In 1983 the late famous sports nutrition guru Dan Duchaine pronounced that growth hormone (GH): " Wow, this is Amazing Stuff". Since then GH has been promoted and viewed by athletes and the public as the "Magic Bullet" to enhance sports performance and even reverse aging. Real GH and its many "bogus" variants are widely sold over the Internet.
Because GH was usually sold together with anabolic steroids (AAS-Anabolic Androgenic Steroids) by underground steroid dealers, the U.S.A. government became early on very concerned about the association between the use of anabolic steroids and GH.Much of the GH / steroid use was in the world of sports performance and body building.
Now GH use and distribution is tightly regulated in the U.S.A. by its inclusion in the Steroid Acts of 1988 and 1993 with stringent controls and higher penalties involving anabolic steroid and GH distribution and use. The U.S.A Federal laws approved uses of GH are limited only to the following conditions
Aids wasting syndrome
Childhood shortness of stature
Growth failure from chronic renal insufficiency
Adult onset GH deficiency (demonstrated by pituitary stimulation testing, history of pituitary surgery, irradiation, trauma to pituitary etc)
Turner's syndrome (a chromosomal abnormality).
Anti-Aging or performance enhancement is considered an illegal off label use of GH.
Despite of the laws GH is still widely used in sport at all levels from Olympic and professional sport to recreational sport. There are tests developed and being developed to test for for GH abuse by an international doping consortium. Even though GH testing has been in place at the Olympic games since about 2004 and at other sporting events, no one yet has been found to have tested as positive for GH doping with the present blood Isotope testing system with over 8, 500 samples tested.
HISTORY OF GH USE
GH was first extracted from pituitary glands of cadavers in 1956 and then in 1959 GH was first used to treat children with shortness of stature.
In 1987 recombinant human GH was engineered in the laboratory (rhGH) using complicated genetic technology.
In 1988 GH entered the Olympic world officially when GH was first found in the suitcase of a Chinese swimmer during an international competition. In 1996 GH treatment was started as a treatment for adults who had been demonstrated to have non-functional pituitary glands from a variety of causes and were not able to secrete normal levels of GH and had the clinical syndrome of "low GH".
IS GH A PERFORMANCE ENHANCING SUBSTANCE IN NORMAL HEALTHY YOUNG ADULTS?
The "gulf" between what scientific studies conclude and what athletes GH say is "huge". Academic science says" there is no evidence that GH enhances performance in young adults", yet GH is widely used in sport. It does leads one to think there must be a "real effect" (mostly males) from GH somehow.
A "systematic review" of the scientific literature was done on the effects of GH on athletic performance (published in "Ann. Internal. Medicine", 2008). The highlights of the study were:
44 articles on GH and sports performance were reviewed.
303 subjects received GH in the study.
Athletes were age 27 ± 3 years old.
All were aerobicaly-physicaly fit with VO2 max 51 ± 8 mL/kg)
The review revealed an average of:
2 kg lean body mass gain using GH,
1 kg loss of fat mass with GH,
0.25 kg gain of body weight.
Exercise performance parameters showed no change in the following parameters:
VO2 max - aerobic capacity
Bicycling speed
Power output
Biceps and quadriceps strength
Energy expenditure.
Why science so far has not given a true picture of GH effects on sports performance are many.
Multiple agents are used with GH by athletes including many sports performance supplements such as amino acids, creatine, herbs, vitamins, and other substances. Some also may use a variety of prescription drugs along with GH. When off GH, energy levels and mood often declines. GH users become less resistant to stress. But there is scanty scientific data on the effects when GH is used with other agents.
GH has subtle but potent mood effects. Studies show that GH can act as an anti-depressant. People on GH of all ages report greater sense of "well-being" with GH. A very small difference in mood can have a powerful effect on high class athletes where a split second difference can mean a gold medal , a championship or failure.
SYNERGISTIC ACTIONS OF GH AND ANABOLIC STEROIDS (AAS)
Effects of GH on "previous anabolic steroid (AAS) users (by Graham in "Hormone Research" 2008) showed that when anabolic steroids were stopped for 12 weeks before GH use the following effects were found:
Increased fat free mass
Decreased fat mass3. Improved VO2 max
Improved cardio-aerobic capacity
Dr. Ken Ho of Australia has shown that when GH is used along with testosterone there was significant increase in muscle mass and increased sprint power compared to placebo controls.
WHY DO ATHLETES USE GH?
Promote skeletal, muscle and other tissue growth or re-growth after injury - faster injury recovery.
Maintain: body composition, energy, metabolism, electrolyte balance, thermoregulation, physical performance, and phycho-physiologic well-being.
TESTING FOR GH DOPING
BLOOD MARKER METHOD
Insulin growth factor (IGF-1) is a protein synthesized by the liver when GH is secreted by the brain (pituitary). GH signals the liver to make IGF-1. The IGF-1 factor has anabolic properties by itself and also has no problems of glucose elevation whereas GH can promote diabetes . The combined use of GH with recombinant IGF-1 can have powerful anabolic and other effects. IGF-1 is not a sensitive measure of GH deficiency. But excess natural GH secretion or by exogenous injection GH will elevate IGF-1 levels. IGF-1 levels are used therapeutically to monitor excessive exogenous GH use or excessive natural production.IGF-1 is not a reliable test for GH doping and maximum levels of IGF-1 levels are seen in 20 year old. The procollagen bone molecule called P-III-NP (type 3 procollagen peptides) marker of bone turnover has been studied and used. High levels may indicate GH doping. Studies of IGF-1 levels in different sports did not show enough variance to be of use. Trauma can increase P-III-NP levels. GH stimulates its release from bone.
BLOOD ISOTOPE RATIO METHOD
Different molecular forms of GH (isoforms) occur in the blood are 3 naturally ocuring forms, which are:
Monomeric 22 kilodalton (kDa) = 43-45 % of total GH in blood.
Dimeric 22 kDa = 20 % of total GH in blood.
Monomeric 20 kDa = 7-8 % of total GH in blood.[Synthetic GH = monomeric 22 kDa only.]
If the ratios of the isotope labeled isoforms are abnormal this can mean a positive GH doping test.Information on a new German CM GH LIA blood assay for GH isomers can be found at the website [www.cmz-assay.com]This assay can recognize pituitary naturally derived GH isoforms ratios from exogenous (external) GH use. This test was just acredited in July 23, 2008.
So far since the 2004 Olympic Olympic Games over 8, 500 athletes have been tested with not a single positive test was found using the older Isomer Isotope Method.
URINE TESTING FOR GH ABUSE
Lance Liotta, M.D. of George Mason University and Don Catlin, M.D. of Los Angeles are developing the first urine test for GH, which shows promise to be the best test for GH abuse. The urine testing uses a novel core-shell hydrogel nanotechnology method, which allows the detection of small amounts of GH molecules in the urine by capturing them with various smart nano-shells. These nano-shells amplify GH levels by over 50 fold which then can be measured easily in the urine. This type of urine GH nanotechnology urine tests is still a few years away from approval and application. The urine of a GH abuser would show an abnormal GH isomer size distribution ratio and would be considered a positive GH test.
CONCLUSIONS
Human growth hormone is widely used and abused in sport and by those who believe it has anti-aging properties.
The present GH Isotope Ratio blood test, which measures the 3 different sizes of GH molecule (isoforms) ratios and has not yieled a positive test in over 8, 500 tests performed by World Anti-Doping Agency (WADA).
In strict scientific studies anabolic steroids such as testosterone can "prime" the effects of GH. "The anabolic steroid" priming effect can occur even if used 12 weeks before using GH.
Many athletes often use multiple performance enhancing agents and or natural supplements. The effects of which are not known and have not been studied.
GH has a potent effect on "mood", which has been documented to provide an anti-depressant effect. This mood effect on sports performance and recovery should be studied.
Most of those who use GH, be it athletes or non athletes, report a greater sense of "well-being" when on GH.
Athletes who may be overtrained and feel "stale" may derive even greater psycho-physiological benefits from GH use.
The new urine nanotechnology method for GH Doping may take some years to be developed, tested, approved and implemented. But when completed may be the best test and may become the standardGH doping test.
The " quest" to find a valid and useful GH doping test has been going on since about 2000.