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ArticlesProducts for Age ManagementBy Janna Gordon, RPh, MBA. In 2011, the "baby boom" generation will begin to turn 65, and by 2030, it is projected that one in five people will be age 65 or older. The size of the older population is projected to double over the next 30 years, growing to 70 million by 2030.8 As the population matures there becomes a growing demand to slow the effects of aging. As we grow older, our organ systems start to slow creating the noticeable effects of aging. Older adults notice a decrease in skin elasticity, hair loss, decreased ability to fight off infection, decrease in muscle strength and size, increased body fat, decreased bone density, decreased flexibility, decreased libido, and decreased memory.1 One reason for these changes is the decrease in human growth hormone (HGH) production. HGH is a complex hormone made up of 191 amino acids and is produced by the pituitary gland. After the age of 30, levels of growth hormone start to decrease at a rate of 14% per decade in a normal adult. When left untreated, HGH deficiency may increase the risk of death from heart problems, decrease skeletal muscle strength, decrease ability to exercise, decrease kidney function, increased sensitivity to temperature change, decreased metabolism, and fatigue.3 Is there a way to fight off these effects of aging related to lowering levels of HGH? Supplementing HGH when levels have been documented as low is one way or encouraging the production of our own HGH is another. In the last few years the use of HGH as a "cure’ for the effects of aging has been explored and exploited when prescribed with anabolic steroids to sports figures for sports enhancement. HGH is approved to treat growth-retarded children5 and is also approved for Adult Growth Hormone Deficiency (AGHD) in adults. Due to the growth in illegal use of HGH, the Food and Drug Administration (FDA) is increasing its scrutiny of how and when growth hormone is prescribed. Currently, it is the only drug for which off-label use is specifically forbidden. Physicians are now being required to document diagnosis, run appropriate lab tests, and include symptoms in the patient’s chart for justification of why growth hormone was prescribed. Pharmacies are also noting the AGHD diagnosis on the face of the prescription when the medication is ordered for an adult. With all the negative press and the increased legal requirements of prescribing growth hormone, why would a person be interested in its supplementation? HGH is involved in many processes in the body related to tissue and muscle growth, brain and mental function, energy and metabolism.4 HGH works in the body by stimulating the liver to make growth factors after its release during the night or between meals. These growth factors are responsible for instructing the cells of the body to maintain themselves. The cells that are affected by growth factor include nerve, bone, skin, and muscle cells. When there is a lower level of growth factor in the body there is less rejuvenation of cells.
Laboratory testing also helps determine a patient’s need for HGH supplementation. Prolactin levels are initially evaluated to ensure they are within normal range. Elevated levels could indicate a pituitary adenoma. Insulin-like Growth Factor 1 (IGF-1) is a growth factor produced by the liver from HGH and blood levels of IGF-1 are used to determine a person’s daily HGH secretion. IGF-1 or somatomedin-C stays in the blood longer than HGH and therefore testing provides an indirect measure of HGH. Most physicians will test IGF-1 levels as it is easier and often less expensive to order than HGH. IGF-1 levels are generally targeted in the upper three-quarters of aged related normal range. HGH levels can also be ordered, testing is very expensive and more difficult to measure because HGH is rapidly taken up by the liver. HGH is released by the pituitary gland in a series of pulses, one just after falling asleep and the other about 2 hours after getting up in the morning making it important to ensure that testing is always done at the same time of day and preferably by the same lab. HGH is generally tested in blood or via a spot urine test. Once it is determined that a patient is deficient in HGH follow-up testing is recommended at 90 days post initiation of therapy and then every 6 months. Direct supplementation of HGH is available as a prescription medication and only as an injection. While dosing may vary, typical dosing is ½ to 1unit daily Monday through Friday, skipping Saturday and Sunday. Its use requires close monitoring of side effects by a physician. Side effects may include hyperglycemia, hypoglycemia, hypothyroidism, leukemia, lipoatrophy, muscle pain, injection site reactions, edema, exacerbation of psoriasis, rash, seizure, or weakness.5 Another prescription medication used to treat growth hormone deficiencies is growth hormone releasing factor 1-29 (GRF, sermorelin). It is commercially available as Geref® and is used to treat idiopathic growth hormone deficiency in children with growth failure. Sermorelin is thought to more directly impact the main effect of aging on HGH, its dwindling episodic release from the pituitary gland. Supplementation restores HGH secretion and returns HGH and IGF-1 levels to youthful levels. In addition, it improves body composition, performance in physical tasks, and improves sleep, especially in men.10
Trans-D Tropin® is a growth hormone releasing hormone analogue that stimulates production and release of growth hormone from the pituitary gland. Unlike other supplements that increase HGH, Trans-D Tropin works by increasing the number of IGF receptor sites without increasing IGF-1 levels to exceed physiological limits. This means that Trans-D Tropin creates IGF-1 receptor sites, preventing the receptor sites from becoming saturated. This is beneficial because IGF-1 levels do not increase and an increase in IGF-1 levels has been linked to heart disease and cancer.7 Trans-D Tropin is available in a topical formulation that is applied to the skin in drops. Fifteen drops are to be applied to the skin three times a day for age management benefit.6 Symbiotropin® is made in the form of an effervescent tablet that is dissolved in 4-6 ounces of water that is taken once daily at bedtime two to three hours after eating. Symbiotropin is taken for five days at a time with a two-day break in between. MediTropin® is available in the form of an effervescent tablet. Three tablets are dissolved in 6-8 ounces of water and taken at bedtime two to three hours after a meal.6 MediTropin is a second generation secretagogue. It is derived from porcine hypothalamic glands. MediTropin is taken for five days at a time with a two-day break in between. MediTropin should be taken for a full three months to see maximum benefit. MediTropin contains Symbiotropin as well as nutrients that work to nourish the hypothalamus and pituitary glands, which produce hormones, stimulate immune function, and help with repair and growth of muscle. MediTropin is a powerful insulin regulator.6 Rejuvamin® and Rejuvamax® are low cost, convenient options in HGH boosters. Both contain pure amino acids. They are available in tablet and powder form. These products can be taken one to three times a day to allow for HGH release to be returned to patterns similar to those of youth. Rejuvaman is for people ages 30 to 60 and Rejuvamax can benefit people over the age of fifty-five as well as those ages thirty to fifty-five.6 Rejuvamax is recommended for older people due to it's higher concentration of amino acids. Because these supplements are categorized dietary supplements there is little known risk of side effects when using them. Patients may notice mild joint aches that go away with continued use. It is important to follow the package directions on all supplements and take breaks from use when advised to prevent over stimulation of the pituitary gland and allow for continued effectiveness of the supplement.6 When looking for answers to manage aging, supplementation with HGH or products such as sermorelin may be appropriate in adult patients with documented AGHD. Treatment with these products must be monitored to ensure that treatment levels stay within physiologic levels to avoid the potential risks of treatment, such as heart disease and cancer that can be seen with supraphysiologic dosing. For patients who desire to encourage youthful aging, but can't afford the necessary testing and diagnosis, supplementing with Trans-D Tropin or one of the other over the counter supplements may be very advantageous to supporting the neuroendocrine system. To learn more about these products, call 1-800-728-0288 and ask to speak with a consultant pharmacist or "Ask the Pharmacist" Resources:
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