Lots of studies on levels after therapeutic injection were published in the 1980s. Levels are biphasic: briefly for a few hours above normal, slowly descending into normal range, and below normal by time for next injection in 24 hours. Search pubmed for growth hormone kinetics. However, there is little published about concurrent use of GH replacement and Ritalin; there is no reason to think that one substantially affects the kinetics of the other. alteripse 01:27, 29 April 2007 (UTC)

Thank you very much for responding, I really appreciate it. I was not talking about Ritalin altering the kinetics of GH, but how ritalin, which is a dopamine agonist, increases GH output. I posted a study above (about methylphenidate and GH) and gave the actual numbers of how much Ritalin increased plasma GH levels. I was just curious if those increases were enough to alter anything physiologically. Also, after looking at your talk page you seem very versed in GH. When I look up old articles/texts most indicate that dopamine antagonists increase GH and dopamine agonists decrease it. Current texts say the exact opposite. I was just curious if you knew why or what study created a paradigm shift. Thanks again, I really appreciate it, Rjkd12 21:09, 29 April 2007 (UTC)

Ritalin has a nasty effect on some kids' growth. I am skeptical that any increase of GH is sustained: many things stimulate it in a single dose (e.g. L-dopa or clonidine) but do not continue to do so when the doses are repeated day after day. Give us the PMID for the study you cite above and for the ones you mention that say dopamine agonists suppress it and I will look at the abstracts and interpret for you if you wish. alteripse 21:39, 29 April 2007 (UTC)

Interesting. So, you are saying that it probably woulnd't increase GH with repeated doses? The pubmed abstract for the study showing a GH increase with ritalin is http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3741917&query_hl=1&itool=pubmed_docsum I do not have one specific study that says dopamine agnonists supress GH. I asked a professor who lectured about GH and in an older textbook of his it stated that. Also, I've seen references against methylphenidate indicating it stunts growth and they cited studies about how anonists supress growth, but I do not have any of these at my fingertips. I just assumed that this was an outdated and incorrect belief. I did a quick search and found this,http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14602782&dopt=Abstract I know its not the best example at all, so please don't think that I'm basing everything off of this one study. But, this study does say that somatostatin and DA were additive, and that DA agonists does decrease GH in acromegaly. Maybe this is because in acromegaly there is already so much GH, I am unsure. But, I do know I have read that in older texts. My main question is though, an adult with repeated methyphenidate administration would they continue to see this GH spike with doses, and is that spike enough to elicit any physiological changes? Thanks again, I really appreciate your time.Rjkd12 13:21, 30 April 2007 (UTC)

You can't extrapolate a single dose effect into either (a) a sustained daily effect with repeated administration, or (b) an effect downstream from the hormone measured. Clonidine is an excellent example of both. In a single dose it is a good enough stimulus for GH release that we use it for GH testing. Some investigators tried to exploit this effect by conducting a trial (published in Lancet late 70s or early 80s) of whether daily clonidine for 6 months or a year could stimulate growth in short children. There was no detectable effect. Some single dose effects of a drug lessen with repetition; others accumulate. a review of growth effects of stimulants alteripse 16:17, 30 April 2007 (UTC)