Once again, a state medical board is charging physicians with unprofessional conduct for prescribing hormone therapy. In this case, Seattle television station KOMO reported that four physicians were inappropriately prescribing human growth hormone (HGH). The Washington State medical board is investigating the physicians who have been prescribing HGH to adult patients for its anti-aging activities. A board spokesman stated that HGH was being prescribed without evidence of growth disorder or human growth hormone deficiency. KOMO's investigation of each doctor offered brief biographical sketches but focused on their prescribing HGH for its anti-aging activities without documenting hormone necessity. The TV report played for two days, stating that the medical board learned about the doctors' prescribing of growth hormone from a whistle-blower. Translation: there was no patient problem – no deaths, no illness, no major adverse effects. Simply, an unidentified individual against the use of growth hormone (and anti-aging medicine) complained that the medical board should discipline doctors prescribing HGH. The Washington medical board, previously criticized for its lackadaisical approach to disciplining unscrupulous doctors, decided to reopen its investigation of doctors prescribing growth hormone. The TV report played on the viewer's emotions – the KOMO story suggested that the public was at considerable peril seeking care from these physicians.
When the Washington state medical board made inquiries about physician use of HGH a few years ago, it expressed concerns that human growth hormone was not approved for use in adults who have not been diagnosed with human growth hormone deficiency. Without such a diagnosis, the administration of HGH posed a significant health risk. One physician quoted on the KOMO show worried about cancer risk. Could it be that a treatment approved for use in juveniles for stunted growth would pose a significant risk in adults? If the hormone has limited risk in juveniles treated for growth disorders, its risk in adults should not be higher. Certainly the putative risk for cancer should not be higher in adults than in children. Side effects from human growth hormone administration are limited in children and adults. It would make sense that adverse effects in adult human growth hormone programs would not be high.
Is human growth hormone effective in adults? Numerous reports and studies have indicated a variety of effective changes in adults using growth hormone. Beyond improvement seen in muscular strengthening and reduction in fat storage, HGH has been somewhat to moderately effective in improving fatigue, depression, attention and cognitive impairment, joint pain and inflexibility, metabolic functioning, skin tone, immune function, and other factors. Given its support in daily functioning, it is understandable that HGH would be considered appropriate for "anti-aging" programs.
However, medicine has become risk adverse and abhors the use of hormone therapy unless a hormone deficiency state is diagnosed. Endocrinology accepts the diagnosis of human growth hormone deficiency, but the diagnosis has strict criteria. From a pathology viewpoint, adult human growth hormone deficiency develops from abnormal functioning of the hypothalamus or pituitary gland. The pituitary does not generally dysfunction unless there is a brain injury, tumor development, or brain surgery, or radiation therapy is administered to the brain. Severe atherosclerosis and other circulatory disorders may impair circulation to the hypothalamus or pituitary. Under these circumstances, it would be possible to develop growth hormone deficiency. Medicine does not accept that the hypothalamus and pituitary gland "age" and develop growth hormone deficiency by the aging process. This is the reasoning of the anti-aging camp. Anti-aging doctors believe that human growth hormone deficiency does develop as one ages, without pathologic damage to the pituitary gland. Medicine has drawn a line in the sand and demands evidence of pituitary dysfunction before adult human growth hormone deficiency can be diagnosed.
Interestingly, the symptom deficiencies of adult growth hormone deficiency appear to be problematic in a wide section of the aging population. Symptoms include less muscle mass, decreased stamina, fatigue, increased body fat, cholesterol and lipid abnormalities, decreased sexual functioning, reduced bone density, increased tendency to bone fracturing, emotional difficulties with anxiety and depression, and a greater sensitivity to heat and cold. It would appear that many aging individuals do suffer with undiagnosed adult human growth hormone deficiency. Unfortunately, they may not be diagnosed with the hormone problem because they fail to demonstrate abnormalities with the pituitary gland.
From a medical-legal viewpoint, another obstacle to HGH prescribing may be due to the strict "anti-doping" programs in professional and amateur sports. Anabolic steroids, including testosterone, are forbidden, and testing programs expose athletes who use such agents. Although HGH is not technically an anabolic steroid, its use has been associated with anabolic steroid use. Olympic sports forbid the use of growth hormone.
Subsequently, growth hormone has been linked with anabolic steroids as an illegal substance to use in competitive sports. With the growing consensus that the use of anabolic steroids must be eliminated in sports programs, HGH has been treated the same and condemned. Hence, an athlete using growth hormone would be obliged to quit participating in sports. Doctors prescribing growth hormone are correspondingly looked on with disrepute: since it is not legal for use in sports, it is considered that the doctor is prescribing an illegal agent and should be disciplined.
Of course, non-athletes and their prescribing doctors are under no obligation to follow "anti-doping" rules (although authorities might think otherwise). Employing a low dose of human growth hormone to "revitalize" one's condition is now being treated as a quasi-illegal activity in many but not all states. The media is drumming up the fact that anti-aging hormones are dangerous and provided at shady medical offices or profit mills. Of course, if it were simply the media making noises, then it would not matter. It isn't just noise – doctors' reputations are being destroyed because establishment medicine does not buy into anti-aging medicine, particularly the use of anti-aging hormone therapy.
There really are two camps, the anti-aging camp and the medical absolutists. A mantra of "standard of care" translates to allowing insurance reimbursement only for "evidence-based medicine." Medicine is now heavily focused on drug therapy for the aging population. The incidence of adverse effects, including the development of inflammatory disease, severe allergy reactions, and malignancy, from the use of drugs is making up a larger percentage of hospitalizations. Offering alternatives to pharmaceutical treatments should be the path that medicine is following. Instead, the medical authorities and insurance companies are limiting treatment options, leading to increasing morbidity and mortality. Human growth hormone should not be categorized as a dangerous treatment but an option permitted with appropriate caveats.
Professor Ruggiero on HIV and AIDS
Marco Ruggiero is a professor at the Institute of Experimental Pathology and Oncology at the University of Florence. Professor Ruggiero belongs to a small club of scientists who do not believe that HIV is the cause of AIDS. Professor Peter Duesberg, PhD, at the University of California at Berkeley championed this theory in the early 1990s. Duesberg was rewarded for his public discussion of HIV not being the cause of AIDS with ostracism from his peers, a series of denials for grants for his research, and general labeling as an AIDS "dissident." In the mid-1990s, dissidents were vigorously expounding on a non-HIV causation of AIDS. Medical societies, AIDS groups, and world health authorities condemned dissidents and recommendations for not using anti-HIV therapies. Professor Ruggiero has examined the controversy and argues that a non-HIV causation for AIDS not only is supported by hypothetical argument but also by experimental data and alternative therapies for AIDS. Ruggiero dismisses the "dissident" label. He cites a growing discussion taking place at AIDS conferences that HIV by itself is not sufficient to explain AIDS causation.
Ruggiero agrees that HIV is associated with AIDS process; that antiretroviral agents do reduce HIV burden; and that markers for AIDS, including viral loads and white blood cell counts, are modified by HIV drug treatments. However, studies with immune supporting agents, including an agent called GcMAF, also reveal changes in HIV burden and modify white blood cell counts. Ruggiero cites data demonstrating improvement in the aforementioned when antiretroviral agents and other HIV drugs were unsuccessful. He argues that an immune-supporting agent for the AIDS process would make better sense for the treatment of AIDS and offers another option than depending on controlling HIV viral load. Ruggiero proposes a novel development utilizing what he calls a specially prepared probiotic yogurt to serve as primary immune support agent.
We are pleased to publish the full interview of Professor Ruggiero by Spanish journalist Jacques Fernández de Santos in this issue.
Dr. Heyman on Metabolic Syndrome in Men
Andrew Heyman, MD, is a faculty member at the University of Michigan, where he has worked with the Complementary and Alternative Medicine Research Center. Dr. Heyman continues his work in the CAM field and currently has a private practice in Virginia. His research focuses on metabolic syndrome in men and shows its relationship to adrenal-related stress and abnormalities in testosterone. Dr. Heyman has found that as men age, there is a tendency to have adrenal gland dysfunctioning with abnormal cortisol levels. He particularly likes studying adrenal physiology with the use of salivary cortisol multipoint studies. When cortisol levels are abnormal, especially in relationship to abnormal, usually low, testosterone levels, there is a high likelihood that there will be insulin dysfunctioning and metabolic syndrome. Heyman believes that adrenal gland dysfunctioning with abnormal cortisol levels does not necessarily mean that the primary problem is insufficient adrenal functioning requiring cortisol supplementation. Instead, he focuses on the brain, which may be the "cause" of why the adrenal gland misfunctions during stress. Heyman thinks that brain centers, including the pituitary, hypothalamus, and connected systems, falter as stress builds. Subsequently, the brain fails to stimulate the adrenal gland, leading to adrenal dysfunction. Rather than supplement testosterone and hydrocortisone, Heyman would recommend supporting the brain. He would advise the use of behavioral therapies such as meditation and breathing techniques to calm stress. Heyman supports the use of adaptogen herbals that tend to calm the brain and adrenal system. He also likes to use nutrients to rebuild the adrenals and support testosterone rather than immediately working with hormone replacement.
Dr. Andrew Heyman is interviewed by Nancy Faass.
Sara Wood, ND, on Low Testosterone
Dr. Sara Wood is a graduate of the National College of Naturopathic Medicine. She practices in Oregon and is a staff physician with Labrix Clinical Services. Dr. Wood examines low testosterone as a primary factor for men developing metabolic syndrome in middle age. Wood would argue that testosterone deficiency by itself plays a pivotal role in insulin dysfunctioning, disrupting lipid control, and setting in play the conditions associated with metabolic syndrome. Dr. Wood reviews the importance of examining testosterone hormone levels in men and recommends hormone replacement unless there is established cancer diagnosis or risk. She also advises herbal support therapies for low testosterone.
Jonathan Collin, MD