It’s long been thought that higher growth hormone(hGH) levels were associated with longer, higher quality lives as we age. Determining levels of hGH has always been the tough part. This paper in the Journal of Managed Care talks at length about what are the accepted mainstream medicine ways to diagnose hGH deficiency.

A quick read of the paper linked above shows that there are several tests to measure hGH levels and all of them are complicated. All of them take several hours. Basically, a substance is given to provoke the release of growth hormone from the pituitary gland. hGH levels are are drawn before the releasing agent is given and then at intervals over several hours. The reason this complicated approach is necessary is that hGH lasts for minutes after release so to accurately determine levels they have to be measure right after release. Clearly, this approach is complicated and inconvenient.

Anti-aging doctors have long been looking for a simpler way to measure and track hGH levels to make treatment with hGH more convenient. hGH causes a number of other hormones to be released in the body. One of these is insulin-like growth factor 1 (IGF-1). This compound is used as a proxy by many doctors to measure the levels of hGH. Low IGF-1 equals low hGH, or at least that’s the thinking. Unfortunately, this isn’t quite true.

Dutch researchers have announced some major findings. Tracking 376 otherwise healthy men between 73 and 94 years of age, they found that those with higher levels of hGH lived longer than those with lower levels of hGH. This was most significant in men at risk of cardiovascular problems. The study was simple: mortality versus hGH level. No looking into lean body mass. No looking at athletic performance. Just mortality.

The other piece of the study is that they used a new test for IGF-I that more accurately mirrors the effects of hGH on levels of this proxy hormone. Using this new study, the researchers found a much closer parallel to levels of the two hormones than available with traditional testing.

Hopefully the newer test will be available widely in the US soon.

I’ve actually intended to write on this for some time. On 5/13, our Las Vegas Fox affiliate chose to do a piece that now makes it timely. In a very one-sided story about a Chiropractor running a weight loss center , Human Chorionic Gonadotropin (HCG) is touted as the next great breakthough in weight loss. It is anything but. HCG has a 54 year history of being the most overhyped and ineffective weight loss aid around.

In 1954, Albert Simeons, a British born physician, posited that HCG could be an effective adjunct to a 500 calorie diet for sustained weight loss. Since that time there have been a number of published studies that almost universally demonstrated that HCG does not enhance weight loss over just maintaining a 500 calorie diet. In 1995, the British Journal of Pharmacology conducted a meta-analysis that looked at both the academic rigor and outcomes of the studies that had been published. The conclusion those researchers reached supported the idea that HCG for weight loss is in all likelihood a crock.

There are numerous legitimate uses for HCG . Because HCG acts like Lutenizing Hormone (LH) which is produced by the pituitary , it stimulates the sex glands (testicles or ovaries) to produce their respective hormones. So, it stands to reason that the legitimate medical uses of HCG would involve conditions where stimulating these glands is desirable.

For instance, in males those might include conditions like undescended testicles , dwarfism and stimulating testosterone production in older men with low testosterone. The testosterone production effects are even part of weight lifting steroid lore with body builders using HCG to insulate their testicles from the adverse effects of steroids. All of this comes with liabilities, of course. Use of HCG in males can be associated with water retention and, worse yet, gynecomastia (enlargement of the breasts). Niether of these side effects really seem compatible with the usual goals of weight loss.

In females, the accepted uses of HCG tend to focus more on fertility . HCG is routinely used with drugs like Clomid to stimulate production of ova and increase the chances of becoming pregnant. For women who repeatedly miscarry, HCG is used to stabilize their hormones to help prevent miscarriage during the early part of pregnancy. Complications for women can be dire. Ovarian hyperstimulation syndrome (OHSS) can occur with the ovaries becoming significantly enlarged and causing abdominal swelling, discomfort and other abdominal symptoms. HCG can cause rupture of ovarian cysts and resultant pain from internal bleeding. HCG has been associated with formation of blood clots. And finally, because of the ovarian stimulation and production of ova, multiple pregnancies (twins or more) can occur when HCG is used.

The FDA has spoken on all of this and has for years required that HCG prescribing information carry in all caps the following warning:

HCG HAS NOT BEEN DEMONSTRATED TO BE EFFECTIVE ADJUNCTIVE THERAPY IN THE TREATMENT OF OBESITY. THERE IS NO SUBSTANTIAL EVIDENCE THAT IT INCREASES WEIGHT LOSS BEYOND THAT RESULTING FROM CALORIC RESTRICTION, THAT IT CAUSES A MORE ATTRACTIVE OR “NORMAL” DISTRIBUTION OF FAT, OR THAT IT DECREASES THE HUNGER AND DISCOMFORT ASSOCIATED WITH CALORIE-RESTRICTED DIETS.

There is no shortage of diet clinics hyping the effectiveness of HCG for weight loss. Those same clinics promise absolute safety. I think it’s pretty clear that neither are true.

A couple of weeks ago, the New York Times wrote an excellent summary piece on the dangers of plastic water bottles. These can be as subtle as heavy metals leaching out of reused bottle water bottles to endocrine disrupting compounds found in otherwise seemingly benign polycarbonate bottles.

Officially, polycarbonate bottles are completely benign with their major contaminant being bisphenol-A. Of course, that’s the official word. Bisphenol-A is a know agonist for estrogen receptors which means that it can in adequate concentrations activate the receptors. The implications are significant. Activating or blocking receptors can interfere with the normal actions of estrogen in females or stimulate estrogen like responses in males and children. Not good, right? It’s worrisome enough that the city of San Francisco banned products for children and infants that contained bisphenol-A in 2006. It does look like they repealed this ban, though.

So what does this matter for adults? This is one of those ongoing scientific arguments. Literature suggests that in-utero exposure to bisphenol-A increasing the lifetime risk of obesity. The chemical industry has spent a lot of money trying to quash this and self described non-partisan think tanks have pumped out paper after paper. The scientific community continues to come up with small study after small study that points to bisphenol-A being less that fully benign. Canada has labeled the compound: inherently toxic. What’s the truth?

Well, for sure bisphenol-A can speed development of fat cells. Exposure to bisphenol-A can speed growth and puberty as well as increase body weight in mice. Whether these are at concentrations similar to what one gets from bottled water is really unknown. Whether the same can be noted in humans is also unknown.

The take home, very likely is to use non-plastics for your water bottle filled from a home reverse osmosis filter. Of course, realistically, most of us will shrug off the risk and use cheap water bottle bought from the warehouse store. It’s not like we haven’t been warned, but like so many things it’s calculating the risks versus convenience.

Scouting through the literature today revealed a study in the journal Circulation. This study showed that low testosterone was a predictor for cardiovascular disease in aging men.

Searching the archives of this same journal finds that in 1999, this study found, “Short-term intracoronary administration of testosterone, at physiological concentrations, induces coronary artery dilatation and increases coronary blood flow in men with established coronary artery disease.” The study actually infused testosterone at normal levels into the coronary arteries of men and observed the flow rate effects on the arteries. Italian researchers found that normal testosterone levels improved ischemia in men who already had heart disease according to this study.

This is one journal and 3 studies. All of these show positive findings relative to testosterone levels in aging men. Searching the endocrine literature reveals more of these kinds of studies. Looking back to last week, the bias of JAMA is more apparent the farther one looks into specialty specific journals.

The new issue of the Journal of the American Medical Association has published a Dutch study on the use of testosterone in aging men. This is interesting because the study itself comes to some interesting conclusions. The Dutch researchers concluded that oral testosterone replacement in men improves lean body mass but did not result in weight loss as seen in other studies of the hormone. They also used a quality of life measurement scale that resulted in no measurable quality of life improvement. The study also showed no improvement in cognitive function amongst those in the study. The study is followed by a lengthy comment and literature review.

Several problems with the study appear on even the first reading. While the Dutch researchers checked for low testosterone in the men in the study before starting medication they did not monitor the testosterone levels through the study. It is entirely possible that the doses of testosterone were inadequate to see the kinds of results that have been documented for testosterone before. Also, the study used oral testosterone for supplementation. Oral testosterone is not considered by those in the know to be acceptable for testosterone replacement. Even the Endocrine Society notes that there are risks of negative effects on the liver from oral testosterone only in their clinical guidelines. Additionally, the paper in JAMA refers to itself as being a “large study” despite the fact there were only 237 test subjects. I personally don’t consider anything less 1000 large, but clearly JAMA differs with me on this. Really, there are statistical rules for analyzing data from numbers as small as 30 and extrapolating to larger populations but this is a dangerous game which is also why so many studies are done over and over again.

The AMA also has a history with anti-aging medicine that’s not good. The American Academy of Anti-Aging Medicine (A4M) has on several occasions made official responses to JAMA articles on hormone replacement because JAMA coverage is universally negative despite what makes it into the endocrinology journals. The responses include this one from 2002 and this one from early 2007. JAMA and the AMA have demonstrated what appear to me to be a political bias against hormone replacement as demonstrated by their ongoing choice to publish only negative studies of hormone replacement.

Since JAMA is very widely read by physicians and covered heavily in the mainstream media, it’s important to make sure you find a physician that reads more than just JAMA if you intend to age against the machine.