Techincal Director - Ray Lian, PhD
While most of us experience a general decline in the production of hormones after about the age of 40 years old, how to test your body for this loss and what to do about it has been the focus of controversy for many years.
Growth hormone (GH) is one of the more controversial hormones that decline with age due to the potential for use by athletes as a performance enhancer. There are a number of ways to test for growth hormone levels as well as many treatments available that may be beneficial. Our Steroid Dept. Manager Dawn Huo, PhD and Laboratory Director Ray Lian, PhD are the developers of our 24 hr urine hormone profiles.
What is perhaps most important to note is that growth hormone levels are not constant at any one point during the day and a 24-hr collection is much more likely to reflect your patient’s GH production.
Steroid Dept. Manager - Dawn Huo, PhD
24-HR GROWTH HORMONE PRODUCTION
The evaluation of partial growth hormone deficiency, also known as GH insufficiency (GHI), can be very challenging and clinical symptoms along with two positive tests are said to be required to make a diagnosis of GHI.1 Traditional signs and symptoms of growth hormone deficiency may not be present and patients rarely show additional pituitary hormone deficiencies in GHI. Lab tests may be in the “normal gender and age-adjusted range” for IGF-1 levels in patients with adult growth hormone deficiency.2 A patient with a suspected growth hormone insufficiency may require multiple tests for detection.
Growth hormone is primarily secreted at night and can easily be measured in a 24-hr urine specimen. Levels of IGF-1 and IGFBP-3 are indirect measurements of GH. The purpose of IGF-1 and IGFBP-3 is to bind GH and prolong their half-life as well as maintain a steady supply of GH. Your body wants a steady supply of GH and although most of it is produced at night, these two binding proteins (IGF-1 and IGFBP-3) help make that happen. Thus, in our sleep we produce – and store – growth hormone so that it is released slowly and steadily to our cells.
The more binding proteins, the more GH we can store but what if there is no GH to store? At a growth hormone deficiency level this is can be detected by pathologically low levels of IGF-1. In terms of growth hormone insufficiency, detecting borderline low levels becomes more difficult with IGF-1. Making clinical decisions on IGF-1 related to GH insufficiency without testing urine GH may make you more liable if your diagnosis ever comes into question. Thus, measuring a 24-hr growth hormone production via urine is likely to be an effective CYA approach as well as accurately assessing the efficacy of your treatments – this will be discussed in greater detail shortly.
SOME DOCUMENTED BENEFITS OF ADEQUATE GROWTH HORMONE
(as you know, experienced practitioners have observed many others)
- Cardiovascular Risk Reduction3
- Immune System Enhancement4
- May Benefit Crohn’s Disease5
- Reduces Bone Fracture Risk and Improves Healing6
- Improves Skin Healing After Burns7
- Assists Obese Individuals In Weight Loss When Exercise and Diet Ineffective8
The association of growth hormone to cancer risks and mortality is unclear. In a study of 300 premenopausal women diagnosed with breast cancer, their levels of IGF-1, IGFBP-3, and GH had no correlation with risk.9 Another study involving colorectal cancer and 41,528 adults found that increases in IGFBP-3 correlated with a reduction in cancer-specific deaths.10 There was no association found for IGF-1 in this study. Some of the research that implicated GH replacement as a potential cancer risk used subjects who had received radiation therapy and GH from cadavers and monkeys. The need for a full review of research related to cancer risks is apparent.
HOW TO TEST GROWTH HORMONE
The “gold standard” for some time has been the Insulin Stress Test (IST). Please don’t confuse this with the Glucose Tolerance Insulin Resistance Test (GIRT) as they are very different. In the IST, patients are given insulin in an attempt to reduce their blood glucose to dangerously low limits that could be fatal and is contraindicated in patients with histories of seizures, cerebrovascular disease, myocardial infarction – or anyone who wants to live, according to Dr. Mark Gordon, MD.
Dr. Gordon lectures around the world about growth hormone testing and treatment and has conducted several clinical studies on the topic.11, 12, 13 He compares growth hormone replacement to thyroid replacement. If a patient is experiencing hypothyroid but their labs are “low normal” we are likely to treat rather than wait until they come in with myxedema. This is similar to growth hormone deficiency where we can actually run many labs to check their levels and have enough evidence along with patient history to treat.
The purpose of IGF-1 and IGFBP-3 is to prolong the half-life of GH and assist in gradually making circulating levels of GH available to cells. As GH acts by entering the cell nucleus and influencing DNA expression immediate increases of bio-availability may be counter to “what nature intended”. Thus, that is why testing for these markers along with urine GH is essential to proper treatment, diagnosis, and monitoring. IGF-1 and IGFBP-3 are available in the Age Management Panel, which can save you hundreds of dollars and help give you a more holistic view of your blood hormones.
He states, “it is imperative that all hormones are measured at baseline before beginning treatment, and therefore minimum testing includes IGF-1, IGFBP-3, DHEA-s, free testosterone, estradiol, and urine GH. Monitor with urine GH and minimal follow-up with IGF-1 and IGFBP-3”.14 IGF-1 and IGFBP-3 are indirect measures of GH while urine growth hormone testing will show you how effective your treatment is a direct measurement. IGF-1, IGFBP-3, DHEA-s, free testosterone, and estradiol are all available in the Age Management Panel.
Monitoring improvements – or lack thereof – of GH deficiency with urine testing can help you get a better idea of what is working and what isn’t. Regular testing of IGF-1 and IGFBP-3 is also indicated for diagnosis, safety, and liability.15 Urine GH is likely also very important for safety as inducing treatment with serum values of IGF-1 and IGFBP-3 are considered insufficient. Testing urine GH is very important when stimulation tests are not used.
Growth hormone in urine has been shown to correlate well with insulin stress tests and is a much safer alternative. The authors of a 1995 study published in the Journal of Clinical Endocrinology, states “the Insulin stress test (IST) which is unpleasant and potentially dangerous, particularly in patients with hypopituitarism.”16 Based on their research, they found that the “diagnosis of adult GH deficiency can be reliably made without the need for an insulin stress test by using a combination of low urinary GH excretion, subnormal IGF-I levels and clinical assessment with regard to the number of other pituitary axes affected.” And since GH is lowest during the daytime and highest at night, a 24-hr urine hormone profile gives the widest angle of detection.
Growth hormone appears to have synergistic effects with other hormones. Have you ever given testosterone to a patient without the expected dose-related benefit? The problem may be that they have GH insufficiency and are lacking this synergistic effect. Growth hormone has been found to work synergistically with both estrogen and testosterone.17 This may be due to the ability of growth hormone to upregulate cell wall receptors. Thus, urine prevents a unique opportunity to measure multiple hormones (over 30) because we want to balance as many hormones as possible and do as Dr. Wright suggests, “copy nature”.
HOW CAN I INCREASE GROWTH HORMONE LEVELS NATURALLY?
Research has shown that exercise and arginine supplementation can increase growth hormone levels.18 Exercise combined with arginine is expected to increase GH by 200% while arginine alone will increase it by 100%. In patients with a history of herpes simplex virus supplementing arginine may be contraindicated as it may cause an outbreak. Consider supplementing with a greater dose of lysine simultaneously.
Arginine has other benefits beyond increasing growth hormone. It has also been shown to increase nitric oxide which is the most important factor in erectile function.19 Urine testing can also determine how effective arginine will be in patients with erectile function. Low urine nitrate and nitrite levels are highly correlated with successful treatment of erectile dysfunction with L-arginine. Consider supplementing 1.67 grams L-arginine, three times daily (TID).
Successful treatment will likely increase urine nitrate, nitrite, and growth hormone levels as well as improve your patient’s sex life. Remember, testosterone levels also decrease with age along with growth hormone. Adequate testosterone levels for men are key to preventing memory loss and improving memory as well.20,21,22,23 Improved memory along with the many other benefits from having hormones in physiologic range will help your patient have better sex and remember it too! What good is great sex if you can’t remember it, right?
While there may be some legal barriers to prescribing injectable hgh there are secretagogues like L-arginine and L-ornithine that can increase endogenous production. At the Tahoma Clinic we often see urine hgh double with a holistic approach. Bottom line: Whatever treatment you do, make sure its effective by measuring 24 hr urine growth hormone levels.
WHERE CAN I PURCHASE URINE GROWTH HORMONE TESTING?
Human growth hormone testing using urine and blood is available at Meridian Valley Lab. Please call 425-271-8689 for details.
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