„The medicalization of old age is slowly entering the endocrine clinic and life-style medication for the affluent adult is about to enter the mainstream of endocrinology“. Intriguing new findings: Single gene mutations have been identified that lead to increased longevity. A highly conserved regulatory system for aging exists. Increased longevity of hypopituitary dwarf mice and GH resistant knockout mice appears to be in contrast with observations made in clinical practice. In humans, patients with a PROP-1 gene mutation can survive to a very advanced age, apparently longer than normal individuals in the same population. These findings may challenge the importance of GH as antiaging drug, and the notion that GH deficiency may shorten life span. On the other hand, reduced longevity in untreated patients with congenital isolated GH deficiency (GH-1 gene deletion) suggests that the lack of GH might have an impact on aging. Four retrospective studies and one prospective have all confirmed increased mortality in patients with hypopituitarism compared with age-matched controls, but the exact cause remains unclear due to the existence of limiting factors. There are no data whether or not GH replacement will prolong life expectancy. Somatopause and GH deficiency in elderly: Against a background of declining GH secretion and serum IGF-I with aging, clinical syndrome of GHD translates into profound changes in body composition and function. The GH Research Society consensus statement on the diagnosis of GHD, however, states that in adults, hypothalamic-pituitary disease must be present before the diagnosis of GHD can be considered. GH secretion in the patients with hypothalamo-pituitary disease is only 12%of that observed in the controls. Thus these patients can be distinguished from hyposomatotropism of ageing. Some studies (but not all) have reported rather convincing positive effects of GH replacement. GH replacement in elderly patients with organic GHD should be included in clinical consideration particularly when designing the individual replacement therapy. Changes in the functional activity of GHRH and somatostatin synthesizing neurons in the hypothalamus play a role in the age-related GH hyposecretion. In the last 10 years the unnatural growth hormone secretagogues (GHS) with the isolation of the endogenous ligand for the GHS-receptor, ghrelin, demonstrate the existence of a third physiologic system of GH regulation and raise the issue of the GHS/ghrelin function in aging. Very old subjects after combined, acute administration of saturating doses of GHRH and GHS, show GH response to be age-independent and fully preserved. Recently orally active GHS in healthy older men showed sustained GH increase for 2 yr. Overall these findings suggest that in aged individuals GH secretion may be restored by pharmacological means, based on the ability of GHSs to correct the attenuated GH pulsatility. The notion of „disease“ is a slippery one and health is equally impossible to define: Recent research efforts have focused on identifying mediators of debilitating processes or markers of poor health. Clinical studies linking catabolic cytokines, circulating levels of IGF-I, sarcopenia with mortality in very old community-dwelling men and women has shown that greater production of catabolic cytokines and reduced IGF-I levels are associated with increased mortality. In the Rotterdam study an association between a polymorphism of the IGF-I gene and total IGF-I serum levels, birthweight, body height and the risk for developing diabetes and cardiovascular diseases later on in life, has been found. Only homozygous carriers of the polymorphism of the IGF-I gene had an age-related and GH-dependent decline in circulating total IGF-I levels. Further research efforts should focus on identifying groups of patients in whom the risk of adverse effects is outweighed by the benefits achieved from GH treatment particularly in the elderly.