The Effects of Growth Hormone and Sex Steroid on Lean Body Mass, Fat Mass, Muscle Strength, Cardiovascular Endurance and Adverse Events in Healthy Elderly Women and Men Effect of growth hormone treatment on hormonal parameters, body composition and strength in athletes. Physical Effects of Short-Term Recombinant Human Growth Hormone Administration in Abstinent Steroid Dependency Body composition and quality of life in adults with growth hormone deficiency; effects of low‐dose growth hormone replacement Short-term recombinant human growth hormone administration improves respiratory function in abstinent anabolic-androgenic steroid users. Growth hormone and sex steroid administration in healthy aged women and men: a randomized controlled trial. The effects of supraphysiological doses of testosterone on angry behavior in healthy eugonadal men--a clinical research center study. Recombinant human growth hormone in abstinent androgenic-anabolic steroid use: psychological, endocrine and trophic factor effects. Growth Hormone Replacement in Healthy Older Men Improves Body Composition but Not Functional Ability Physiological elevation of endogenous hormones results in superior strength training adaptation Cardiovascular effects of growth hormone treatment in growth-hormone-deficient adults: stimulation of the renin-aldosterone system. Supraphysiological growth hormone: less fat, more extracellular fluid but uncertain effects on muscles in healthy, active young adults Effects of Physiologic Growth Hormone Therapy on Bone Density and Body Composition in Patients with Adult-Onset Growth Hormone Deficiency Single and combined effects of growth hormone and testosterone administration on measures of body composition, physical performance, mood, sexual function, bone turnover, and muscle gene expression in healthy older men. Evidence for a decrease in cardiovascular risk factors following recombinant growth hormone administration in abstinent anabolic-androgenic steroid users. The effects of an anabolic steroid on the strength, body composition, and endurance of college males when accompanied by a weight training program. Effect of growth hormone and resistance exercise on muscle growth in young men.
Decreases in growth hormone ( GH ) and insulin-like growth factor I occur with age , in addition to oestrogen deficiency in women and a reduction in the levels of testosterone in men . These age-related hormonal changes may contribute to reductions in lean body mass , muscle strength and cardiac endurance , which can be partially reversed in elderly people with GH treatment , and testosterone supplements and oestrogen/progestin hormone replacement therapy in men and women , respectively . These treatments are , however , thought to have potentially serious adverse effects . We conducted a study to evaluate the separate and interactive effects of GH and sex steroids on body composition , muscle strength and cardiac endurance as well as the rate of adverse events in healthy elderly people . The results of the study showed that although there were beneficial effects with GH and sex steroid treatment , a high percentage of adverse effects occurred after 26 weeks of treatment , demonstrating a need for more research on the safety of hormonal therapy in the elderly population The effect of recombinant GH on strength , body composition and endocrine parameters in power athletes was investigated in a controlled study . Twenty-two healthy , non-obese males ( age 23.4 + /- 0.5 years ; ideal body weight 122 + /- 3.1 % , body fat 10.1 + /- 1.0 % ; mean + /- SEM ) were included . Prob and s were assigned in a double-blind manner to either GH treatment ( 0.09U ( kg BW)-1 day-1 sc ) or placebo for a period of six weeks . To exclude concurrent treatment with and rogenic-anabolic steroids urine specimens were tested at regular intervals for these substances . Serum was assayed for GH , IGF-I , IGF-binding proteins , insulin and thyroxine before the onset of the study and at two-weekly intervals thereafter . Maximal voluntary strength of the biceps and quadriceps muscles was measured on a strength training apparatus . Fat mass and lean body mass were derived from measurements of skinfolds at ten sites with a caliper . For final evaluation only data of those 8 and 10 subjects in the two groups who completed the study were analyzed . GH , IGF-I and IGF-binding protein were in the normal range before therapy and increased significantly in the GH-treated group . Fasting insulin concentrations increased insignificantly and thyroxine levels decreased significantly in the GH-treated prob and s. There was no effect of GH treatment on maximal strength during concentric contraction of the biceps and quadriceps muscles . Body weight and body fat were not changed significantly during treatment . We conclude that the anabolic , lipolytic effect of GH therapy in adults depends on the degree of fat mass and GH deficiency . ( ABSTRACT TRUNCATED AT 250 WORDS Background / Aims : Recombinant human growth hormone ( rhGH ) as opposed to cadaver pituitary GH is misused for physical improvement . Six days ’ rhGH administration , in abstinent anabolic- and rogenic steroid dependents , was compared with controls . Method : Male subjects ( n = 48 ) were r and omly divided into two groups : ( 1 ) : control group ( C ) , n = 24 , mean ± SD , age 32 ± 11 years , height 1.8 ± 0.06 m ; ( 2 ) :  rhGH-using group  ( 0.058 IU·kg–1·day–1 ) ( GH ) , n = 24 , mean ± SD , age 32 ± 9 years , height 1.8 ± 0.07 m. Physiological measurements included anthropometry , strength , power and peak oxygen uptake ( VO2 peak ) . Biochemical measurements included haemoglobin , packed cell volume , glucose , sodium , potassium , urea , creatinine , total protein , albumin , thyroid function , testosterone , prolactin , cortisol , GH and insulin-like growth factor-I ( IGF-I ) . Results : Strength , peak power output and IGF-I significantly increased and total protein , albumin and free tetra-iodothyronine significantly decreased compared to controls ( p < 0.05 ) and within the GH group ( p < 0.017 ) . Fat-free mass index and VO2 peak significantly increased , while body fat and thyroid-stimulating hormone significantly decreased within the GH group ( p < 0.017 ) . Conclusions : Short-term rhGH  increased strength and power . Of therapeutic value is the possibility that muscle bulk and strength could be increased in patients with muscle-wasting conditions OBJECTIVE Adult growth hormone deficiency ( AGHD ) is characterized by abnormalities in body composition and a poor perceived quality of life ( QoL ) . Weight‐based high‐dose growth hormone replacement ( GHR ) results in improvements in body composition and QoL in AGHD . However , a high patient percentage reported side‐effects on high‐dose GHR result ing in a high rate of patient withdrawal from growth hormone ( GH ) treatment . High‐dose GH therapy also leads to supraphysiological serum insulin‐like growth factor‐I ( IGF‐I ) concentrations that have been associated with breast and prostate cancer , raising major concerns over the use of such high‐dose GH regimen in AGHD . The aim of this study was to assess the effects of low‐dose growth hormone replacement ( GHR ) on body composition and QoL as early as 1 and 3 months OBJECTIVES To determine whether 6 days recombinant human growth hormone ( rhGH ) administration , in an abstinent anabolic- and rogenic steroid ( AAS ) using group had any respiratory , endurance exercise and biochemical effects compared with an abstinent AAS control group . METHODS Male subjects ( n=48 ) were r and omly divided , using a single blind procedure into two groups : ( 1 )  control group ( C ) n=24 , means+/-SD , age 32+/-11 years ; height 1.8+/-0.06 m ; ( 2 ) rhGH using group ( 0.019 mg kg(-1 ) day(-1 ) ) ( GH ) n=24 , means+/-SD , age 32+/-9 years ; height 1.8+/-0.07 m.  Anthropometry , respiratory muscle function and endurance exercise were investigated . Respiratory measurements examined , were forced expiratory volume in one second , forced vital capacity , maximum inspiratory pressure and maximum expiratory pressure . Endurance exercise was assessed by measuring peak oxygen uptake ( VO(2)peak ) . Biochemical analysis included ; haemoglobin , packed cell volume , glucose , sodium , urea , creatinine , total protein , albumin , testosterone and insulin like growth factor-I ( IGF-I ) . RESULTS Forced expiratory volume in one second/forced vital capacity , maximum inspiratory pressure , maximum expiratory pressure , and IGF-I significantly increased compared with the control group ( all P<0.05 ) . Body mass index , fat free mass index , peak oxygen uptake , maximum inspiratory pressure , maximum expiratory pressure , IGF-I and serum sodium significantly increased , whilst body fat , total protein and albumin , significantly decreased within the GH group ( all P<0.017 ) . CONCLUSION The findings of this study indicated that short-term high dose rhGH increased aerobic performance and respiratory muscle strength in former AAS users CONTEXT Hormone administration to elderly individuals can increase lean body mass ( LBM ) and decrease fat , but interactive effects of growth hormone ( GH ) and sex steroids and their influence on strength and endurance are unknown . OBJECTIVE To evaluate the effects of recombinant human GH and /or sex steroids on body composition , strength , endurance , and adverse outcomes in aged persons . DESIGN , SETTING , AND PARTICIPANTS A 26-week r and omized , double-blind , placebo-controlled parallel-group trial in healthy , ambulatory , community-dwelling US women ( n = 57 ) and men ( n = 74 ) aged 65 to 88 years recruited between June 1992 and July 1998 . INTERVENTIONS Participants were r and omized to receive GH ( starting dose , 30 micro g/kg , reduced to 20 micro g/kg , subcutaneously 3 times/wk ) + sex steroids ( women : transdermal estradiol , 100 micro g/d , plus oral medroxyprogesterone acetate , 10 mg/d , during the last 10 days of each 28-day cycle [ HRT ] ; men : testosterone enanthate , biweekly intramuscular injections of 100 mg ) ( n = 35 ) ; GH + placebo sex steroid ( n = 30 ) ; sex steroid + placebo GH ( n = 35 ) ; or placebo GH + placebo sex steroid ( n = 31 ) in a 2 x 2 factorial design . MAIN OUTCOME MEASURES Lean body mass , fat mass , muscle strength , maximum oxygen uptake ( VO(2)max ) during treadmill test , and adverse effects . RESULTS In women , LBM increased by 0.4 kg with placebo , 1.2 kg with HRT ( P = .09 ) , 1.0 kg with GH ( P = .001 ) , and 2.1 kg with GH + HRT ( P<.001 ) . Fat mass decreased significantly in the GH and GH + HRT groups . In men , LBM increased by 0.1 kg with placebo , 1.4 kg with testosterone ( P = .06 ) , 3.1 kg with GH ( P<.001 ) , and 4.3 kg with GH + testosterone ( P<.001 ) . Fat mass decreased significantly with GH and GH + testosterone . Women 's strength decreased in the placebo group and increased nonsignificantly with HRT ( P = .09 ) , GH ( P = .29 ) , and GH + HRT ( P = .14 ) . Men 's strength also did not increase significantly except for a marginally significant increase of 13.5 kg with GH + testosterone ( P = .05 ) . Women 's VO(2)max declined by 0.4 mL/min/kg in the placebo and HRT groups but increased with GH ( P = .07 ) and GH + HRT ( P = .06 ) . Men 's VO(2)max declined by 1.2 mL/min/kg with placebo and by 0.4 mL/min/kg with testosterone ( P = .49 ) but increased with GH ( P = .11 ) and with GH + testosterone ( P<.001 ) . Changes in strength ( r = 0.355 ; P<.001 ) and in VO(2)max ( r = 0.320 ; P = .002 ) were directly related to changes in LBM . Edema was significantly more common in women taking GH ( 39 % vs 0 % ) and GH + HRT ( 38 % vs 0 % ) . Carpal tunnel symptoms were more common in men taking GH + testosterone ( 32 % vs 0 % ) and arthralgias were more common in men taking GH ( 41 % vs 0 % ) . Diabetes or glucose intolerance occurred in 18 GH-treated men vs 7 not receiving GH ( P = .006 ) . CONCLUSIONS In this study , GH with or without sex steroids in healthy , aged women and men increased LBM and decreased fat mass .  Sex steroid + GH increased muscle strength marginally and VO ( 2)max in men , but women had no significant change in strength or cardiovascular endurance . Because adverse effects were frequent ( importantly , diabetes and glucose intolerance ) , GH interventions in the elderly should be confined to controlled studies UNLABELLED Anecdotal reports of " roid rage " and violent crimes by and rogenic steroid users have brought attention to the relationship between anabolic steroid use and angry outbursts . However , testosterone effects on human aggression remain controversial . Previous studies have been criticized because of the low and rogen doses , lack of placebo control or blinding , and inclusion of competitive athletes and those with preexisting psychopathology . To overcome these pitfalls , we used a double-blind , placebo-controlled design , excluded competitive athletes and those with psychiatric disorders , and used 600 mg testosterone enanthate (TE)/week . Forty-three eugonadal men , 19 - 40 yr , were r and omized to 1 of 4 groups : Group I , placebo , no exercise ; Group II , TE , no exercise ; Group III , placebo , exercise ; Group IV , TE plus exercise . Exercise consisted of thrice weekly strength training sessions . The Multi-Dimensional Anger Inventory ( MAI ) , which includes 5 different dimensions of anger ( inward anger , outward anger , anger arousal , hostile outlook , and anger eliciting situations ) , and a Mood Inventory ( MI ) , which includes items related to mood and behavior , were administered to subjects before , during , and after the 10 week intervention . The subject 's significant other ( spouse , live-in partner , or parent ) also answered the same questions about the subject 's mood and behavior ( Observer Mood Inventory , OMI ) . No differences were observed between exercising and nonexercising and between placebo and TE treated subjects for any of the 5 subdomains of MAI . Overall there were no significant changes in MI or OMI during the treatment period in any group . CONCLUSION Supraphysiological doses of testosterone , when administered to normal men in a controlled setting , do not increase angry behavior . These data do not exclude the possibility that still higher doses of multiple steroids might provoke angry behavior in men with preexisting psychopathology This study examined whether six days recombinant human growth hormone ( rhGH ) affected psychological profile in an abstinent and rogenic-anabolic steroid ( AAS ) abusing group , compared with an abstinent AAS control group . Male subjects ( n = 48 ) were assigned in a r and om fashion into one of two groups : ( 1 ) : ( n=24 ) control group ( C ) ; ( 2 ) : ( n=24 ) rhGH group ( GH ) . A hospital anxiety scale ( HADS ) question naire was completed by all subjects . Physiological responses investigated included anthropometry . Biochemical markers examined included ; serum glucose , sodium , urea , lipid profile , high sensitivity C-reactive protein ( hsCRP ) , homocysteine ( HCY ) , tetra-iodothyronine ( T4 ) , thyroid stimulating ( TSH ) , luteinising ( LH ) and follicle stimulating ( FSH ) hormones , testosterone ( T ) , prolactin ( PRL ) , cortisol and insulin like growth factor-1 ( IGF-I ) . HADS question naire significantly decreased in both anxiety ( A ) and depression ( D ) symptoms within GH ( P<0.017 ) and compared with C ( P<0.05 ) . Body mass index ( BMI ) and fat-free mass index ( FFMI ) significantly increased ( both P<0.017 ) while body fat significantly decreased within GH ( P<0.017 ) . IGF-I significantly increased within GH ( P<0.017 ) and significantly increased compared with C ( P<0.05 ) . Serum sodium significantly increased ( P<0.017 ) and serum HCY , hsCRP , TSH and T4 , significantly decreased within GH ( all P<0.017 ) . PRL significantly increased and T4 significantly decreased compared with C ( both P<0.05 ) . The findings of this study suggest that short term use of rhGH has beneficial effects on mental state  in individuals who were previous abusers of AAS and appeared to have a beneficial effect on cardiovascular risk markers associated with adverse mental health Aging is associated with alterations in body composition and a decline in functional status . Healthy older persons have decreased muscle mass , increased fat mass , and decreased strength [ 1 - 3 ] . The muscle strength of 70-year-old men is about half that of young adults [ 3 ] . The risk for falls , fractures , and frailty increases with age-related decreases in muscle strength [ 4 - 6 ] . Pituitary secretion of growth hormone and circulating levels of insulin-like growth factor 1 decrease with aging [ 7 ] ; these events are called somatopause . Growth hormone is both anabolic and lipolytic [ 8 - 10 ] , and the action of growth hormone on peripheral tissues is mediated , in part , by circulating insulin-like growth factor 1 [ 11 ] . Growth hormone deficiency results in body composition changes that are similar to the changes seen with aging [ 1 , 7 ] . Growth hormone replacement in patients with hypopituitarism and in older men reverses some of the body composition changes associated with both growth hormone deficiency and aging [ 12 - 14 ] . In a study by Rudman and colleagues [ 14 ] on the effects of growth hormone replacement therapy on body composition , the administration of growth hormone to 12 men 61 to 73 years of age for 6 months increased lean body mass by 9 % and decreased adipose tissue mass by 15 % ( P < 0.005 ) . Circulating insulin-like growth factor 1 levels increase similarly in young and old men after exogenous administration of either growth hormone or growth hormone-releasing hormone [ 7 , 11 ] . Therefore , low insulin-like growth factor 1 levels reflect decreased growth hormone secretion rather than a loss of hepatic responsiveness to the hormone . On the basis of these data , it has been proposed that diminished secretion of growth hormone is responsible , in part , for the somatic changes of aging [ 14 ] . Growth hormone replacement has been shown to improve muscle volume , isometric strength , and exercise capacity in young adults with hypopituitarism [ 12 , 13 ] . In one study of growth hormone-deficient young adults treated with growth hormone [ 12 ] , thigh muscle volume increased by 6 % ( P < 0.01 ) , and isometric strength increased by 8 % ( P = 0.08 ) compared with controls . Increases in isometric strength were associated with increases in muscle volume ( r = 0.75 ; P < 0.001 ) . Exercise capacity also increased by 12 % ( P < 0.05 ) . Such data on the effects of growth hormone replacement therapy on strength or function are not available for older persons . To test the hypothesis that the muscle weakness and functional decline associated with aging are in part due to decreased growth hormone secretion , we conducted a 6-month r and omized , controlled , double-blind trial comparing recombinant human growth hormone therapy with placebo in 56 elderly men whose baseline insulin-like growth factor 1 levels were less than the tenth percentile found in younger healthy adults . Methods Participants We recruited healthy , ambulatory , community-dwelling men older than 69 years of age . Because growth hormone secretion is pulsatile and diurnal , a more convenient measure of growth hormone secretion is insulin-like growth factor 1 , which has constant and nonpulsatile plasma levels [ 1 , 7 , 15 , 16 ] . Inclusion criteria included two fasting morning plasma insulin-like growth factor 1 levels ( assayed after plasma was extracted with acid ethanol by the Nichols Institute [ 17 ] ) less than 161 ng/mL that were obtained at least 2 weeks apart , a fasting blood glucose level less than 8.4 mmol/L ( 140 mg/dL ) , stable body weight between 80 % and 120 % of ideal body weight [ 18 ] during the previous year , and a normal complete blood count at baseline . Participants had to be able to follow the study instructions and perform the strength measurements . Exclusion criteria included diseases that might contraindicate the use of growth hormone ( such as carcinoma within the previous 5 years , diabetes mellitus , and the carpal tunnel syndrome ) , uncontrolled hypertension ( blood pressure more than 180/100 mm Hg ) , oral corticosteroid use within the previous year , or a recent change in ambulatory status ( for example , as the result of a stroke ) . Design After the participants gave informed written consent , the following baseline measurements were obtained : question naires ( demographic characteristics and medical conditions ) ; fasting blood chemistry ( levels of electrolytes , urea nitrogen , creatinine , glucose , calcium , phosphate , and albumin ) ; complete blood count ; serum and rogen levels ( total and free testosterone and dehydroepi and rosterone ) ; fasting lipoprotein levels ( total cholesterol , high-density lipoprotein cholesterol , low-density lipoprotein cholesterol , and triglycerides ) and thyroid-stimulating hormone and free thyroxine levels ; 24-hour urinary calcium excretion ; and creatinine clearance . At baseline , we also measured the body composition , strength , and functional ability of all participants . We then used a computer-generated r and omization table to assign each participant to receive either growth hormone or placebo . Participants , investigators who had contact with the participants , and laboratory personnel were blinded to treatment status . Treatment consisted of recombinant human growth hormone ( somatropin [ Nutropin , Genentech ] ) , 0.03 mg/kg of body weight , or an equivalent placebo volume ( supplied in identical vials by Genentech ) injected subcutaneously three times per week in the morning for 6 months . We evaluated the participants after 2 , 4 , 8 , 12 , 18 , and 24 weeks of treatment to determine whether side effects developed and to ensure compliance . Participants were examined and specifically asked about the presence of the following side effects : malaise , fatigue , edema , arthralgias , arthritis , the carpal tunnel syndrome , muscle discomfort , dyspnea , depression , polydipsia , polyuria , nocturia , and tender or enlarged breasts . At each visit , we measured fasting morning plasma insulin-like growth factor 1 levels 48 hours after the last treatment dose and repeated most of the baseline blood and urinary tests . We adjusted the dose of recombinant human growth hormone to maintain serum insulin-like growth factor 1 levels between 190 and 350 ng/mL ( the 25th to 75th percentiles of a young adult population ) 48 hours after a dose . To preserve blinding , each growth hormone recipient was paired with a placebo recipient . An unblinded physician who had not had contact with the participants review ed insulin-like growth factor 1 levels during the trial . If the levels were less than 190 ng/mL or greater than 350 ng/mL , the unblinded physician instructed study personnel to make identical dose adjustments for both participants in the pair . The dose was also decreased in any participant who reported troublesome side effects that were potentially attributable to growth hormone . We repeated all study outcome measurements after 6 months of treatment . We also measured fasting plasma renin activity , cortisol and aldosterone levels , and 24-hour urine aldosterone excretion . The investigational review boards of the University of California , San Francisco , and the Department of Veterans Affairs Medical Center , San Francisco , approved the study protocol . Measurements Body Composition We used dual-energy x-ray absorptiometry ( Lunar DPX-Plus , Madison , Wisconsin ) total-body composition scans to measure lean tissue mass and fat mass , and we used anterior-posterior lumbar scans to measure bone mineral content . We measured skin thickness using ultrasonography with a 10-MHz transducer ( Diasonics , Milpitas , California ) that was positioned transversely 5 cm below the umbilicus . Using the same transducer , we made two ultrasonographic measurements on each participant . The average of the two measurements was used for analysis . The study radiologist , who was blinded to the participants ' treatment status , interpreted all test results . Muscle Strength The study 's physical therapist measured the muscle strength of the participants ' knee flexor and extensor muscles using an isokinetic dynamometer ( Cybex 340 , Lumex , Bay Shore , New York ) . Using a st and ard protocol , we measured peak torque of knee flexion and extension at joint speeds of 90 , 120 , and 180 degrees per second . We measured h and grip strength according to a st and ardized protocol using a grip dynamometer ( Smedley Grip Dynamometer , JA Preston , Jackson , Mississippi ) . The greater of the two measurements was used for analysis . Systemic Endurance To assess systemic endurance , we measured maximal oxygen consumption ( Vo 2 max ) during exercise cycle testing . Upright exercise testing was done using an electronically braked cycle ergometer ( Erich Jaeger , Rockford , Illinois ) . Exercise was initially done unloaded and was then increased by 25 watts every 2 minutes . Participants continued to exercise until they were exhausted or unable to maintain critical pedal frequency ( greater than 50 revolutions per minute ) . During exercise cycle testing , we continuously measured respiratory gas exchange to determine Vo 2 max ( Ergopneumotest , Erich Jaeger ) . Physical Performance The study 's physical therapist used the Physical Performance Test [ 19 ] to assess the participants ' performance on nine physical functions . Participants were asked to write a prescribed sentence , transfer kidney beans using a teaspoon , place a heavy book on a shelf , remove a jacket , pick up a penny from the floor , turn 360 degrees , walk a 50-foot walking test course , and climb stairs to determine speed and the number of flights climbed before the development of fatigue . The test score is based on the time required to complete each task . Higher scores ( the best performance is a maximum score of 36 ) are associated with the shortest time required to complete a task and with better functional status . Cognitive Function and Mood Each participant completed the Trails B Test , the Mini-Mental State Examination , the Digit Symbol Substitution Test , and the Geriatric Depression Scale [ 20 - 23 ] . The Trails B Test ( from the Halstead-Reitan Neuropsychological Test The purpose of this study was to determine the influence of transiently elevated endogenous hormone concentrations during exercise on strength training adaptations . Nine subjects performed four unilateral strength training session per week on the elbow flexors for 11 weeks . During two of the weekly sessions , leg exercises were performed to acutely increase the systemic anabolic hormone concentration immediately before the exercises for one of the elbow flexors ( L + A ) . On the two other weekly training sessions , the contralateral elbow flexors were trained without prior leg exercises ( A ) . By r and omizing one arm of the subjects to serve as a control and the other as experimental , both conditions have the same nutritional and genetic environment . Serum testosterone and growth hormone was significantly increased during the L − A training session , while no hormonal changes occurred in the A session . Both A and L + A increased 1RM in biceps curl , peak power in elbow flexors at 30 and 60 % of 1RM , and muscle volume of the elbow flexors ( p < 0.05 ) . However , only L + A achieved increase in CSA at the part of the arm flexors with largest cross sectional area ( p < 0.001 ) , while no changes occurred in A. L + A had superior relative improvement in 1RM biceps curl and favorable muscle adaptations in elbow flexors compared to A ( p < 0.05 ) . In conclusion , performing leg exercises prior to arm exercises , and thereby increasing the levels of serum testosterone and growth hormone , induced superior strength training adaptations compared to arm training without acute elevation of hormones 1 . In adult humans with growth hormone deficiency , treatment with growth hormone has recently been shown to have major anabolic effects and to improve exercise performance . The cardiovascular effects of growth hormone in adults with growth hormone deficiency were examined in 24 patients treated with recombinant human growth hormone ( 0.07 units/kg at night ) in a double-blind , placebo-controlled trial lasting 6 months . 2 . Compared with placebo , resting M-mode echocardiography showed increases in left ventricular end-diastolic dimension and stroke volume in the group treated with recombinant human growth hormone . No differences were noted between the groups with respect to left ventricular end-systolic dimension , fractional shortening , wall thicknesses or mean arterial blood pressure . Left ventricular myocardial mass increased in the group given recombinant human growth hormone . 3 . The supine plasma renin activity was increased and remained elevated over the 6 months , whereas the plasma aldosterone concentration was unchanged , after treatment with recombinant human growth hormone . Clinical signs of sodium retention were evident during the first 3 months of treatment with recombinant human growth hormone . 4 . We conclude that treatment with recombinant human growth hormone in adults with growth hormone deficiency result ed in small increases in left ventricular pre-load , due to the sodium-retaining action of growth hormone . Activation of the renin-aldosterone system was involved in such changes . Myocardial hypertrophy was observed without changes in mean arterial pressure , reflecting the anabolic action of growth hormone Objectives To study the effects on body composition after 1 month 's administration of supraphysiological doses of growth hormone ( GH ) in healthy , active young adults with normal GH‐IGF‐I axis Adults with hypopituitarism receive therapy that replaces cortisol , thyroid hormone , and gonadal steroids , but growth hormone replacement has typically been reserved for children with growth hormone deficiency . However , several observations suggest that growth hormone may have an important role in maintaining bone density and body composition in adults .  Bone density is reduced in patients with growth hormone deficiency that develops during childhood or adulthood [ 1 - 3 ] . In vitro , growth hormone binds to growth hormone receptors on rat osteoblast-like cells and produces a mitogenic response mediated by local synthesis and action of insulin-like growth factor 1 ( IGF-1 ) [ 4 , 5 ] . Administration of growth hormone to adults with growth hormone deficiency increases serum and urine markers of bone turnover [ 6 - 10 ] . In adults with childhood-onset growth hormone deficiency ( in whom osteopenia probably results from a failure to reach peak bone mass ) , growth hormone therapy increases bone density [ 3 , 8 , 10 , 11 ] . However , the effects of growth hormone replacement on bone density in adult-onset growth hormone deficiency are largely unknown . In addition to having an increased risk for fracture , adults with growth hormone deficiency have an excess risk for cardiovascular-related death that may be attributed to increased central fat mass [ 12 - 17 ] . Growth hormone therapy reduces body fat and increases lean mass in adults with growth hormone deficiency , primarily those in whom the deficiency developed during childhood [ 6 - 9 , 18 - 20 ] . However , previous studies of growth hormone replacement in adults have several important limitations . First , most of these studies used pharmacologic rather than physiologic doses of growth hormone . Second , most have focused on childhood-onset growth hormone deficiency . Third , effects of growth hormone on bone density in patients with adult-onset growth hormone deficiency have not been examined in a controlled study . Because of these limitations , the critical question of whether long-term growth hormone therapy is beneficial in patients with adult-onset growth hormone deficiency has not been definitively answered . We sought to determine whether long-term growth hormone replacement therapy , given at a dose adjusted according to IGF-1 levels , improves bone density , bone turnover , body composition , and several variables associated with quality of life in patients with adult-onset growth hormone deficiency . Methods Patients Thirty-two men ( median age , 51 years ; range , 24 to 62 years ) with a history of pituitary disease were recruited from the Massachusetts General Hospital Neuroendocrine Clinical Center and from surrounding communities . Growth hormone secretion profiles in 23 of these patients have been reported elsewhere [ 21 ] . All patients met the following inclusion criteria : 1 ) normal growth and development , 2 ) benign sellar neoplasm , pituitary apoplexy , or idiopathic hypopituitarism diagnosed after age 18 years , and 3 ) peak serum growth hormone levels less than 5 mg/L after receipt of two pharmacologic stimuli on separate mornings . The 13 patients younger than 50 years of age received intravenous insulin , 0.1 U/kg of body weight , and oral clonidine , 0.15 mg . The 18 patients 50 years of age or older received oral clonidine , 0.15 mg , and intravenous arginine , 30 g ; these patients were given arginine rather than insulin to avoid potential cardiovascular complications of hypoglycemia . Patients were excluded if they had a history of acromegaly or diabetes mellitus ; were taking drugs ( such as phenytoin or etidronate ) known to affect bone density ; were not receiving st and ard thyroid or adrenal hormone replacement therapy  if the patient was deficient in those hormones ; or had begun receiving adrenal , gonadal , or thyroid hormone replacement therapy within 6 months before study enrollment . Growth hormone deficiency was caused by a clinical ly nonfunctioning pituitary adenoma in 12 patients , prolactinoma in 9 patients , craniopharyngioma in 9 patients , pituitary apoplexy in 4 patients , Cushing disease in 1 patient , and adult-onset idiopathic hypopituitarism in 1 patient . Twenty-one patients were deficient in adrenocorticotropin , thyroid-stimulating hormone , and gonadotropins .  Five patients had two of these deficiencies , 5 patients had one , and 1 patient had none . Twenty-five patients were treated surgically ( 16 of the 25 were also treated with radiation or bromocriptine , or both ) . Five patients received bromocriptine with or without radiation therapy , and 2 were treated with hormonal replacement only . The Subcommittee on Human Studies of the Massachusetts General Hospital approved the study , and all patients gave written informed consent . Protocol Patients were r and omly assigned to receive recombinant human growth hormone ( Nutropin , Genentech , Inc. , South San Francisco , California ) at a daily dose of 10 g/kg subcutaneously or a placebo . The computerized r and omization , done by statisticians at Genentech , Inc. , stratified patients to assure balance between the groups with respect to age . Staff at Genentech , Inc. , informed the primary investigator of treatment assignment by telephone ; the study physician kept the information in a private computer data base . Only the study physician was aware of the treatment assignment . Patients were admitted to the General Clinical Research Center for measurements of bone mineral density of the lumbar spine , femoral neck , and proximal radius . Body mass index , lean body mass , and percentage of body fat were also measured . Patients had echocardiography and were tested for strength and exercise capacity . Urine was collected for 24 hours for measurement of pyridinoline , deoxypyridinoline , calcium , and creatinine excretion . Fasting blood sample s were drawn at 0900 hours for measurement of IGF-1 , glucose , insulin , lipids , and hemoglobin A1c values . Patients returned at 1 week , 1 month , and 3 months for outpatient measurement of serum IGF-1 , glucose , insulin , lipid ( at 1 and 3 months ) , and hemoglobin A1c ( at 3 months only ) values . Patients were readmitted at 6 , 12 , and 18 months so that the baseline evaluation could be repeated . Echocardiography and tests of strength and exercise capacity were repeated only at the 18-month visit . The growth hormone dose was reduced by 25 % if the patient 's serum IGF-1 level was found to be elevated at the 6- or 12-month visit ; serum IGF-1 levels were remeasured approximately 1 month after the dose was decreased . The dose was further adjusted if necessary . To maintain patient blinding , each placebo recipient was asked to reduce his dose by 25 % during the first 6 months of the study . Bone Density Bone mineral density of the lumbar spine , femoral neck , radius , and total body was determined by dual-energy x-ray absorptiometry ( Hologic QDR-2000 , Waltham , Massachusetts ) . Density of the nondominant radius was measured at the junction of the proximal two thirds and the distal one third of the radial shaft ; the coefficient of variation for this measurement is 1.5 % [ 22 ] . The bone mineral density of the lumbar spine was assessed in the anteroposterior projection in all patients and in the lateral projection in the 22 patients whose body thickness did not exceed the manufacturer 's specified limit for the lateral measurement . Because lateral measurements of bone density in the spine eliminate the contribution of the posterior vertebral elements , they estimate trabecular bone mass better than do measurements made in the anteroposterior projection [ 23 ] . In 50 persons with paired measurements , the SDs for the anteroposterior and lateral measurements were 0.010 g/cm2 and 0.013 g/cm2 , respectively ; these values did not vary with bone density . The coefficient of variation for bone density at the femoral neck was 2.1 % in 51 persons with paired measurements [ 24 ] . All scans were review ed by one physician who did not know the patients ' treatment assignment . Follow-up scans were matched to baseline scans to ensure that identical bone regions were measured . Body Composition A research dietitian determined body mass index . Lean body mass and percentage of body fat were measured by dual-energy x-ray absorptiometry ( Hologic QDR-2000 ) . According to the manufacturer , the coefficient of variation is 1.0 % for lean mass and 1.5 % for percentage of body fat . This compares favorably with the coefficients of variation of other techniques for determining body composition , such as bioelectrical impedance ( 5 % ) , 40 K counting ( 3 % ) , and deuterium oxide dilation ( 3 % ) [ 25 ] . Biochemical Assays Serum IGF-1 levels were measured by radioimmunoassay after acid-alcohol extraction ( Nichols Institute , San Juan Capistrano , California ) . The ageadjusted normal ranges for this assay were 83.3 to 378.0 mg/L for men 20 to 40 years of age and 54.0 to 328.5 mg/L for men older than 40 years of age . Interassay coefficients of variation were 5.2 % at 121.5 mg/L and 15.2 % at 84.5 mg/L. Serum osteocalcin levels were measured by immunoradiometric assay ( SmithKline Beecham , Van Nuys , California ) . The intra-assay coefficients of variation were 11.5 % for low control serum pools ( 3 to 6 mg/L ) , 11.6 % for medium pools ( 6 to 10 mg/L ) , and 10.6 % for high pools ( 25 to 35 mg/L ) . Urinary excretion of total pyridinoline and deoxypyridinoline was measured using high-performance liquid chromatography ( SmithKline Beecham ) . The intra-assay coefficients of variation for measurement of pyridinoline levels were 9.5 % at 13.8 nmol/mmol of creatinine , 9.6 % at 37.0 nmol/mmol of creatinine , and 10.7 % at 47.5 nmol/mmol of creatinine . The intra-assay coefficients of variation for measurement of deoxypyridinoline excretion were 15.8 % at 3.2 nmol/mmol of creatinine , 13.5 % at 6.7 nmol/mmol of creatinine , and 9.8 % at 10.7 nmol/mmol of creatinine . Other assays were done at the Massachusetts General Hospital as described elsewhere [ 26 ] . Echocardiography Transthoracic two-dimensional echocardiography was done while patients were in the left lateral decubitus We examined the effects of GH and /or testosterone ( T ) administration on body composition , performance , mood , sexual function , bone turnover , and muscle-gene expression in healthy older men . Ten men [ mean ( SEM ) age , 68 ( 2.5 ) yr ; height , 171.5 ( 2.4 ) cm ; and weight , 80 ( 3.0 ) kg ] completed each of the following 1-month , double-blind interventions after a baseline ( B ) study in r and omized order with an intervening 3-month washout : transdermal T patch ( 5.0 mg/daily ) ; recombinant human GH ( 6.25 micro g/kg sc daily ) ; and combined hormones ( GHT ) . ANOVA with repeated measures was used to evaluate interventional effects . Integrated serum GH concentrations [ mean ( SEM ) ] were elevated comparably by GH and GHT : [ B = 363 ( 55 ) , GH = 1107 ( 120 ) , T = 459 ( 131 ) , and GHT = 1189 ( 46 ) micro g/liter.min ; P < 0.0001 ] . Serum IGF-I concentrations also increased commensurately after GH and GHT : [ B = 168 ( 14 ) , GH = 285 ( 16 ) , T = 192 ( 25 ) , and GHT = 294 ( 25 ) micro g/liter ; P < 0.0001 ] . GHT administration increased total estradiol : [ B = 110 ( 20 ) , GH = 106 ( 13 ) , T = 129 ( 13 ) , and GHT = 153 ( 17 ) pmol/liter ; P < 0.02 ] , and both T and GHT elevated free T : [ B = 12 ( 2.1 ) , GH = 11 ( 1.5 ) , T = 22 ( 2.8 ) , and GHT = 24 ( 2.5 ) pg/ml ; P < 0.0001 ] . No significant changes occurred in strength , flexibility , percentage body fat , or sexual function and mood . However , fat-free mass increased under combined GHT exposure : [ B = 55 ( 1.3 ) , GH = 56 ( 1.1 ) , T = 55 ( 1.5 ) , GHT = 57 ( 1.7 ) kg ; P < 0.03 ] . Balance improved in response to GH intervention ( P < 0.05 ) , as did 30-m walk time during T and GHT interventions [ B = 6.6 ( 0.3 ) , GH = 6.2 ( 0.7 ) , T = 5.9 ( 0.3 ) , GHT = 5.5 ( 0.3 ) sec ; P = 0.04 ] and stair climb time for all three interventions [ B = 32.2 ( 1.4 ) , GH = 29.8 ( 1.2 ) , T = 30.5 ( 1.4 ) , and GHT = 29.9 ( 1.2 ) sec ( P = 0.0034 ) , wherein the effects of GH , T , and GHT were different from that of B ] . Muscle IGF-I gene expression increased by 1.9-fold during GH administration and by 2.3-fold during GHT administration ( P < 0.05 , compared with B ) . Myostatin and and rogen receptor gene expression were not affected . Serum osteocalcin increased in response to the GH and GHT interventions : [ B = 4.8 ( 0.52 ) , GH = 5.7 ( 0.54 ) , T = 4.7 ( 0.33 ) , and GHT = 5.5 ( 0.39 ) ; P < 0.009 ] . There were no significant adverse events during 30 patient-months of intervention . We conclude that 1 month of GH and /or T administration improves certain measures of balance and physical performance in older men and increases muscle IGF-I gene expression OBJECTIVES To determine whether six days recombinant human growth hormone ( rhGH ) in an abstinent anabolic- and rogenic steroid ( AAS ) group had any cardiovascular and biochemical effects compared with a control group . METHODS Male subjects ( n=48 ) were r and omly divided , using a single blind procedure into two groups : ( 1 )  control group ( C ) n=24 , mean+/-SD , age 32+/-11 years ; height 1.8+/-0.06 m ; ( 2 ) rhGH using group ( 0.058IUkg(-1)day(-1 ) ) ( GH ) n=24 , mean+/-SD , age 32+/-9 years ; height 1.8+/-0.07 m . Physiological responses , anthropometry , arterial pulse wave velocity ( APWV ) , blood pressure ( BP ) , heart rate ( HR ) , peak oxygen uptake ( VO(2 ) peak ) and biochemical indices were investigated . RESULTS Body mass index , fat-free mass index and VO(2 ) peak significantly increased while body fat significantly decreased within GH ( all P<0.017 ) . Insulin like growth factor-I significantly increased within GH ( P<0.017 ) and compared with C ( P<0.05 ) . Serum sodium significantly increased ( P<0.017 ) and serum homocysteine , high sensitivity C-reactive protein , thyroid stimulating hormone and tetra-iodothyronine ( T(4 ) ) , significantly decreased within GH ( all P<0.017 ) . T(4 ) significantly decreased compared with C ( P<0.05 ) . Arterial pulse wave velocity , peak and recovery systolic and diastolic BP , significantly decreased compared with C ( P<0.05 ) . Resting HR and rate pressure product ( RPP ) significantly increased compared with C ( P<0.05 ) . CONCLUSION The findings of this study suggest that short term use of rhGH may have beneficial effects on endothelial function and specific inflammatory markers of cardiovascular disease in abstinent AAS users , but may have an adverse effect on the cardiovascular system , as evidence d by the increase in resting RPP ABSTRACT The purpose of the investigation was to determine the effects of administering an anabolic steroid to weight lifters of limited experience on strength , body composition , and endurance .  Twenty-eight healthy males were assigned to matched treatment or control groups based upon lean body The purpose of this study was to determine whether growth hormone ( GH ) administration enhances the muscle anabolism associated with heavy-resistance exercise . Sixteen men ( 21 - 34 yr ) were assigned r and omly to a resistance training plus GH group ( n = 7 ) or to a resistance training plus placebo group ( n = 9 ) . For 12 wk , both groups trained all major muscle groups in an identical fashion while receiving 40 micrograms recombinant human GH.kg-1.day-1 or placebo . Fat-free mass ( FFM ) and total body water increased ( P less than 0.05 ) in both groups but more ( P less than 0.01 ) in the GH recipients . Whole body protein synthesis rate increased more ( P less than 0.03 ) , and whole body protein balance was greater ( P = 0.01 ) in the GH-treated group , but quadriceps muscle protein synthesis rate , torso and limb circumferences , and muscle strength did not increase more in the GH-treated group . In the young men studied , resistance exercise with or without GH result ed in similar increments in muscle size , strength , and muscle protein synthesis , indicating that 1 ) the larger increase in FFM with GH treatment was probably due to an increase in lean tissue other than skeletal muscle and 2 ) resistance training supplemented with GH did not further enhance muscle anabolism and function
RESULTS Body cell mass was correlated with all measures of performance at baseline .
Growth hormone significantly reduced fat mass , increased lean body mass through an increase in extracellular water , and increased body cell mass in men when coadministered with testosterone .
Growth hormone supplementation influenced body composition and increased sprint capacity when administered alone and in combination with testosterone .
BACKGROUND Growth hormone is widely abused by athletes , frequently with and rogenic steroids .
Its effects on performance are unclear .
OBJECTIVE To determine the effect of growth hormone alone or with testosterone on body composition and measures of performance .