a short piece on growth hormone

this blog is like a box of chocolates
you never know what you’re going to get, right!? (ps: yes, the pun in the title was intentional. i decided on that rather than “growth hormone: a tall tale” because then you might have thought i made all this up!)

while i’ve spent 5+ years blogging about working in the medical field (with a focus on the *rest* of life), i don’t think i’ve really ever done a truly ‘medical’ post! i was excited to receive a few requests to provide a recap/summary of my growth hormone presentation from tuesday. so, please excuse this post if you find these kinds of things totally boring!

since i know even the most enthusiastic reader doesn’t want to sit through a full recap of my 45 minute talk, i’m going to post 10 slides (the more fun/interesting ones!), and just try to mention some of the high points.

here goes nothing!

growth hormone is a substance released in the brain that can have powerful effects on growth (extra makes growing kids taller) and body composition (decreases fat, builds muscle). the amount naturally present in our bodies sadly decreases as we get older, likely one of the many reasons that careers like this do have a shelf life. also, probably why multiple celebs are rumored to be on the stuff.

so are there any other miracle drugs that can make kids taller? here’s a rundown of some of the alternatives. things like testosterone actually are used sometimes to ‘jump-start’ short and late-developing boys into puberty — but this strategy is not without risks, as too much can actually make the growth plates fuse earlier (ie, making them shorter in the long run!). sometimes, it’s actually advantageous to delay puberty with GnRH agonists such as lupron. unfortunately, all of the available medications have potential risks/benefits. no magic ‘grow me’ pill yet!

in the talk, i go through various indications for growth hormone – these include growth hormone deficiency (duh), specific disorders like turner’s syndrome, chronic renal failure, and prader-willi syndrome, and low birthweight babies. it’s also been approved for use in something known as “idiopathic short stature” (described below — and yes, shawn johnson would qualify!). something that was surprising to me: with a few exceptions, it works in all of these conditions — at least to some degree — whether a kid is actually deficient in GH or not!

then i get into some trickier territory. YES — you can make most short kids taller, typically anywhere from 1-3 inches (it does vary). but does this really make their lives better? there’s not lots of evidence to show that it does . . .

although we DO know that heights are correlated with higher incomes (at least initially) and a greater chance of achieving a position of power. check it out: we haven’t had a president of average height since jimmy carter in 1976! (we haven’t had any women, either, but that’s a whole ‘nother issue 🙂 )

of course, any medicine comes with risks! in addition to the annoyance of having to get an injection every day (there is no way to give GH as a pill – at least not yet!), there are possible side effects — increased pressure in the brain that can cause headaches, enlargement of tonsils, and an increase in insulin resistance can occur (although no cases of true diabetes have been attributed to GH).

there’s also a potential link with cancer. studies of older patients receiving GH (back in the day when it came from ground up human tissue — ew!) have revealed a very small increase in the number of cases of colon cancer and hodgkin’s disease. studies of patients receiving the synthetic form of GH given today just show an increased risk for second tumors in children that have already had cancer and were treated with radiation.

oh, and the ‘self-esteem issues’ — this isn’t often addressed, but like it or not, it does send a powerful message to your kid if you are bringing them in to get treated (with shots, no less!) for their shortness.
also, it’s expensive. VERY. very!! and of course, insurance coverage varies.

all of this — and i think the high cost in particular — raises multiple ethical questions. who should get GH? what are we treating, exactly? is it worth it?

i think these are all important questions to think about. after much thought, i am not “anti-GH”, although i was worried i would come off that way. i’ve seen kids get it and really seem to benefit. especially for those on the very short end of the spectrum — i mean, i feel like it would be much easier to function in this world at 4’11” compared to say, 4’8″.

i also brought up the cultural perspective — especially to reinforce that standards of what’s ‘normal’ and ‘preferred’ are relative! it was actually fairly common several decades ago for girls who were going to be tall (as in – 5’9″ and up, not 6’5″!) to be treated with estrogen to close their growth plates and prevent this ‘undesirable’ outcome. i’m sure gabrielle reece wouldn’t have appreciated that ONE BIT.

my conclusion slide — i tried to tie it together by presenting a continuum. some conditions (those who are VERY GH deficient and have other problems in addition to being short) obviously need treatment. those who just want to improve their athletic performance clearly do not. but everyone else exists in a gray area, where cost/benefit/risks really need to be weighed for each individual.

as someone who will be prescribing GH in the future, i feel like doing this research gave me a better perspective! it was a fun topic and very interesting to me. [even if i did whine and complain about having to put it together for weeks on end.]

if you’ve made it this far, thanks for bearing with this medical-leaning post! i’d love to hear your thoughts . . . especially if you received GH or if it was considered for you!

and no, i did not get GH as a child . . . nor would i have particularly wanted it. i actually don’t mind being short, except when i have to go hem my jeans.