© Dr.

Thierry
Information Hertoghe General
Classification:
 © Dr. Thierry
Information Hertoghe General
Classification:
Thierry Hertoghe, MD
 Growth hormone treatment for adults

© Dr. Thierry
Information Hertoghe General
Classification:
 GH treatment for adults

= Efficient

= Safe

= Legal
Supported by:
• Partially reverses aging
abundant,
• Reduces the cardiovascular risk and reverses cardiovascular disease solid &
updated
• Reduces the cancer risk scientific data

• Increases human longevity

© Dr. Thierry
Information Hertoghe General
Classification:
 © Dr. Thierry
Information Hertoghe General
Classification:
 GH article in 1996 (Anti-aging Medical Therapeutics)

© Dr. Thierry
Information Hertoghe General
Classification:
 => What are GH’s beneficial effects?
© Dr. Thierry
Information Hertoghe General
Classification:
 Hormone of the leader:
big boss or spiritual master Freshness

Power
Deep sleep

GH
=> Mind

Inner peace,
Insight, spirituality
see priorities
© Dr. Thierry
Information Hertoghe General
Classification:
 GH => Body

Younger body,
 fat mass,  muscle
mass & body water
 skin elasticity

Relaxed
body & breathing
Power

Low fat mass  Age-related diseases:

including
 Obesity, & diabetes
 Osteoporosis
 Atherosclerosis, etc.

© Dr. Thierry
Information Hertoghe General
Classification:
 Growth hormone treatment with IGF-1 => Reverse aging

GH treatment = most potent hormone therapy to reduce/reverse aging

Older Younger

GH =>  Firmness

© Dr. Thierry
Information Hertoghe General
Classification:
 => Production
© Dr. Thierry
Information Hertoghe General
Classification:
 GH production

Pituitary gland

produces growth hormone

Daily production
(healthy adult)

 0.35 mg/24 h

© Dr. Thierry
Information Hertoghe General
Classification:
 GH secretion => During day & night in men & women
Young woman Young man
Men

L = large GH pulses
Daytime S = small GH pulses
GH pullses

In contrast to the men, ± 70% of the GH pulses during sleep

GH pulses occur predominantly during daytime coincide with slow-wave sleep.
contributing to the greater part The GH pulse is generally = largest & often
of the 24-h release of GH. the only pulse observed over a 24-h period.

Takahashi Y, Kipnis DM, et al. 1968;47:2079–90; Miller JD, Esparza A, Wright NM, et al. 1993;76:1058–62
© Dr. Thierry
Information Hertoghe General
Classification: Costin G, Kaufman FR, Brasel JA. 1989;115:537–44;Ho KY, Evans WS, Samojlik E, et al. 1987;64:51–8
 GH deficiency

After age 30 => Gradual  GH levels

• Progressive  GH deficiency complaints, physical signs

• Progressive  Disease

© Dr. Thierry
Information Hertoghe General
Classification:
 => Many beneficial effects through IGF-1
© Dr. Thierry
Information Hertoghe General
Classification:
 GH & IGF-1 productions

Pitutary gland

GH

Many beneficial effects

through IGF-1
Liver

IGF-1

© Dr. Thierry
Information Hertoghe General
Classification:
 GH treatment => in one month =>  Serm IGF-1 plateau
Young GH-deficient adults
GH
treatment After 1 month: plateau
Serum
at the same dose
IGF-1
350
GH
300
250
200
150 Placebo
100
50
0
0 1 3 6
Months
© Dr. Thierry
Information Hertoghe General
Classification:
 © Dr. Thierry
Information Hertoghe General
Classification:
 Adult growth hormone deficiency => Diagnosis
Adult growth hormone deficiency Diagnosis is based on

Complaints & physical signs

Tests: intermediate information GH therapeutic trial
= final GH effects in target cells = just a passage of GH & IGF-1
to the target cells = final GH effects in target cells

Serum 24h urine

© Dr. Thierry
Information Hertoghe General
Classification:
 ©
© Dr.
Dr. Thierry
Information Hertoghe
Classification:
Thierry Hertoghe,General
2020
 Symptoms
© Dr. Thierry
Information Hertoghe General
Classification:
 GH deficiency => Psychological symptoms
48 adults (aged 27 to 82 yrs)
with  serum IGF-1 Permanent fatigue (73 %)

Easily exhausted after physical activity (89%)

(89,6 %)

Low resistance to staying up after midnight (83%)

(83,3 %)

© Dr. Thierry
Information Hertoghe General
Classification: Hertoghe T. Anti-aging Med Ther. 1997; 1:10-28
 CFS =>  GH & IGF-1

20 Adults with chronic fatigue syndrome Chronic fatigue syndrome

(7 men, 13 women; 30-60 yrs)

vs healthy controls

• - 48%  Nocturnal GH secretion

(62.7 vs 32.4 µg/L/15 min. ; p = 0.06)

• -0.72 SD  Serum IGF-1 from the mean of healthy controls

(-0.39 vs + 0.33, p < 0.02)

© Dr. Thierry
Information Hertoghe General
Classification: Berwaerts J, et al. Growth Horm IGF Res 1998 Apr;8 Suppl B:127-9
 GH deficiency => Psychological symptoms

Anxiety (71 %)

Excessive emotions (73 %)

Dramatizing

Sharp verbal retorts (65 %)

© Dr. Thierry
Information Hertoghe General
Classification:
Hertoghe T. Anti-aging Med Ther. 1997; 1:10-28
 GH deficiency symptoms

from

© Dr. Thierry
Information Hertoghe General
Classification:
 © Dr. Thierry
Information Hertoghe General
Classification:
 Adulthood => Physical signs
© Dr. Thierry
Information Hertoghe General
Classification:
 Adult growth hormone deficiency
Adult onset
Normal GH deficiency

© Dr. Thierry
Information Hertoghe General
Classification:
 Adult growth hormone deficiency

Shoulder muscle atrophy (52 %) Pseudo-

gynaecomastia

Abdominal obesity
Buttock muscle atrophy (52 %)

Droopy abdomen (85 %)

Thigh muscle atrophy

Fatty cushions above

the knees

Penis & testicle atrophy

© Dr. Thierry
Information Hertoghe General
Classification:
 Adult growth hormone deficiency

Thinning of hair (atrophy)

Deep wrinkles (wrinkling)

Sagging cheeks (ptosis)

© Dr. Thierry
Information Hertoghe General
Classification:
 Adult GH deficiency

Eyebrow thinning

Droopy eyelids

© Dr. Thierry
Information Hertoghe General
Classification:
 Adult GH deficiency

Face: less firm & flat hair

GH treatment

© Dr. Thierry
Information Hertoghe General
Classification:
 Adult IGF-1 or GH deficiency

Bowed & tensed back

© Dr. Thierry
Information Hertoghe General
Classification:
 IGF-1 or GH deficiency

« Draperies »

Droopy
muscles

‘Draperies’

© Dr. Thierry
Information Hertoghe General
Classification:
 Adult GH deficiency

Fat accumulation on the back

© Dr. Thierry
Information Hertoghe General
Classification:
 Adult GH deficiency

Atrophic hand palm

© Dr. Thierry
Information Hertoghe General
Classification:
 Growth hormone deficiency

Longitudinal lines on nails

© Dr. Thierry
Information Hertoghe General
Classification:
 Adult GH deficiency

Abdominal fat

Droopy abdomen

© Dr. Thierry
Information Hertoghe General
Classification:
 GH & IGF-1 deficiencies ++

Thin skin

© Dr. Thierry
Information Hertoghe General
Classification:
 © Dr. Thierry
Information Hertoghe General
Classification:
 Serum IGF-1 & IGFBP-3 = Main tests
© Dr. Thierry
Information Hertoghe General
Classification:
 Lab tests => Growth hormone & IGF-1

Serum IGF-1 LOW (below the lower limit)

to LOW-NORMAL
IGFBP-3
(within the reference range)

 Suggests:
GROWTH HORMONE & IGF-1
DEFICIENCIES

24-hour
Growth hormone
urine
© Dr. Thierry
Information Hertoghe General
Classification:
 Serum IGF-1 test

Serum IGF-1 level

= more stable measurement of the growth hormone activity than serum GH

but IGF-1 must preferably be measured with RIA (radioimunoassay),

not chemoluminescence test

© Dr. Thierry
Information Hertoghe General
Classification:
 Serum IGF-1/IGF-BP-3 ratio

What really matters is the amount of bioavailable serum

IGF-1, not the serum IGF-1 test alone

Reflected by the ratio

serum IGF-1 = approximately 1:10 to 1/ 20 in µg/L

serum IGF-BP-3

© Dr. Thierry
Information Hertoghe General
Classification:
 The optimal serum IGF-1

for older adults

© Dr. Thierry
Information Hertoghe General
Classification:
 Optimal serum IGF-1 for older adults => Serum IGF-1 of young adults

The optimal serum IGF-1 for older adults

= ± same as the optimal serum IGF-1 they had as young adults

as their body is still of ± same size & volume as when they were young
& apparently needs the same amounts of GH & IGF-1 to remain healthy.

© Dr. Thierry
Information Hertoghe General
Classification:
 Each patient needs

=> Personalized optimal serum IGF-1(-IGF-BP-3)

© Dr. Thierry
Information Hertoghe General
Classification:
 Taller men => Need a optimal serum IGF-1
Small & poorly muscled adults Tall & athletic-build adults
Average adults

need an average
serum IGF-1

need a  than average need a  than average

serum IGF-1
© Dr. Thierry
Information Hertoghe General
Classification:
serum IGF-1
 Taller older men =>  Serum IGF-1
400 Serum IGF-1 +86 % (1m90 vs 1m65)
(µg/l) Each + 13 %  serum IGF-1
Serum
IGF-1
300
(µg/dL)

153 older men

(51 men with prostate
cancer, 50 men with benign 200
prostatic hyperplasia, & 52
apparently healthy older predicted a + 5 cm  height
men (controls)) (sign. positive association)
100
165 170 175 180 185 190 cm

© Dr. Thierry
Information Hertoghe General
Classification:
Signorello LB, et al. Eur J Cancer Prev. 2000 Jun;9(3):173-8
 Women =>  Optimal serum IGF-1

Men Women

have on the average a

 serum IGF-1, as

• they are often smaller

height than men
• have less
testosterone
(to potentialize the
effects of GH on
serum IGF-1
production) than men

© Dr. Thierry
Information Hertoghe General
Classification:
 At the same dose of GH => Women => Less  serum IGF-1 than men

Men
Mean (±SEM) rhGH responsivity in

GH-deficient men & women during GH treatment

Women

© Dr. Thierry
Information Hertoghe General
Classification:
Span JP, Pieters GF, Sweep CG, et al. 2000 Mar;85(3):1121-5.
 => How to interpret ?
© Dr. Thierry
Information Hertoghe General
Classification:
 Only below the reference range?

Good news! Your test

Your test indicates that you are in the
lower quarter/third/half of the normal range
indicates that you’re
for serum IGF-1 & thus have
an intermediate degree of GH deficiency
in the normal range!

This explains your fatigue,

low mood, overweight, …

© Dr. Thierry
Information Hertoghe General
Classification:
 Many
IGF-1/GH deficits

with lab tests within the reference range

© Dr. Thierry
Information Hertoghe General
Classification:
 Medical research shows

Many GH & IGF-1 deficiencies

at serum IGF-1 levels
within the reference range! of young .. & old adults!

© Dr. Thierry
Information Hertoghe General
Classification: j
 Premature aging
Inverse associations: 0-220?:  Biological age,  premature aging in normal adults and adults with disease
Stojanovic M 2021, Koca TT 2020, Chen LY 2018, Chin KY 2014, Jakobsdóttir S, 2010, Barbieri M 2009

0-205 µg/L = 0-26.8 nmol/L:  Leukocyte telomere length in older adults  65 years
Kaplan RC 2009; also: Movérare-Skrtic S 2009,;in young and older adults Barbieri M 2009

0-114 = 0-14.9 nmol/L Facial aging, skin wrinkling in normal persons Noordam R 2013

Mortality
0-164 = 0- 21.5 nmol/L :  All-cause & breast cancer mortality in women with invasive breast cancer Zhu Y 2020

0-140 = 0- 18.3 nmol/L :  All-cause mortality in patients with liver cancer (meta-analysis) Wang J 2017
Serum IGF-1
0-131= 0- 17.1 nmol/L :  Covid mortality, in adults with Covid-19 infection Fan X 2021
of young adults
Inverse associations: 0-100?:  All-cause mortality in very old adults Roubenoff R 2003; in adults with chronic heart (21-25 years):
failure Petretta M 2007; in adults with stroke Denti L 2004; in adults with liver cancer Elmashad N 2015, etc. 11.1- 45.8 nmol/L
0-79 = 0- 10.3 nmol/L:  All-cause mortality in kidney failure patients Nilsson E 2016 = 80-350 µg/L

0- 66 = 8.6 nmol/L:  Mortality in adults with kidney cancer Rasmuson T 2004

Lower limit Mean

Upper limit

0 5 10 15 20 25 30 35 40 45 50 55
nmol/L
0 © Dr. Thierry
Information 50
Hertoghe General
Classification: 100 150 200 250 300 350 400 µg/L
 Mood
0-190 µg/L = 0-19.6 nmol/L:  Anxiety in adults with chronic insomnia Zhang Y 2023

0-97 = 0-12.7 nmol/L:  Postpartum depression in pregnant women Adachi S 2021

0-84.2 = 0- 11.0 nmol/L:  Depressive symptoms in older adults Chigogora S 2016

Sleep
0-190 µg/L = 0-19.6 nmol/L:  Chronic sleep disorder in adults with chronic insomnia Zhang Y 2023

Inverse association: 0-150= 0-19.6 nmol/L? :  Obstructive sleep apnea in adults (meta-analysis of 34 studies) He J 2023

Sexuality
0-114.5 = 0-15.0nmol/L:  Erectile dysfunction in men Otunctemur A 2015 2018
Serum IGF-1
Memory of young adults
0-180 = 0-23.5 nmol/L:  Worse Parkinson’s disease, atrophy of brain structures in Parkinson's disease adults Shi X 2022 (21-25 years):
11.1- 45.8 nmol/L
0-121 = 0-15.8 nmol/L:  Cognitive dysfunction &  fatigue in healthy and multiple sclerosis adults Nageeb RS 2018
= 80-350 µg/L
0-112 = 0-14.6nmol/L:  Brain atrophy ( hippocampal volume) in adults with cognitive impairment Horvath A 2022

0-98 = 0-12.8 nmol/L :  Cognitive dysfunction in Parkinson's disease adults Picillo M 2017
Lower limit Mean Upper limit

0 5 10 15 20 25 30 35 40 45 50 55
nmol/L
0 © Dr. Thierry
Information 50
Hertoghe General
Classification: 100 150 200 250 300 350 400 µg/L
 Fitness
0-121 = 0-15.8 nmol/L:  Fatigue in healthy and multiple sclerosis adults Nageeb RS 2017

Lowest quartile:  Fatigue in adults with fibromyalgia Bjersing JL 2013

Lowest quartile:  Fatigue in children with irritable bowel Lucia Casadonte CJ 201

Functional capacity Health

Inverse association:  Performance in strength-power training & endurance in athletic adults Santos PA 2023

0-190 µg/L = 0-19.6 nmol/L:  Lung function in adults with asthma Han YY 2021
confirmed by  Lung function in young men aged 25-85 & women > 50 years Gläser S 2009 Serum IGF-1
of young adults
0-120 µg/L = 0-15.7 nmol/L:  Disability in older adults Doi T Y 2016
(21-25 years):
11.1- 45.8 nmol/L
0-70 µg/L = 0-9.2 nmol/L:  Physical unfitness (slow walking speed) in oldest old adults Córdova C 2016 = 80-350 µg/L

Lower limit Mean Upper limit

0 5 10 15 20 25 30 35 40 45 50 55
nmol/L
0
© Dr. Thierry
Information
50
Hertoghe General
Classification:
100 150 200 250 300 350 400 µg/L
 Brain
0-91 = 10- 1.9 nmol/L :  Stroke in older adults aged 72-95 years Saber H 2017

Heart
0-222 µg/L = 29.0 nmol/L  Ischemic heart disease in young and older adults Juul A 2002

0-216 = 0-28.2 nmol/L:  Atherosclerosis (carotid intima media):in metabolically healthy obese adultls Abd El-Hafez H, 2014
Lowest 3 quartiles: 0-190 = 0-24.8 nmol/L::  Arterial hypertension in normal adults aged 30-62 years Hunt K 2006

0-179 = 23.4 nmol/L:  Ischemic heart disease mortality in older men and postmenopausal women Laughlin GA 2004
Inverse associations 0-150= 0-19.6 nmol/L? :
•  Coronary heart disease in adults with acute coronary syndrome Wang W 2023 Serum IGF-1
•  Varicose veins in young and older adults Papier K, 2022 of young adults
•  CRP in adults with metabolic syndrome Efstratiadis G 2006
(21-25 years):
0-140 = 18.3 nmol/L:  Heart failure in older adults Vasan RS 2003 11.1- 45.8 nmol/L
0-136 = 0-17.8 nmol/L :  Arterial hypertension in women aged 30-55 years Zhang L, 2011 = 80-350 µg/L
Inverse associations: 0-125 = 16.3 nmol/L ? :
•  Carotid arterial intima media thickness in older men Van den Beld AW 2003
•  Dyslipidemia,  atherosclerosis,  blood pressure , Angina pectoris or myocardial infarction history in older adults Janssen JA 1998
•  Cardiac function ( left-ventricle ejection fraction) in adults with kidney failure Prelevic V 2020
•  Cardiac arrhythmia in adults older than 55 years Ittermann T 2012
Lower limit Mean Upper limit

0 5 10 15 20 25 30 35 40 45 50 55
© Dr. Thierry Hertoghe General
nmol/L
0 50 100 150 200 250 300 350 400
Information Classification:
µg/L
 Muscles
0-138.5 = 0-18.1 nmol/L:  Sarcopenia in young and older adults aged 18-70 years with rheumatoid arthritis Baker JF A 2015

0-111 = 0-14.5 nmol/L:  Sarcopenia in older adults Bian A 2020

Bones
0-250 = 0-32.7 nmol/L:  Bone strength in anorexia nervosa women Fazeli PK 2020
Health
0-209 = 0-27.3 nmol/L:  Osteoporosis,  bone density in older osteoporosis adults Sun L 2019
Inverse associations 0-140???
•  Vertebral osteoporotic fractures in postmenopausal women (not men) Kanazawa I 2011 Serum IGF-1
•  Non-vertebral osteoporotic fractures in postmenopausal women with type 2 diabetes (not men) Miyake H 2017
of young adults
0-85 = 0-11.1 nmol/L:  Bone fractures & bone density in older adults van Varsseveld NC 2015
(21-25 years):
Inflammation 11.1- 45.8 nmol/L
= 80-350 µg/L
Inverse associations:
•  CRP and  prothromobotic state ( D-dimers,fibrin degradation products) in middle-aged and older adults Harada K 2020
•  CRP in adults with metabolic syndrome Efstratiadis G 2006
•  CRP and  liver fibrosis in adults with nonalcoholic fatty liver disease A Hribal ML 2013
•  Systemic inflammation, malaria parasitemia, intestinal Shigella, Campylobacter, enterovirus infection in very small children Maleta K 2021

0-79 = 10.3 nmol/L  CRP in adults with kidney failure Nilsson E 2016
Mean
Health Upper limit
Lower limit

0 5 10 15 20 25 30 35 40 45 50 55
nmol/L
0Information
© Dr. Thierry
50
Hertoghe General
Classification:
100 150 200 250 300 350 400 µg/L
 Obesity
0-205 µg/L = 0-26.8 nmol/L:  BMI,  Obesity,  weight loss in postmenopausal women Mason C 2013

Inverse associations: 0-170?:  Obesity in older men and women aged 30-64 years Maison P 2007

0-166 = 21.7 nmol/L:  BMI, weight in normal adults Henderson KD 2006

0-106 = 13.9 nmol/L:  Visceral fat mass in normal men Marin P 1993

Diabetes Serum IGF-1

of young adults
0-277 µg/L = 36.2 nmol/L:  Diabetes in type 1 diabetic patients Dills DG 1990 (21-25 years):
11.1- 45.8 nmol/L
Lowest 3 quartiles:  Hyperglycemia in normal adults aged 30-62 years Hunt KJ 2006 = 80-350 µg/L
0-175 = 22.9 nmol/L:  Metabolic X syndrome in middle-aged men with a family history of type 2 diabetes Tong PC 2005

Inverse associations: 0-170 ?:

•  Hyperglycemia in adults with metabolic syndrome Maison P 2007
•  Number of metabolic syndrome features in adults with metabolic syndrome Efstratiadis G, 2006
Lower limit Mean Upper limit

0 5 10 15 20 25 30 35 40 45 50 55
nmol/L
© Dr. Thierry Hertoghe General
0 50 100 150 200 250 300 350 400
Information Classification:
µg/L
 Cancer

Inverse associations:  Lung (only in ever smokers), ovaries, head, neck ,& liver cancers in 412,645 (UK
biobank) normal young and older adults , very small (+3%) positive associations with overall cancer, thyroid,
colorectal, breast, prostate, melanoma, & kidney cancers Qian F 2020

0-251 = 0-32.8 nmol/L:  Malignant melanoma in adults with no history of melanoma Park SL 2011

Serum IGF-1
0-164 = 0- 21.5 nmol/L:  All-cause & breast cancer mortalities, in women with invasive breast cancer Zhu Y 2020
of young adults
(21-25 years):
0-140 = 0- 18.3 nmol/L:  Liver cancer (worse stage, meta-analysis) in patients with liver cancer Wang J 2017 11.1- 45.8 nmol/L
= 80-350 µg/L

Lower limit Mean Upper limit

0 5 10 15 20 25 30 35 40 45 50 55
nmol/L
0© Dr. Thierry
Information 50
Hertoghe General
Classification: 100 150 200 250 300 350 400
µg/L
 => Practical aspects
© Dr. Thierry
Information Hertoghe General
Classification:
 Bio-identical GH

Growth
hormone Bioidentical growth hormone

= chain of 191 amino acids

© Dr. Thierry
Information Hertoghe General
Classification:
 GH => Best product ?

The best treatment

= bioidentical growth hormone

Growth
hormone = chain of 191 amino acids

Not as first choice = GH fragments 176 or 177

= AOD9401 or AOD9604
= short chain of 16 or 17 amino acids of the GH
molecule (from amino acid 176 or 177 to 191)

© Dr. Thierry
Information Hertoghe General
Classification:
 Subcutaneous injections
© Dr. Thierry
Information Hertoghe General
Classification:
 Route of administration ?

Take subcutaneous GH injections

= better than Intramuscular injections

=>  local muscle damage

© Dr. Thierry
Information Hertoghe General
Classification:
 Human growth hormone (hGH)
Pen ? or Syringe?

© Dr. Thierry
Information Hertoghe General
Classification:
 Subcutaneous hGH injections => Prefer the pen

Easiest treatment = pen

=> Growth hormone

Doses: 0.05-0.4 mg/day

NOTE: Be sure there is no

untreated cortisol deficiency

© Dr. Thierry
Information Hertoghe General
Classification:
 subcutaneous
injections

=> How to inject?

© Dr. Thierry
Information Hertoghe General
Classification:
 How to inject GH?

Extend the skin

No skin
pinching

© Dr. Thierry
Information Hertoghe General
Classification:
 subcutaneous
injections

=> Where?
© Dr. Thierry
Information Hertoghe General
Classification:
 Where to inject?
Where to inject?

Abdomen

External sides of the thighs

© Dr. Thierry
Information Hertoghe General
Classification: Regularly change place
 Subcutaneous
injections

=> When?
© Dr. Thierry
Information Hertoghe General
Classification:
 How frequent to inject ?

1 x/day (without interruption)

(possibly 1/3 in the morning
+ 2/3 in the evening)

© Dr. Thierry
Information Hertoghe General
Classification:
 When to inject?

24-hour GH pattern in a healthy 31 year-old man

Serum GH
Inject at
(ng/mL) bedtime Mimicks the natural
GH secretion

Time (hours)

© Dr. Thierry
Information Hertoghe General
Classification:
24h 3h
 Daily injections of GH better
34 GH-deficient adults Starting dose of rGH = 10 µg/kg/day (70 kg: 0.7 mg/day)
(13 W, 12 M; med.age, 39 yr; Daily GH injections
in all => then adjusted to maintain serum IGF-I
range,30-55 yr) 18 patients in the normal age-adj.range
vs 34 healthy
adults
vs 3x/week GH injections
(16 patients)
Sign. disturbed
• Serum lipids After 3 months,:
• Body comp. • Better  Normalization of serum IGF-I (83% of patients in 1x/day inj. vs 44% for 3x/wk inj.)
•  Bone
• Higher  mean serum IGF-1 more (202 vs 155 µg/L for 3x/wk injections; P = 0.001)
density
After 6 months of therapy, in all patients (both groups)
• Normalized & similar serum IGF-I (223 vs. 212 µg/L & remained nl at 1 y
• Sign.  total cholesterol, LDL cholesterol, triglycerides, bioel. impedance, body fat mass
• Sign.  serum HDL cholesterol , bone GLA protein & procollagen III & lean body mass
in both groups of patients, without any difference between them. No further change in
lipid profile and body composition was observed after 12 months of treatment.
Only after 12 months: slight, but sign.,  bone density in both groups (P = 0.0001).
=> Compliance: All patients with 3x/wk had good compliance to the TIW treatment, whereas
5 patients in group taking daily GH had poor compliance to treatment (chi2 = 3.2; P = 0.07).

© Dr. Thierry
Information Hertoghe General
Classification:
Amato G, et al. J Clin Endocrinol Metab. 2000 Oct;85(10):3720-5
 Doses for an adult ?
© Dr. Thierry
Information Hertoghe General
Classification:
 Minimal adult GH doses

Average dose for sufficient mental improvement

= 0.10 mg/day

Average dose for clear physical improvement

 0.15 up to 0.35 -0.75 mg/day

© Dr. Thierry
Information Hertoghe General
Classification:
 GH

1 mg = 3 I.U
0.1 mg = 0.3 I.U

© Dr. Thierry
Information Hertoghe General
Classification:
 Improvements
 Take months & years
(not days)
© Dr. Thierry
Information
to get all beneficial effects
Hertoghe General
Classification:
 GH therapy => Time => For first sign. improvement
Start of GH therapy After 14 days => Earliest significant improvements

FIRST,
after 14 days: body
Body composition 1-5 composition & QoL
Quality of life5-6 sign. improve,
THEN, after 3 months:
Facial signs of GH deficiency7 ( self-reported )
face, chol.,
Serum total & LDL cholesterol8-11 atherosclerosis &
improve,
Premature (carotid) atherosclerosis*12-13
THEN, after 6 months:
Serum trigycerides11, 14 serum triglycerides &
bone density improve1-
Bone mineral density15-17 17

3 months 6 months 9 months 1 year 2 years

* 3 months for sign.  brachial arterial distensibility, 6 months for sign.  intima media thickness
Studies: 1. Ahmad AM, et al. J Clin Endocrinol Metab 2001 Aug;86(8):3499-506 (1 month); 2. Paton NI, et al. AIDS 1999 Jul 9;13(10):1195-202 (2 weeks); 3. Gillberg P, et al. Growth Horm IGF Res
2001 Oct;11(5):273-81 (3 months); 4. Al-Shoumer KA, et al. Eur J Endocrinol 1996 Nov;135(5):559-67 (1 year); 5. Ahmad AM, et al. Clin Endocrinol (Oxf) 2001 Jun;54(6):709-17 (1 month for QoL
& body C); 6. Kozakowski J, et al. Pol Merkuriusz Lek 1999 Mar;6(33):131-4 (12 months); 7. Hertoghe T. Anti-aging Med Ther. 1997; 1:10-28; 8. Davies JS, et al. Clin Endocrinol (Oxf) 2000
Mar;52(3):295-303 (3 months for lipid profile); 9. Webster JM, et al. Atherosclerosis 1997 Aug;133(1):115-21 (6 months for Chol & LDL); 10. Vahl N, et al. Int J Obes Relat Metab Disord 1998
un;22(6):529-36 (1 yr for Chol.); 11. Gotherstrom G, et al. J Clin Endocrinol Metab 2001 Oct;86(10):4657-65 (1 yr for LDL; > 1 year for TG); 12. Pfeifer M, et al. J Clin Endocrinol Metab 1999
Feb;84(2):453-7; 13. Borson-Chazot F, et al. J Clin Endocrinol Metab 1999Apr;84(4):1329-33; 14. Amato G, et al. J Clin Endocrinol Metab 2000 Oct;85(10):3720-5 (Italy) ( 6 months for TG); 15.
© Dr. Thierry
Information Hertoghe Rudman
Classification: General D, et al. N Engl J Med 1990 Jul 5;323(1):1-6 (6 months); 16. Vandeweghe M, et al. Clin Endocrinol (Oxf) 1993 Oct;39(4):409-15 (longer than 3 months) 17. Biller BM, Sesmilo G, Baum
HB, Hayden D, Schoenfeld D, Klibanski A. J Clin Endocrinol Metab 2000 Mar;85(3):970-6
 GH treatment => Partiallly reverses aging

GH treatment

© Dr. Thierry
Information Hertoghe General
Classification:
 Droopy eyelids

Before

GH treatment

in 2-6 months
Droopy eyelids Firmer eyelids

85% of patients
71% of them improved
with low serum IGF-1

© Dr. Thierry
Information Hertoghe General
Classification:
Hertoghe T. Growth hormone therapy in aging adults. Anti-aging Med Ther. 1997; 1:10-28
 GH treatment =>  Sagging cheeks

Adults with GH deficiency

& sagging cheeks

Growth hormone treatment

vs before

76% firmer cheeks

24% no change
= most frequent physical
improvement

© Dr. Thierry
Information Hertoghe General
Classification:
Hertoghe T. Growth hormone therapy in aging adults. Anti-aging Med Ther. 1997; 1:10-28
 GH treatment

in 3-8 months

Less muscled More muscular

shoulders & chest shoulders & chest
© Dr. Thierry
Information Hertoghe General
Classification:
 Atrophic
palm, GH treatment Firmer
soft tone tone
in 3-8 months

© Dr. Thierry
Information Hertoghe General
Classification:
 Longitudinal Smooth
lines surface

GH treatment

Slow: in 9-15 months

© Dr. Thierry
Information Hertoghe General
Classification:
 Bowed, Straighter,
tensed relaxed back
back

GH treatment

Quick: in 2-5 months

© Dr. Thierry
Information Hertoghe General
Classification:
 GH treatment + weight loss diet => Abdomen

GH treatment + Hypocaloric diet

Fat, droopy in 6 months

abdomen
(abdominal
obesity)

© Dr. Thierry
Information Hertoghe General
Classification:
 GH treatment

in 3-9 months

Sagging inner sides Firmer thighs

of the thighs
© Dr. Thierry
Information Hertoghe General
Classification:
 => Feet: Avoid GH overdose
© Dr. Thierry
Information Hertoghe General
Classification:
 GH or IGF-1 overdose => After 2 to 10 days

Swollen feet

Usually the first sign of GH excess!

© Dr. Thierry
Information Hertoghe General
Classification:
 How to legally
prescribe
Growth Hormone to
Adults in the USA

All you need to know

© Dr. Thierry
Information Hertoghe General
Classification: Thierry Hertoghe, MD
 In the package inserts

OLD PACKAGE INSERT “In general, confirmation of the diagnosis of adult GHD
usually requires an appropriate GH stimulation test. However, confirmatory GH
stimulation testing may not be required in patients with congenital/genetic GHD or
multiple pituitary hormone deficiencies due to organic disease.”

NEW PACKAGE INSERT: “Initiate ZOMACTON with a dose of approximately 0.2

mg/day (range, 0.15 mg/day to 0.3 mg/day) and increase the dose every 1-2
months by increments of approximately 0.1 mg/day to 0.2 mg/day, according to
individual patient requirements based on the clinical response and serum insulin-
like growth factor 1 (IGF-1) concentrations. Use the patient’s clinical response,
adverse reactions, and determination of age- and gender-adjusted serum IGF-1
concentrations as guidance in dose titration.”

© Dr. Thierry
Information Hertoghe General
Classification:
 FDA => Indication of GH use for disease or other recognized condition

Lawyers asked the FDA the question directly GH treatment can only be used
=> FDA answer:
to treat
The following section of the Federal Food Drug and
Cosmetic Act provides the restrictions and penalties • a disease , such as GH deficiency
regarding the distribution of HGH: • or other recognized medical
•Title 21: Food and Drugs, Chapter 9–Federal Food, conditions, such as
Drug, and Cosmetic Act, Subchapter III: Prohibited Acts • Childhood short stature
and Penalties, Sec. 333. Penalties • Willi-Pradder syndrome
• Childhood renal failure
Section (e) lists:

(e) Prohibited distribution of human growth hormone

(1) Except as provided in paragraph (2), whoever knowingly distributes, or possesses
with intent to distribute, human growth hormone for any use in humans other than
the treatment of a disease or other recognized medical condition, where such use has
been authorized by the Secretary of Health & Human Services under section 355 of
this title and pursuant to the order of a physician, is guilty of an offense punishable by
not more than 5 years in prison, such fines are authorized by title 18 or both
© Dr. Thierry
Information Hertoghe General
Classification:
 What You Need to Know about GH

• FDA Somatropin (GH)

• Only drug that can NOT be used off label

• Write the diagnosis on the RX.

• For Treatment of Adult GH deficiency

• For Short Stature

© Dr. Thierry
Information Hertoghe General
Classification:
 Write the diagnosis on the Rx

ADULT Growth hormone deficiency

Sign

© Dr. Thierry
Information Hertoghe General
Classification:
 © Dr. Thierry
Information Hertoghe General
Classification:
Thierry Hertoghe, MD
 A must for any physican treating adults with GH

Provides alle the

information

Answers all the

questions

(medical, practical,
scientific, legal, etc.)

© Dr. Thierry
Information Hertoghe General
Classification:
 Professional books

To order the books:

https://ucprx.com
©Information
Dr.
© Dr.Thierry
Thierry Hertoghe
Hertoghe
Classification: General
 © Dr. Thierry
Information Hertoghe General
Classification:
 © Dr. Thierry
Information Hertoghe General
Classification: