Growth hormone in anti-aging medicine: A critical review

Abstract

The demographic development of industrialized nations shows clear evidence for the necessity of geronto-endocrmology or anti-aging medicine. On examining the reviewed data, it is clearly evident that GH is an extremely interesting substance. Nevertheless, currently available data are contradictory and present no consistent indication to include GH in the therapeutic repertoire of anti-aging medicine. Rather, further research is still required, in particular with regard to the safety of such treatment. Further uncertainty remains about the target parameters of such treatment. Do these include retaining the ability to work, retaining independence, avoiding the need for care, increasing vitality, or reducing morbidity? How should these target parameters be measured, from a medical, scientific, socioeconomic and ethical point of view? Finally, it remains to be determined how indications for therapy should be defined: are we talking of clinical, subjective or disorders possibly related to other causes? Could IGF-I serum concentration be the indicator? Observing the situation from a different perspective, we can conclude that we enjoy the favorable situation of a constant extension of life expectancy and improved quality of life in the Western industrialized nations. There is no justification for a medical movement marked by panic and despair. From the medical, scientific and ethical point of view, it is imperative to tread carefully: target parameters and indications for therapy must be defined and based on studies carried out in compliance with the criteria of evidence-based medicine. Finally, we must assess how far decisions for therapy according to pharmacogenetic parameters can be met. In the author's opinion, the current widespread random use of GH in anti-aging medicine conceals a great danger. Besides individual risks for the treated patients, which cannot yet be estimated, there is the danger prematurely and irreversibly to discredit GH as a possible beneficial and useful substance, in particular when associated with unwanted side-effects, even if there is no causal connection to the administration of GH. GH replacement really is useful when used as a valid replacement in organic-related hypopituitarism. This therapy is scientifically well endorsed and has been approved by the official authorities. However, concerning the pharmacotherapy with GH in the elderly with a healthy pituitary gland, taking into account the present level of scientific knowledge, this has to be considered as not sufficiently founded.