Idiopathic Growth Hormone Deficiency in Adults, Ben Johnson and the Somatopause

Abstract

In his update on the syndrome of adult GH deficiency in this issue of the JCEM, Melmed (1) draws attention to the growing number of people being diagnosed with “idiopathic GH deficiency in adults.” He also states that “the propensity by some practitioners for inappropriate IAGHD (idiopathic adult-onset GH deficiency) diagnosis as a prelude to administering unsafe nonapproved GH supplementation for athletes or for the frail elderly underscores the need for a stringent diagnostic approach”— thus implying that the increase in idiopathic adult-onset GH deficiency diagnosis, typified by that seen in the HYPOCCS postmarketing surveillance database that he quotes (2), is because fellow practitioners are overdiagnosing the condition in order to legitimize undesirable practice. These are strong words. Although few doctors would prescribe GH (recombinant human GH [rhGH]) as a performance-enhancing drug for an athlete, few of us would not prescribe a trial of therapy in someone we believed to be suffering from GH deficiency and appearing to have ill health as a consequence. Let us not forget that in the early days of the use of rhGH in adults, there was considerable skepticism and some frank hostility to this from some established endocrinologists. It is difficult to distinguish the GH deficiency in older people from the GH deficiency secondary to pituitary or hypothalamic damage. There is a clear rationale for prescribing a trial of rhGH for prevention and/or treatment of frailty in suitable patients (3–5). Let us put this in context: athletes and their coaches were the first to discover the powerful anabolic actions of GH in adults (6, 7). GH was given a glowing write-up by the California “doping guru” Daniel Duchaine in “The Underground Steroid Handbook” (6); in 1982, he wrote: “We find that GH is the most expensive, most fashionable, and least understood of the new athletic drugs. It has firmly established itself in power-lifting and within a few years will be a commonly used drug in all strength athletics.” Thus, human GH was established as a drug of abuse in sport some 7 years before the results of the first 2 randomized controlled trials confirming its powerful anabolic actions in humans were published in the bona fide medical literature (8, 9). A year earlier, the sprinter Ben Johnson won a gold medal at the Olympic Games in Seoul, only to lose it 3 days later when his urine test confirmed that he had been taking the anabolic steroid stanozol; he subsequently admitted under oath that at the time he was also taking GH. These performance-enhancing effects of GH have now been confirmed using randomized controlled trials—first in abstinent, previously steroid-dependent athletes by Graham et al (10); and, together with sex steroids in young athletes, by Meinhardt et al (11), 29 years after Duchaine’s first publication. I use these anecdotes to illustrate that it is not always the scientists who make the discoveries; sometimes, like the athletes, it is the people who are most likely to benefit and who are always hungry for an effective new therapy. If they find such a substance, try it, and find that it works, then the word spreads and later we, as clinician scientists, come along and discover it “officially.” Athletic competition is so strong and the rewards are so great that new ways of improving performance are constantly being sought. The intelligent athletes and their coaches are constantly using the “trial of one” paradigm (12) to test new training regimes, diets, supplements, and substances. Athletes know their best performance for a given event to a